Objectives
Thoracic outlet syndrome, a condition commonly reported in adults, occurs infrequently in the pediatric population. The objective of this study was to assess the outcome of surgical interventions of
thoracic outlet syndrome in pediatric patients. Methods Clinical records of all pediatric patients with
thoracic outlet syndrome who underwent operative repair from 2002 to 2015 in a tertiary pediatric hospital were reviewed. Pertinent clinical variables and treatment outcomes were analyzed. Results Sixty-eight patients underwent a total of 72
thoracic outlet syndrome operations (mean age 15.7 years). Venous, neurogenic, and arterial
thoracic outlet syndromes occurred in 39 (57%), 21 (31%), and 8 (12%) patients, respectively. Common risk factors for children with
venous thoracic outlet syndrome included sports-related
injuries (40%) and hypercoagulable disorders (33%). Thirty-five patients (90%) with
venous thoracic outlet syndrome underwent
catheter-based interventions followed by
surgical decompression. All patients underwent first rib resection with scalenectomy via either a supraclavicular approach (n = 60, 88%) or combined supraclavicular and infraclavicular incisions (n = 8, 12%). Concomitant temporary
arteriovenous fistula creation was performed in 14 patients (36%). Three patients with
arterial thoracic outlet syndrome underwent first rib resection with concomitant subclavian artery
aneurysm repair. The mean follow-up duration was 38.4 ± 11.6 months. Long-term symptomatic relief was achieved in 94% of patients. Conclusions
Venous thoracic outlet syndrome is the most common form of
thoracic outlet syndrome in children, followed by neurogenic and arterial
thoracic outlet syndromes. Competitive sports-related
injuries remain the most common risk factor for venous and neurogenic
thoracic outlet syndromes. Temporary
arteriovenous fistula creation was useful in
venous thoracic outlet syndrome patients in selective children.
Surgical decompression provides durable treatment success in children with all subtypes of
thoracic outlet syndrome.