Surgical Experiences of Arterial Thoracic Outlet Syndrome (TOS)

ABSTRACT

PURPOSE: We wanted to investigate the clinical features and treatment results of arterial type thoracic outlet syndrome (a-TOS). METHODS: We retrospectively reviewed the surgical treatments (n=9) of a-TOS for 6 patients (4 primary, 2 secondary, males 100%, mean age 39.6 years). For achieving thoracic outlet decompression, we performed cervical rib resection (n=6) and scalenectomy (n=7) through a supraclavicular incision. Among the primary TOS patients, 4 patients required subclavian artery (SCA) reconstruction. Arterial bypass were performed using saphenous vein grafts for 2 patients with secondary a-TOS. RESULTS: As an underlying cause of primary a-TOS, all the patients revealed bilateral cervical ribs whereas the secondary a-TOS were caused by malunion of clavicular fractures. All the patients presented with hand ischemia resting pain in 4, cyanosis in 4, tingling sense in 4, pallor in 2 and finger tip gangrene in 2. After surgical treatment, the ischemic symptoms improved in all patients, but not to a satisfactory levels in the patients with distal arterial emboli. We experienced pneumothorax, transient phrenic nerve palsy and winged scapula as the operative complications. CONCLUSION: To achieve better treatment outcomes, we recommend early surgical treatment before the occurrence of distal arterial embolization even in the asymptomatic patients who reveal subclavian artery abnormalities. For surgical treatment of a-TOS, the supraclavicular approach combined with infraclavicular incisions offers good exposure for achieving thoracic outlet decompression and SCA reconstructions.