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Management-Operative Management

If patients fail conservative management of TOS and have severe and persistent symptoms or progressive neurological dysfunction, surgery often is recommended. Surgical intervention bypassing conservative treatment usually is indicated for patients with acute vascular insufficiency.

A variety of surgeries have been recommended for the treatment of TOS; however, because TOS may result from a variety of causes, the specific recommended surgery is based on the underlying pathology. Thus, surgery often involves the release or removal of the structures that appear to be causing the compression, and it may involve releasing the scalene muscles, resection of the first rib or cervical rib, claviculectomy and/or resection of anomalous fibromuscular bands, or some combination of these procedures.

The surgical approach can be transaxillary, anterior supraclavicular, posterior subclavicular, or some combination of these. Series of surgical decompression of TOS have reported success rates ranging from 70% to 90%, with poorer results in patients having work-related TOS.

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