[The costoclavicular neurovascular compression syndrome].

This is a description of a great variety of abnormal compressions of nerve, arterial, and rather seldom venous structures at the base of the neck or thoracic outlet, such as supernumerary cervical rib. abnormal ligaments, musculus scalenus anterior hypertrophy and positional alterations, interfering with the normal inter-reactions between first rib and structures overlying it. With a special reference to the hypothetical mechanism of the symptomatology a wide range of denominations of this particular syndrome have been adopted, namely: scalenus anticus syndrome, cervical rib syndrome, costoclavicular syndrome, hyperabductions syndrome and thoracic outlet syndrome--a term gaining widest popularity in the Anglo-Saxon literature. It is the purpose of this study to present experience hitherto accumulated worldwide with the diagnosis and treatment of such pathology, and analyze the authors' experience based on the results of 13 operative interventions for decompressions of the costoclavicular groove against the background neurovascular costoclavicular syndrome. Special attention is focused on the surgical management of this particular pathology using the modern transaxillary approach for resection of supernumerary first rib, thoracic extrapleural sympathectomy--a method successfully introduced in Bulgaria by the authors' team for the first time in 1984. The early and long-term results in 13 patients (7 of them women) operated through transaxillary access over a 10-year period, the complication ensuing and their treatment, as well as comparative assessment with other operative procedures described in the literature, are discussed.