Our Summary

This study looked at 30 years of data on a condition called arterial thoracic outlet syndrome (ATOS), which is quite rare. It happens when the main artery to your arm, the subclavian artery, is squeezed by a bone in your upper chest area. The researchers looked back at all the patients who’d had surgery for this condition between 1988 and 2018 at a particular medical center.

They found that 41 patients had the surgery, with some having it done on more than one limb, making a total of 45 limbs treated. Most of these patients had been dealing with symptoms for more than 6 weeks. Some of them, in fact, 29%, came to the hospital with a critical condition called acute limb ischemia, where the blood flow to a limb suddenly stops. This can be a medical emergency and requires immediate treatment to remove the blood clot that is blocking the artery.

All of these patients had surgery to relieve the pressure on the subclavian artery. Most also needed further surgery to reconstruct the artery. There were no deaths related to the surgery and only one person had a major event related to their limb.

For the patients who originally presented with acute limb ischemia, the researchers found that about 62% had more blood clots before they could have the surgery to relieve the pressure. They also found that the chance of having more blood clots increased with time.

They followed up with most of the patients for about a year. They found that the artery or the graft used to replace the artery stayed open in most cases. Some patients had ongoing pain and weakness in their arm. Having pain in the forearm or hand before surgery and having the brachial artery (a major artery in the arm) blocked were linked with chronic pain and weakness after surgery.

The researchers concluded that ATOS can present in many ways and it can take time to diagnose. Having pain in the upper extremity and having the brachial artery blocked when a patient presents with acute limb ischemia are associated with chronic pain and weakness after surgery. Delaying the surgery to relieve the pressure can lead to more blood clots in patients who present with acute limb ischemia. Therefore, it’s important to diagnose ATOS early and accurately to reduce the chance of ongoing issues and improve patient outcomes.

FAQs

  1. What is arterial thoracic outlet syndrome (ATOS) and how is it treated?
  2. What were the outcomes for patients who had surgery for ATOS according to the study?
  3. What complications can arise if the diagnosis and treatment of ATOS is delayed?

Doctor’s Tip

One helpful tip a doctor might tell a patient about thoracic outlet syndrome surgery is to seek treatment early to prevent complications such as acute limb ischemia and ongoing pain and weakness. Early diagnosis and surgical intervention can improve outcomes and reduce the risk of further blood clots and complications. It’s important to follow post-operative care instructions and attend follow-up appointments to monitor the healing process and address any concerns.

Suitable For

Patients who are typically recommended for thoracic outlet syndrome surgery are those who have been dealing with symptoms for an extended period of time, particularly those with acute limb ischemia. Patients who present with acute limb ischemia may require immediate surgery to prevent further complications such as blood clots. Additionally, patients who have pain in the forearm or hand before surgery and have the brachial artery blocked are more likely to experience chronic pain and weakness after surgery. Early and accurate diagnosis of ATOS is crucial in order to improve patient outcomes and reduce the chance of ongoing issues.

Timeline

In summary, a patient with thoracic outlet syndrome may experience symptoms such as pain, numbness, and weakness in the arm for weeks or even months before seeking medical treatment. If left untreated, the condition can lead to more serious complications such as acute limb ischemia. Surgery to relieve the pressure on the subclavian artery and reconstruct the artery may be necessary, especially in cases of acute limb ischemia. After surgery, patients may experience ongoing pain and weakness in the arm, particularly if they had pain in the forearm or hand before surgery or if the brachial artery was blocked. Close follow-up and early diagnosis are important to prevent further complications and improve patient outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about thoracic outlet syndrome surgery include:

  1. What are the risks and benefits of thoracic outlet syndrome surgery?
  2. How long will the recovery process take?
  3. Will I need physical therapy after surgery?
  4. What can I expect in terms of pain management post-surgery?
  5. Are there any alternative treatments or therapies I should consider before opting for surgery?
  6. How likely is it that I will need additional surgeries or procedures in the future?
  7. What are the potential long-term effects of thoracic outlet syndrome surgery?
  8. How experienced are you in performing this type of surgery?
  9. What is the success rate of this surgery for patients with my specific condition?
  10. Are there any specific lifestyle changes or precautions I should take after surgery to prevent future complications?

Reference

Authors: Pitcher GS, Sen I, Mendes BC, Shuja F, DeMartino RR, Bower TC, Kalra M, Harmsen WS, Colglazier JJ. Journal: J Vasc Surg. 2022 Aug;76(2):523-530. doi: 10.1016/j.jvs.2022.03.870. Epub 2022 Apr 1. PMID: 35378247