St. Vincent Heart Center's surgery center treats more than just heart cases. Our thoracic surgeons are also oncology surgeons treating lung and esophageal cancers. That makes St. Vincent Heart Center the busiest non-cardiac thoracic surgery facility in Indiana.
Lung cancer is still the most common cause of cancer death in men and women. At St. Vincent we are making progress and lung cancer screening is an important first step.
Thoracic Surgeons are trained to treat benign and cancerous diseases of the lung and chest, not necessarily the heart. At St. Vincent Heart Center the versatility of these surgeons is a value-added benefit for heart patients being treated for an aortic aneurysm. Surgeons are able to rebuild the aortic artery with a prosthetic graft. In other cases, they can use minimally invasive endovascular stent grafts to repair thoracic aortic aneurysms.
The St. Vincent Thoracic Surgery Program performs more thoracic surgeries than any other group in Indiana and in most cases these surgeons are using catheters, robotic-assisted surgery and advanced imaging techniques. They are also one of four groups in the nation performing thymus gland removal with this technology. For adults who experience persistent, excessive sweating (sometimes due to medication) these surgeons provide the only definitive treatment for hyperhidrosis using video-assisted surgical technology. To learn more about hyperhidrosis click here.
Case in point as presented by Richard Freeman, MD, St. Vincent Cancer Care Medical Director and board-certified Thoracic Surgeon at St. Vincent Heart Center
A 60-year-old woman and 35-year smoker gets a St. Vincent flyer in the mail about low-dose CT scans as a lung cancer screening. She calls and makes an appointment. The CT scan shows a lung nodule. She is referred to a St. Vincent thoracic surgeon and at the bedside a navigational bronchoscopy procedure is done to get within proximity of the lung by navigating through the esophagus. A nodule is positively identified. Next an endobroncho -ultrasound probe takes the same path and extracts a biopsy. All of this has been done without making an incision. She is scheduled for surgery, having a VATS minimally invasive procedure using robotic-assisted technology to make 3-4 small incisions to remove the cancerous mass. In this case, the recovery is quicker and this woman needs a much shorter interval of cancer therapy. Early detection of lung cancer matters, so does the experience of the surgeons and the innovative tools they use.
The St. Vincent thoracic surgeons lead a multidisciplinary thoracic malignancy clinic working in cooperation with cardiologists, pulmonologists, oncologists, gastroenterologists and your primary care physician to coordinate the highest standards of care. This group is actively involved in local and national clinical research efforts to ensure that our patients receive innovative yet proven therapies.
Are you a long-time smoker? Have a persistent unproductive cough?
The low-dose CT lung scan is a painless lung cancer screening test that takes just a few minutes.Did you know?
At St. Vincent, Indianapolis, Vascular Surgeon George Sheng, MD, has created a multi-disciplinary approach to diagnosing and treating thoracic outlet syndrome (TOS) to significantly improve a patient’s quality of life. TOS is associated with nerve and blood vessel entrapment in the shoulder and arm. Dr. Sheng and colleagues diagnose TOS in adults and children who work extensively doing overhead tasks, including athletes in swimming, baseball, softball and volleyball. In many cases the pectoralis minor muscle is also injuried. This multi-disciplinary center includes a thorough evaluation and onsite diagnostic testing, a specialized physical therapy approach, trigger point injection program, botox injection and surgical interventions.
When left-sided shoulder pain is present, St. Vincent physicians always rule out heart disease and use nerve-conduction studies to rule out other causes of nerve pain in the neck and shoulder. Trigger point pain in the pectoralis minor muscle (radiating through the shoulder, pecs and shoulder blade) may occur secondarily to underlying heart disease and may be related to TOS. The TOS staff provides comprehensive follow-up care for all types of TOS including pectoralis minor syndrome.
Universally, this condition is caused by the compression of body structures (nerves and blood vessels) in the neck and upper chest area. Our vascular physicians are highly experienced in diagnosing and treating this often misdiagnosed condition.
