Arterial Thoracic Outlet Syndrome: A 32-year Experience

Background: Clinical manifestations of thoracic outlet syndrome (TOS) differ depending on the compromised anatomic structure. Arterial TOS is the least common (1-5% of all cases of TOS), yet the most threatening, due to the risk of limb loss. Methods: We conducted a retrospective review of consecutive patients treated for arterial TOS between January 1979 and June 2012. Medical records and diagnostic images were reviewed, and follow-up was obtained. Results: Nineteen procedures were performed in 18 patients for symptomatic arterial TOS. The average age was 34 years (range 16-69 years), and 12 patients were female (63.2%). Surgical indications were upper limb critical ischemia in 8 (acute in 5 cases and acute-on-chronic in 3 cases) and claudication in 11. Imaging studies revealed a subclavian aneurysm in 7 patients, stenosis in 4 patients, and 2 patients with subclavian artery occlusion. The 6 remaining cases had symptoms caused by arterial compression in dynamic studies without arterial wall damage at rest. All limbs underwent surgery with outlet decompression; in addition, 13 underwent arterial reconstruction, and 7 were treated for distal embolic complications. There were no deaths, amputations, or early reoperations; 1 patient was readmitted 2 weeks after surgery for chylothorax, which resolved with conservative measures. During a mean follow-up of 155.8 +/- 103.1 months, 1 patient underwent successful reintervention at 4 months for bypass occlusion. Conclusions: Arterial TOS is an infrequent but relevant manifestation of TOS. An accurate and early diagnosis allows for timely surgery and adequate results, as shown in this group of patients.