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Dalio MB, Filho ERDS, Barufi MB, et al. Contemporary Management of Arterial Thoracic Outlet Syndrome. Ann Vasc Surg. 2021;74:42-52doi: 10.1016/j.avsg.2021.01.078.
Dalio, M. B., Filho, E. R. D. S., Barufi, M. B., Ribeiro, M. S., & Joviliano, E. E. (2021). Contemporary Management of Arterial Thoracic Outlet Syndrome. Annals of vascular surgery, 7442-52. https://doi.org/10.1016/j.avsg.2021.01.078
Dalio, Marcelo Bellini, et al. "Contemporary Management of Arterial Thoracic Outlet Syndrome." Annals of vascular surgery vol. 74 (2021): 42-52. doi: https://doi.org/10.1016/j.avsg.2021.01.078
Dalio MB, Filho ERDS, Barufi MB, Ribeiro MS, Joviliano EE. Contemporary Management of Arterial Thoracic Outlet Syndrome. Ann Vasc Surg. 2021 Jul;74:42-52. doi: 10.1016/j.avsg.2021.01.078. Epub 2021 Feb 05. PMID: 33556514.
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Ann Vasc Surg. 2021 Jul;74:42-52. doi: 10.1016/j.avsg.2021.01.078. Epub 2021 Feb 05.

Contemporary Management of Arterial Thoracic Outlet Syndrome.

Annals of vascular surgery

Marcelo Bellini Dalio, Elpídio Ribeiro da Silva Filho, Marina Britto Barufi, Maurício Serra Ribeiro, Edwaldo Edner Joviliano

Affiliations

  1. University of São Paulo, Ribeirão Preto Medical School, Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, Ribeirão Preto, São Paulo, Brazil. Electronic address: [email protected].
  2. University of São Paulo, Ribeirão Preto Medical School, Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, Ribeirão Preto, São Paulo, Brazil.

PMID: 33556514 DOI: 10.1016/j.avsg.2021.01.078

Abstract

BACKGROUND: Arterial thoracic outlet syndrome (aTOS) is characterized by compression of the subclavian artery as it exits the thoracic girdle. Chronic and repetitive compression leads to several degrees of arterial wall damage. The treatment is varied and depends on the presentation severity. This study aimed to describe the contemporary experience in managing arterial thoracic outlet syndrome at a large tertiary hospital.

METHODS: We conducted a single-institution retrospective review of aTOS cases from January 2009 to January 2020. Demographic data, clinical presentation, medical images, operative notes, and outcomes were assessed.

RESULTS: Thirteen aTOS cases were identified. The mean age was 43 ± 10 years, and 11 (85%) were women. Both sides were equally affected: right (7 cases, 54%) and left (6 cases, 46%). The most common clinical presentation was arm claudication (7 cases, 54%). Other presentations were: acute arm ischemia, pulsatile neck mass and distal embolization. Cervical ribs were identified by plain X-rays in most cases. All patients were submitted to surgical decompression through the supraclavicular approach. Patients with early disease stages were not submitted to arterial reconstruction and were followed with duplex scan. Arterial reconstruction was done in advanced disease stages (5 cases, 38%): end-to-end anastomosis, interposition graft, and bypass graft. The mean follow-up duration was 32,6 ± 25 months. In all patients, the subclavian artery/graft was patent, and the vascular symptoms were entirely resolved. There were no deaths or amputations.

CONCLUSIONS: Arterial thoracic outlet syndrome has a varied clinical presentation. Cervical ribs are the most common anatomic abnormalities. The diagnosis was based on history, physical examination, and imaging exams. Surgery consisted of supraclavicular decompression, arterial resection, and vascular reconstruction, according to the disease stage. The outcomes were excellent.

Copyright © 2021 Elsevier Inc. All rights reserved.

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