Thoracic outlet syndrome (NTOS) and pectoralis minor syndrome (PMS) are the most common and presents with series of vague neurological symptoms, ranging from numbness and tingling in hands and fingers with activity -- to weakness and debilitating pain in shoulder, neck, and arm. To learn more about NTOS click here.
Venous thoracic outlet syndrome (VTOS) causes a blood clot to form in deep venous system in the affected arm. As result of the upper extremity deep venous thrombosis (DVT), a patient can have debilitating arm swelling and even a life-threatening pulmonary embolism. To learn more about VTOS click here.
Arterial thoracic outlet syndrome (ATOS) is an exceedingly rare form of TOS and is frequently associated with the presence of an extra rib (referred to the 1st rib or cervical rib) on the affected side. ATOS can be limb threatening due to aneurysm formation in the artery. To learn more about ATOS click here.
The St. Vincent Center for Treatment of Thoracic Outlet Syndrome attracts patients from throughout Indiana and the nation. Our staff has streamlined the patient experience so that during a 2-3 hour appointment all the necessary tests, a thorough evaluation, and a personalized treatment plan can be developed. Online consultations are also available to individuals seeking a second opinion. Please contact our office to schedule an appointment or consultation.
The least common form of Thoracic Outlet Syndrome. This condition threatens the arm and hand due to blockages in the artery that go to arm and hand. ATOS is typically related to the presence of an extra rib and repetitive use of that extremity.
Most patients with ATOS have a congenital cervical rib. This rib sits above the 1st rib and causes compression of subclavian artery (the artery that provides blood supply to arm and hand). With repetitive injury the artery can form aneurysm (abnormal dilation of the artery) that either shower clots to the hand or clots off completely. This condition, if not treated immediately, could lead to limb loss. The medical image below is from one of our patients. The arrow shows the location of aneurysm and extra rib.
The treatment of ATOS is immediate removal of the extra rib, removal of aneurysm, and restoration of blood flow to the hand.
This condition is the most common form of thoracic outlet syndrome. NTOS represents up to 90% of all TOS diagnoses. Most commonly, the patient will presents with vague upper extremity, shoulder, and neck symptoms.
Symptoms of Neurogenic Thoracic Outlet Syndrome
NTOS is caused by dynamic compression and irritation of nerves at the neck and shoulder level. Deep muscles in the neck anterior scalene muscle and 1st rib form a narrowed space through which the brachial plexus passes through (outlined in green on the illustration below). This is one site where nerve and blood vessel compression typically occurs.
Pectoralis Minor Syndrome (PMS) can present by itself in conjunction with NTOS. This condition is caused by compression of nerve fibers below the collarbone by a muscle called pectoralis minor muscle. Symptoms are similar to NTOS.
Physical therapy is the initial treatment option for NTOS. It is important to work with physical therapists that are familiar with this condition. We have teamed up with physical therapists and chiropractors throughout the country to establish a care system for these patients. With effective physical therapy, 60 to 70% of NTOS and PMS patients are cured without further treatment.
BOTOX® injection (a neuromuscular blocker) in the trigger points related to the shoulder and arm nerve compression site can be extremely effectively in managing the debilitating symptoms of NTOS and PMS. This procedure with insurance coverage is done as an outpatient in our facility. For more information about BOTOX see frequently asked questions.
Surgical decompression of the entrapped nerve is reserved for those that fail to respond to conservative treatments for NTOS and PMS. This procedure is performed through a small incision above the collarbone. Scalene muscle and first rib are removed to achieve the most effective decompression. Pectoralis minor muscle resection can be performed at the same time or independently. This procedure usually takes 1 to 2 hours and the patient will typically recover in the hospital for 1 to 2 days. These vascular surgeons are very experienced in these advanced surgical techniques. Annually the TOS surgical team performs approximately 40 to 50 procedures with outstanding results. (Since, no complications or adverse events have been reported).For more information about the NTOS surgical procedure, see frequently asked questions.
