J Korean Surg Soc.
2006 Jul;71(1):49-55.
Surgical Experiences of Arterial Thoracic Outlet Syndrome (TOS)
- Affiliations
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- 1Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. young52.kim@samsung.com
- 2Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Deagu, Korea.
Abstract
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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.
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