Thoracic-Outlet-Syndrom

Zusammenfassung

Einleitung Das Thoracic-Outlet-Syndrom (TOS) gehört zu den am längsten und intensivsten diskutierten Diagnosen. Es existiert kein einheitliches Erkrankungsbild und keine klare Definition. Das TOS vereint eine Vielzahl von Symptomen und Beschwerden, die ihre Ursache in einer Kompression vaskulärer oder nervaler Strukturen in einer der 3 Engen der oberen Thoraxapertur haben.

Methoden Anhand einer umfangreichen Literaturrecherche werden Ätiologie, Epidemiologie, Diagnostik, Möglichkeiten und Ergebnisse der chirurgischen Therapie dargestellt.

Ergebnisse Das TOS wird aktuell in 3 Hauptformen unterschieden: das vaskuläre TOS (vasTOS) mit einem arteriellen (aTOS) und einem venösen TOS (vTOS), das neurologische TOS (nTOS), welches sich in ein typisches (nTOS) und in ein atypisches (disTOS) unterteilt, und eine Mischform von vaskulärem und neurogenem TOS (nvasTOS). Die Diagnostik ist umfangreich und schwierig, da bis zu 90 % aller Patienten einem atypischen (disTOS) zugeordnet werden müssen. Neben dem Versuch einer konservativen Therapie des nTOS stehen zur Dekompression der neurovaskulären Strukturen chirurgische Therapieverfahren mit einer signifikanten primären Verbesserung der Beschwerden in bis zu 92 % der Fälle zur Verfügung. Der supraklavikuläre und der transaxilläre Zugangsweg sind die am häufigsten verwendeten. Langfristig profitieren 50–80 % der Patienten von einer operativen Therapie. Die Raten an vaskulären oder neurologischen Komplikationen in Zentren liegen dabei bei 0–2 %, Minorkomplikationen wie Pneumothorax, Nachblutung und Lymphfisteln werden in bis zu 25 % der Fälle beobachtet.

Zusammenfassung Die meisten Patienten profitieren unabhängig von der Form des TOS von einer chirurgischen Therapie. Entscheidend für einen Therapieerfolg sind neben Dauer der Symptomatik und sozioökonomischen Faktoren vor allem eine dezidierte Diagnostik und die Wahl eines adäquaten operativen Verfahrens durch erfahrene Zentren.

Abstract

Introduction Thoracic outlet syndrome (TOS) is one of the most extensively discussed diagnoses. There is neither a clear and homogenous clinical presentation nor an accepted definition. The term describes a complex of symptoms and complaints caused by the compression of nerves and vascular structures at one of the three defined constrictions of the upper thoracic aperture.

Methods Based on a comprehensive literature review, this article presents the etiology, epidemiology and clinical diagnostics as well as the possibilities and outcomes of surgical treatment.

Results The thoracic outlet syndrome is currently subdivided into three main forms: vascular TOS (vasTOS) including arterial TOS (aTOS) and venous TOS (vTOS), neurogenic TOS (nTOS), which is further subdivided into typical (nTOS) and atypical TOS (disTOS), and a mixed form of nTOS and vasTOS (nvasTOS). The diagnosis is complex and difficult since the disTOS group comprises over 90 % of all patients. In addition to conservative treatment attempts, nTOS may be treated by surgical procedures focusing on the decompression of neurovascular structures. A significant improvement after surgery was found in up to 92 % of cases. The most common access sites are supraclavicular and transaxillary. 50 to 80 % of patients benefit from surgery in the long run. The rates of vascular or neurological complications reported by specialised centres are 0 to 2 %; minor complications such as pneumothorax, bleeding and lymphatic fistula are reported in up to 25 % of cases.

Summary Most patients suffering from any form of TOS benefit from surgical treatment. Duration of symptoms, socioeconomic factors and, most notably, stringent diagnostic workup and an adequate operative procedure performed by an experienced centre are crucial to success.

Schlüsselwörter

TOS - Thoracic-Outlet-Syndrom - nTOS - aTOS - vTOS - disTOS

Key words

TOS - nTOS - aTOS - vTOS - disTOS - thoracic outlet syndrome

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