This condition is also known as Effort Thrombosis or Paget-Schroetter Syndrome. While venous thoracic outlet syndrome can coincide with NTOS, it often presents independently. VTOS often affects “overhead” athletes. Patient presents with classic findings of blood clots in subclavian and arm vein on affected side. Common symptoms are bluish color and swelling of arm and shoulder with pain.
VTOS is caused by chronic compression and subsequent scarring of subclavian vein between collarbone (clavicle) and 1st rib (see picture below with blue arrow). Repetitive use of upper extremity leads to scar formation around the vein that ultimately causes blood clot to form. Some patient also have undetected clotting disorders that put them at further risk for Venous Thoracic Outlet Syndrome.
VTOS is treated urgently with blood thinners. This prevents blood clot from going to lungs, also known as pulmonary embolism. Also the blood thinner keeps extension of clots to small veins in arm. The immediate treatment for VTOS is dissolving the clot using a catheter. This procedure is known as catheter directed thrombolysis. Once the blood clot is fully dissolved, surgical removal of 1st rib is usually recommended to prevent future development of blood clot and to open collapsed vein.
The overall outcome with treatment of VTOS is very good. Greater than 95% of the patients are able to resume normal use of their arms without any swelling. The rest of the patients may experience mild swelling with vigorous use of that arm. Majority of our patients are off the blood thinner within three months.
For additional information contact Dr. George Sheng , Vascular Surgeon, email George.Sheng@ascension.org or call the Center at 317-583-7600.
NTOS rarely causes permanent nerve damage; however, debilitating pain, numbness and tingling can cause significant life style limitations. This patient also tends to use the affected extremity less which may lead to muscle atrophy and impaired range of movement.
With a dedicated physical therapist who is familiar with this condition, 60% of our patients never required further therapy.
Trigger point injection using BOTOX is able to dramatically improve
symptoms of NTOS. The BOTOX injection may completely eliminate symptoms
of NTOS in select patients for at least 3 months. With continued and
effective physical therapy, approximately 20-30% of these patient have
very good results ultimately. We offer a second injection if symptoms
recur after 3 months. With careful patient selection and accurate
injection, many patients avoided surgery in our Center.
BOTOX works by relaxing muscles in neck and shoulder area, this allows
the pressure on nerves to decrease with time. Additionally, there is
increasing evidence that BOTOX can directly decrease nerve sensitivity
We offer a maximum of two treatment per site. BOTOX injection is especially useful in a selected group of “overhead” athletes (swimming, baseball, softball, and volleyball). When NTOS and/or PMS is related to repetitive use associated with sports only (a patient’s daily life is not significantly affected), we can often get these athletes through the season without surgery. Additionally, we also have good success with insurance coverage when it comes to BOTOX injection.
3 to 5 days to achieve maximal effect. It typically lasts 3 months minimally.
Minimal if any. We have performed more than 200 injections to date, and had no adverse effect in any patient.
If the diagnosis is established accurately by someone who is experienced
through trigger point injection and vascular studies, surgical
treatment has over 90% success rate. Surgery is only reserved for those
that have failed conservative management.
This depends on the patient. Pain control is the primary reason for
patients to stay in hospital. Patients usually stay in hospital
overnight up to 3 days. Most patients return to work in 2 to 4 weeks
with weight lifting restrictions. We start physical therapy within days
of discharge from hospital. Athletes may take up to 6 to 8 weeks before
reconditioning due to weight lifting restrictions.
Nerve injury, bleeding, lymphatic fluid leak and infection. These risks significantly decrease with a surgeon how has extensive experience surgically treating TOS. At the St.Vincent Center for Thoracic Outlet Syndrome, our surgical team performs 50 to 60 of these procedures a year and have had no complications to date.