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Transaxilläre oder supraklavikuläre Dekompression bei Kompressionssyndromen der oberen Thoraxapertur?

Transaxillary or supraclavicular decompression for compression syndromes of the upper thoracic aperture?

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Zusammenfassung

Fragestellung

Das Thoracic-outlet-Syndrom (TOS) ist bedingt durch anlagebedingte Engstellen der oberen Thoraxapertur und kann aufgrund der komprimierten Strukturen in verschiedene Formen unterteilt werden. Die Diagnose ist schwierig. Zur operativen Therapie stehen mehrere Zugangswege zur Verfügung.

Material und Methode

Techniken, Risiken und Ergebnisse sowohl des transaxillären als auch des supraklavikulären Zugangs werden anhand der aktuellen Literatur dargestellt. Hierzu wurde MEDLINE (1966–2012) nach den Stichwörtern TOS sowie „supraclavicular“ und „transaxillary incision“ durchsucht.

Schlussfolgerung

Beide Verfahren sind zur Behandlung des TOS geeignet, anhand der zur Verfügung stehenden Studienlage kann kein Verfahren eindeutig präferiert werden. Neben den absoluten Erfolgsraten erscheint insbesondere in diesem komplexen Krankheitsbild die lokale chirurgische Expertise von enormer Bedeutung.

Abstract

Objective

Thoracic outlet syndrome (TOS) is caused by an inherent constriction of the upper thoracic outlet and can be classified into several forms based on the compressed structures. The diagnosis is difficult; there are several possible approaches for surgical therapy.

Materials and methods

Technique, risks and results of the transaxillary and the supraclavicular approaches are presented according to the current literature. MEDLINE (1966–2012) was searched using the key words TOS, supraclavcular and transaxillary incision.

Conclusion

Both procedures are suitable for the surgical treatment of TOS; however, based on existing studies no procedure can be preferred. In addition to absolute success rates, local surgical expertise seems to be of great significance in the treatment of this complex clinical picture.

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Compliance with Ethics Guidelines

Conflict of Interest K. Balzer declares that he has no conflict of interest.

This article does not contain any studies with human or animal subjects.

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  1. Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    K.M. Balzer

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Correspondence to K.M. Balzer.

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Balzer, K. Transaxilläre oder supraklavikuläre Dekompression bei Kompressionssyndromen der oberen Thoraxapertur?. Gefässchirurgie 18, 177–183 (2013). https://doi.org/10.1007/s00772-013-1150-8

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