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 Vascular Experts Achieve Excellent Results for Thoracic Outlet Syndrome

Vascular Experts Achieve Excellent Results for Thoracic Outlet Syndrome

X-ray of a patient with cervical ribs which may cause thoracic outlet syndrome

Ohio State's Wexner Medical Center Leads Region in Case Volume and Experience

In pursuit of a professional dance career, 16-year-old Samantha saw her dancing come to a sudden halt when a blood clot developed in her arm. After a month of testing, consultations and referrals, Samantha's family sought the expertise of Michael R. Go, MD, FACS, vascular surgeon and assistant professor of surgery for the Division of Vascular Diseases and Surgery at The Ohio State University Wexner Medical Center.

The vascular surgery team at Ohio State's Wexner Medical Center has earned renown for diagnosing and treating thoracic outlet syndrome (TOS), a rare, debilitating syndrome caused by compression of nerves and blood vessels in the thoracic outlet.

Ninety-five percent of TOS cases are neurogenic, affecting the brachial plexus. Venous and arterial TOS make up the remainder.

Diagnosis

Diagnosis for TOS can be a cloudy subject, and early referral to a vascular center with expertise and patient volumes, such as those at Ohio State's Wexner Medical Center, can provide an accurate diagnosis. The vascular team receives referrals from hematologists, sports medicine physicians, athletic trainers and primary care doctors.

Applying his extensive experience with TOS and the medical center's wealth of diagnostic tools -- ultrasound, EMG nerve conduction studies, scalene muscle injections -- Dr. Go diagnosed Samantha with venous TOS, noting that her collarbone was compressing a vein and causing deep venous thrombosis in her right upper extremity.

The extremely rare venous TOS generally occurs in young people in their teens and 20s, especially in athletes. Samantha's countless hours of extending her arm in the air during ballet practices and performances most likely contributed to the compression of her vein between the clavicle and first rib.

Treatment

Dr. Go recommends surgery for arterial and venous cases; patients with neurogenic TOS often attempt physical therapy before pursuing surgery.

Performing 30 to 50 surgeries a year to relieve compression of nerves and blood vessels in the thoracic outlet, Dr. Go and his fellow surgeons demonstrate surgical volumes and outcomes that surpass any medical center in the region.

In Samantha's case, Dr. Go chose a transaxillary approach, using a three-inch incision. Samantha and her family are pleased that the scarring is barely noticeable.

The TOS surgeons at Ohio State's Wexner Medical Center can also perform the surgery from a supraclavicular approach or infraclavicular approach, depending on which option is most likely to produce the best outcome.

Clinical Expertise That Exceeds Expectations

Few medical centers offer the depth and range of experience Samantha and her family found at Ohio State's Wexner Medical Center. As residents of a Columbus, Ohio, suburb, Samantha and her family felt fortunate to have the medical center close by.

"I didn't see the need to go out of town," says Samantha's mom, Wendy. "I didn't worry for one minute. I knew she was going to be OK."

The highly specialized TOS team routinely achieves positive surgical outcomes, including prevention of permanent nerve damage, prevention of blood clot formation (venous TOS) and elimination of pain, weakness, numbness and tingling in the arm.

The Human Touch

Wendy praised Dr. Go and his surgical team for being "reassuring, comforting, knowledgeable and informative. Nothing was a surprise. The communication was great."

She appreciated Dr. Go's inclusion of Samantha in discussions, his willingness to answer questions and his accessibility by phone.

Samantha received the go-ahead to return to dancing after a 3 ½-week recovery.

"Living with TOS would have limited Samantha's abilities," Wendy comments. "To not be able to dance would be like not being able to breathe. We're grateful Dr. Go provided a solution that allowed her to continue to pursue her dreams."

To refer a patient or learn more about our vascular services, call 614-293-ROSS (7677)

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