Blunt trauma precipitating arterial thoracic outlet syndrome: a case report

A 39-year-old male who sustained polytraumatic injuries in a motor vehicle collision, including a neck seatbelt sign and acute thrombosis of the left subclavian artery adjacent to an undiagnosed hypoplastic cervical rib, presented with a threatened left upper extremity. He underwent emergent surgical exploration through a supraclavicular incision, with cervical rib resection, resection of the contused subclavian artery segment, and end-to-end anastomosis. Through an infraclavicular incision, he had a thrombectomy of the axillary and brachial arteries. Postoperatively, he developed progressive left upper extremity deficits. Imaging revealed proximal axillary and distal subclavian artery dissection with near occlusion, requiring re-exploration and subclavian-axillary bypass using prosthetic conduit to restore distal perfusion. He was discharged on hospital Day 6 on aspirin and anticoagulation. At 5-months, he had no ischemic symptoms, improving fine motor function, and a patent bypass. This case highlights a rare presentation of arterial thoracic outlet syndrome precipitated by blunt trauma.