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Home > Vascular Annual Meeting > VS4. A Videotape Guided Journey of the Transaxillary...

VS4. A Videotape Guided Journey of the Transaxillary Approach for the Treatment of Thoracic Outlet Syndrome (TOS)

James L. Guzzo1, Mark Fugate1, Lisa Rotellini-Coltvet2, Jennie McKown1, Julie Ann Freischlag1
1The Johns Hopkins Hospital, Baltimore, MD; 2Mayo Clinic Hospital Arizona, Phoenix, AZ

OBJECTIVES: The transaxillary approach is our preferred exposure for patients with venous or neurogenic TOS. It is thought this is difficult to teach and does not provide adequate, safe exposure to the axillary structures. The objective of this study is to utilize videotaping to identify anatomy and safely teach our technique to vascular residents.

METHODS: A Surgitel Surgicam was used to capture twenty cases and demonstrate critical anatomy: subclavius tendon, subclavian vein, anterior scalene muscle, subclavian artery, and brachial plexus. Techniques of first rib elevation, anterior scalene muscle division, complete first/cervical rib resection, and testing for pneumothorax will be shown.

RESULTS: The subclavian vein can be easily viewed and patency confirmed. The subclavius tendon can be completely incised and anterior scalene muscle divided under direct vision. The brachial plexus can be viewed easily during rib resection. In neurogenic patients, the brachial plexus is displaced laterally under the first rib as compared to its location in venous patients. The cervical rib can be resected enbloc if fused to the first rib or following first rib resection if separated.

CONCLUSIONS: The use of the intraoperative videotaping aids in ensuring a safe operation and serves as a teaching tool for vascular residents.

AUTHOR DISCLOSURES: J.L. Guzzo, None; M. Fugate, L. Rotellini-Coltvet, None; J. McKown, None; J.A. Freischlag, None.