J Korean Soc Vasc Surg.  2004 Dec;20(2):224-231.

Diagnosis and Management of Arterial Thoracic Outlet Syndrome (TOS)

Affiliations
  • 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. sjkimgs@plaza.snu.ac.kr

Abstract

PURPOSE
Arterial TOS is a rare condition caused by compression of the subclavian artery at the thoracic outlet area, which is composed of the anterior and middle scalene muscles, the first rib and the clavicle. We have experienced four cases of arterial TOS and we reviewed them to determine the appropriate management of arterial TOS. METHOD: We reviewed the medical records of 26 patients who were diagnosed and managed for TOS at Seoul National University Hospital from 1985 to 2004. We reviewed the clinical manifestations, diagnostic tools, mode of management and the outcomes. RESULT: The four patients with arterial TOS, 3 males and 1 female, had an average age of 41.3 years (range: 30~53 years). They complained of a tingling sense, coldness, weakness, and cyanosis of affected limb, and a gangrenous finger. They were diagnosed with CT angiography, conventional angiography and Doppler US. The findings were stenotic artery segments, post- stenotic dilatation and luminal thrombi of the subclavian artery. Two of them showed multiple peripheral arterial embolic obstructions and numerous collateral vessels. Three patients with arterial TOS underwent surgery. The operation consisted of the excision of the bony abnormality and the scalene muscle, segmental resection of subclavian artery including the aneurismal dilatation, interposition of a saphenous vein graft, and thromboembolectomy. Their symptoms improved after restoration of blood circulation, but the gangrenous finger required amputation.
CONCLUSION
Arterial TOS has the definite risk of limb loss. If there is a high clinical suspicion of this lesion, early diagnosis and confirmation by angiogram may be critical to prevent limb loss. Surgical revascularization provides satisfactory results for limb salvage with low operative morbidity.

Keyword

Thoracic outlet syndrome; Arterial thoracic outlet syndrome

MeSH Terms

Amputation
Angiography
Arteries
Blood Circulation
Clavicle
Cyanosis
Diagnosis*
Dilatation
Early Diagnosis
Extremities
Female
Fingers
Humans
Limb Salvage
Male
Medical Records
Muscles
Phenobarbital
Ribs
Saphenous Vein
Seoul
Subclavian Artery
Thoracic Outlet Syndrome*
Transplants
Phenobarbital
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