Thoracic outlet-syndrome with vascular complications

Area of Science:

• Vascular Surgery
• Thoracic Surgery
• Neurology

Background:

• Thoracic outlet syndrome (TOS) frequently presents with arterial lesions like aneurysms and emboli, often stemming from subclavian artery compression.
• Venous complications, such as axillary vein thrombosis, may originate from intimal damage due to costoclavicular space compression.
• Neurological symptoms are most common in TOS (90%), but often absent in cases with vascular complications.

Purpose of the Study:

• To elucidate the mechanisms and clinical manifestations of arterial and venous lesions in thoracic outlet syndrome.
• To outline optimal surgical strategies for managing TOS-related vascular and neurological complications.
• To emphasize the importance of considering TOS in young patients with unilateral hand or finger ischemia.

Main Methods:

• Review of clinical cases and surgical outcomes for patients with thoracic outlet syndrome.
• Analysis of the relationship between anatomical compression and vascular/neurological sequelae.
• Evaluation of surgical techniques including rib resection, vascular repair, and sympathectomy.

Main Results:

• Arterial emboli manifest TOS in 48% of cases, often linked to subclavian artery compression.
• Surgical correction involves rib resection, arterial repair, and potentially thoracic sympathectomy.
• Venous thrombectomy for acute thrombosis benefits from concurrent first rib resection and may utilize temporary arteriovenous fistulas.

Conclusions:

• Thoracic outlet syndrome requires a comprehensive surgical approach addressing both vascular and neurological components.
• Early recognition of TOS, particularly in young individuals with ischemic symptoms, is vital.
• Combined surgical strategies improve outcomes for arterial and venous thoracic outlet syndrome complications.