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. 2013;6(1):74-9.
doi: 10.3400/avd.oa.12.00081. Epub 2013 Feb 28.

Surgical management of vascular thoracic outlet syndrome: a teaching hospital experience

Badr Aljabri  1 , Mohammed Al-Omran
Affiliations

Surgical management of vascular thoracic outlet syndrome: a teaching hospital experience

Badr Aljabri et al. Ann Vasc Dis. 2013.

Abstract

Objectives: Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that are caused by compression of the brachial plexus and/or subclavian artery and vein. The aim of this study was to highlight the different modalities of diagnosing and treating vascular TOS and evaluate outcomes.

Methods: We conducted a retrospective cohort study between 1999 and 2011 using the medical records database from a teaching hospital.

Results: During the study period, 54 cases with vascular TOS were identified in 38 patients. Bilateral TOS was in 16 patients. The median age of the patients was 33 years (range 12-49), and the majority (79%) were female. Arterial TOS represented forty-nine cases (90.7%). Preoperative information derived from plain x-ray, duplex scanning and in selected cases computed tomography (CT) and/or angiography. Decompression of the TOS was performed through a supraclavicular approach in all cases with scalenectomy coupled with either cervical rib excision (70%), 1st rib excision alone (15%) and excision of both cervical and 1st ribs (15%). Adjunctive vascular reconstructive procedures were done in 11 cases (20.3%); 9 arterial cases and 2 venous cases. There was no mortality; however, postoperative complications occurred in 7 cases (13%).

Conclusion: The use of advanced radiological imaging and careful surgical planning for Vascular TOS in a high volume center resulted in good outcomes.

Keywords: subclavian artery; subclavian vein; thoracic outlet syndrome.

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Figures

Fig. 1
Fig. 1
Different radiological modalities used to diagnose and plan the management of thoracic outlet syndrome: (A) and (B) Arterial duplex study showing the compressed left subclavian artery with hyperabduction. (C) Reconstructive computed tomography (CT) angiography showing compression of the right subclavian artery between the cervical rib and first rib. (D) Conventional arteriogram for a right subclavian artery showing stenosis of the artery with hyperabduction.
Fig. 2
Fig. 2
Intra-operative image of a supraclavicular incision after decompression of the right thoracic outlet showing the exposed right subclavian artery with an aneurysm.
See this image and copyright information in PMC

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