Síndromes compresivos vasculares: un desafío diagnóstico / Vascular Compressive Syndromes: A Challenge Diagnosis

Resumen Los síndromes de compresión vascular constituyen un grupo de patologías poco frecuentes con prevalencia incierta, no solo por el desconocimiento que se tiene de estos, sino también por su presentación clínica inespecífica. Eso conlleva a que sean infradiagnosticados o detectados en etapas tardías, con secuelas a largo plazo. Su fisiopatología y clínica dependen del tipo de vaso comprometido, el sitio anatómico afectado y la causa subyacente que lo esté produciendo. La anamnesis, el examen físico dirigido y el uso de métodos complementarios como la ultrasonografía Doppler y la angiografía por tomografía computarizada (ATC) o angiografía por resonancia magnética (ARM), son herramientas vitales para su correcto diagnóstico, planificación terapéutica y seguimiento.

Abstract Vascular compression syndromes constitute a group of rare pathologies with uncertain prevalence not only because of their unawareness, but also for its nonspecific clinical presentation. This leads to their underdiagnosis, or detection in late stages with long-term sequelae. Its pathophysiology and presentation depends on the type of vessel involved, the affected anatomical site and the underlying cause producing it. Clinical history, physical examination and use of complementary methods such as Doppler ultrasonography, Computed Tomography Angiography (CTA) or Magnetic Resonance Angiography (MRA), are essential tools for its proper diagnosis, therapeutic planning and follow-up.

Supraclavicular decompression for neurogenic thoracic outlet syndrome; an individually tailored approach

The objective of this study was to evaluate the clinical outcome of supraclavicular decompression for thoracic outlet syndrome, and whether first rib resection is needed in all cases. 51 patients underwent 58 procedures, 7 being bilateral. There were 48 females and 3 males. The mean age was 26 years. 88% had lower plexus symptoms, and 5% had a motor deficit. The most sensitive provocative test was the plexus compression test [95%]. Through a supraclavicular approach, the plexus was explored, and the compressing agents resected. Intraoperative dynamic assessment of the plexus was an important part of the procedure. Using the Balci et al, staging system, 90% obtained a good to excellent result at latest follow up. Minimal complications were encountered in this series. In conclusion, the supraclavicular approach affords an excellent exposure of the plexus elements and its compressing agents, and allows dealing with them successfully. The extent of the decompression is individually assessed based upon the patient symptoms, the provocative positioning aggravating his symptoms, the operative findings and the intraoperative dynamic assessment of the plexus including provocative tests, and longitudinal traction of the arm. The final aim should be a plexus free of compression