J Korean Soc Vasc Surg.  1999 Nov;15(2):322-326.

Arterial Thoracic Outlet Syndrome (TOS) with Multiple Distal Embolization: A case report

• Lee JE
• Min SK
• Ahn MS
• Huh S
• Jung IM
• Ha JW
• Chung JK
• Sung SW
• Kim SJ

Abstract

Thoracic outlet syndrome (TOS) is an uncommon condition which is caused by compression of subclavian artery, vein or brachial plexus in the region of thoracic outlet area, which is composed by the first rib, clavicle, anterior and middle scalene muscles and other connective tissue. In arterial TOS, chronic arterial compression causes arterial stenosis, poststenotic dilatation, aneurysm formation, intramural thrombus and peripheral arterial embolism. We present herein a case of arterial TOS patient with multiple distal embolization. The patient was 43-year old male with crutch ambulation because of sequelae of polioviral infection in his youth. His chief complaint was discoloration and gangrenous change of five right digits for 1 month. A rudimentary first right rib was found in simple chest X-ray. Angiographic findings were stenosis and poststenotic dilatation of right subclavian artery, multiple peripheral arterial embolic obstructions and numerous collateral vessel formation. Right thoracoscopic sympathectomy (T2), resection of the abnormal first rib and the abnormal axillary arterial segment was performed through the supraclavicular and transaxillary incision, then interpositional graft with saphenous vein was done for arterial reconstruction. A minor lymphatic fluid collection around the area of operation occurred, but it was easily controlled by percutaneous drainage. The gangrenous wounds of digits were improved after restoration of blood circulation.

Keyword

Arterial thoracic outlet syndrome; First rib resection; Arterial embolism

MeSH Terms

Adolescent
Adult
Aneurysm
Blood Circulation
Brachial Plexus
Clavicle
Connective Tissue
Constriction, Pathologic
Dilatation
Drainage
Embolism
Humans
Male
Muscles
Ribs
Saphenous Vein
Subclavian Artery
Sympathectomy
Thoracic Outlet Syndrome*
Thorax
Thrombosis
Transplants
Veins
Walking
Wounds and Injuries