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Transaxillary Approach -- Thoracic Outlet Syndrome Decompression Surgery

The Thoracic Surgery Section at Boston Medical Center prides itself on the ability to diagnose and treat a wide variety of thoracic conditions and symptoms, including thoracic outlet syndrome, or TOS. We do so in an environment of caring and compassion, in which our priority is the well-being of you and your family.

Overview

TOS is a condition that results from compression of the blood vessels, nerves or veins in the thoracic outlet, which is the space between the base of the neck and the armpit.

There are three types of TOS:

  • Nerve compression, which makes up about 95 percent of TOS cases
  • Venous compression, which accounts for three to four percent of cases
  • Arterial compression

TOS typically appears between the ages of 20 and 50. It is more common in women, and occurs most frequently among active young adults who engage often in activities requiring them to raise their arms repetitively. Dental workers, truck drivers and weightlifters are examples.

TOS may also be caused by:

  • Injury
  • Strenuous use of the arm or shoulder
  • Poor posture
  • Aging
  • Disease
  • An abnormality of unknown origin
  • The presence of an extra rib

There are a variety of ways to treat TOS, including TOS-decompression surgery. In this procedure, which we recommend only in severe cases that don’t respond to other, less invasive therapies, we surgically remove part of the first rib or the whole extra rib, which enlarges the thoracic outlet space and relieves pressure. Surgeons may perform TOS-decompression surgery using several approaches, one of which is the transaxillary method, which allows surgeons to access the space through an incision in the patient’s armpit.

How to Prepare

It’s important to follow instructions given to you by your physician to prepare for surgery. These instructions generally include:

  • Not eating or drinking anything after midnight on the night before your procedure
  • Bringing a list of your medications with you to the hospital
  • Arriving one hour before your surgery

You may have a pre-admission appointment before your surgery, during which you will have routine blood tests and speak with the anesthesiologist who will give you medicine during your procedure that will put you to sleep and ease pain.

If possible, do some mild physical activity, such as walking, and eat a balanced diet leading up to your scheduled surgery. In the week before, try to:

  • Limit alcohol consumption to one to two glasses a day.
  • Stop using tobacco.
  • Make a list of all the medications you take and bring it with you to the hospital. Include prescription and over-the-counter medications, herbs, supplements, aspirin and corticosteroids.

What to Expect

You should receive a call from us before your procedure. We’ll give you information about the day of your surgery, including where to go and when to arrive. When you arrive, we’ll take you to a pre-surgery area so that we can take your temperature, blood pressure and pulse, and listen to your heart and lungs. We’ll place an intravenous (IV) line in a vein in your arm, so we can give you medications and fluids before, during and after the procedure.

Once you’re asleep, your surgeon will make an incision in your armpit and free up the nerves, artery or veins. He or she will then have access to the thoracic space and will be able to remove the rib or rib section. When your surgeon is finished, he or she will close the incision(s).

Recovery

After surgery, we will take you to the Post Anesthesia Unit and monitor you for any changes in blood pressure, heart rate and breathing. An IV line will remain in the vein in your arm to keep you hydrated and administer pain medication, if necessary. If a breathing tube was inserted during surgery to control your breathing, it may remain in place for a brief time.

You’ll likely remain in the hospital for one to two days; a full recovery usually takes two to four weeks. It’s important to follow your doctor's instructions about eating, drinking and taking medications after your procedure. Always take your medicine exactly as prescribed. Call us if you have any questions or changes.

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Fax: 617.638.7382


Boston Medical Center
Thoracic Surgery
Preston Family Building
732 Harrison Avenue, 4th Floor
Boston, MA 02118


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Boston, MA 02118
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