Our Summary

This research paper discusses a condition called arterial thoracic outlet syndrome (aTOS), where the main artery exiting the chest area gets squeezed. This repeated squeezing can cause different levels of damage to the artery. The treatment for aTOS varies depending on how bad the condition is.

The researchers looked back at cases of aTOS from 2009 to 2020 at a large hospital. They studied things like patient demographics, symptoms, medical images, surgical procedures, and results.

They found 13 cases of aTOS. The average patient age was 43, and the majority (85%) were women. The condition affected both the right and left sides almost equally. The most common symptom was arm pain due to inadequate blood supply. Other symptoms included sudden lack of blood supply to the arm, bulging neck mass, and distal embolization (where a blood clot travels and blocks a blood vessel). Most patients had cervical ribs (an extra rib in the neck area) identified by X-rays.

All patients underwent surgery to relieve the pressure on the artery. Those with early stages of the disease did not need to reconstruct the artery and were monitored with ultrasound scans. For advanced cases, the artery was reconstructed using various methods.

The average follow-up period was around 33 months. In all cases, the repaired artery/graft was functioning well, and all symptoms were completely resolved. There were no deaths or amputations.

In conclusion, aTOS presents differently in different people and is most commonly associated with cervical ribs. Diagnosis is based on patient history, physical examination, and imaging exams. The treatment involves surgery and depends on how advanced the disease is. The results from this study were very positive.

FAQs

  1. What is arterial thoracic outlet syndrome (aTOS) and what causes it?
  2. What are the common symptoms of arterial thoracic outlet syndrome?
  3. What does the treatment for arterial thoracic outlet syndrome involve, particularly in advanced cases?

Doctor’s Tip

A helpful tip a doctor might tell a patient about thoracic outlet syndrome surgery is to follow post-operative care instructions carefully, including keeping the incision site clean and dry, taking prescribed medications as directed, and attending follow-up appointments to monitor healing and ensure the best possible outcome. It is also important to communicate any concerning symptoms or changes in condition to the medical team promptly.

Suitable For

Patients with arterial thoracic outlet syndrome (aTOS) who are recommended for surgery typically have severe symptoms such as arm claudication, acute arm ischemia, pulsatile neck mass, or distal embolization. They may also have anatomical abnormalities such as cervical ribs identified on imaging. Patients who have not responded to conservative treatment or have progressive symptoms despite conservative management may also be candidates for surgery. The decision to undergo surgery is based on the severity of the symptoms and the extent of arterial wall damage. In cases where arterial reconstruction is necessary, patients with advanced disease stages may be recommended for surgery to prevent further complications and improve vascular symptoms.

Timeline

Before thoracic outlet syndrome surgery:

  1. Patient experiences symptoms such as arm claudication, acute arm ischemia, pulsatile neck mass, and distal embolization.
  2. Diagnosis is made based on history, physical examination, and imaging exams such as plain X-rays.
  3. Surgical decompression through the supraclavicular approach is recommended for patients with arterial thoracic outlet syndrome.
  4. Patients with early disease stages may not require arterial reconstruction and are followed with duplex scan.
  5. Patients with advanced disease stages may require arterial reconstruction through procedures such as end-to-end anastomosis, interposition graft, or bypass graft.

After thoracic outlet syndrome surgery:

  1. The subclavian artery/graft is found to be patent in all patients.
  2. Vascular symptoms are entirely resolved.
  3. The mean follow-up duration is 32.6 ± 25 months.
  4. There are no deaths or amputations reported in the study.
  5. The outcomes of the surgery are considered excellent, with all patients experiencing successful resolution of their symptoms.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with thoracic outlet syndrome surgery?
  2. How long is the recovery process expected to take after surgery?
  3. Will physical therapy be necessary following surgery, and if so, for how long?
  4. What are the expected outcomes and success rates of thoracic outlet syndrome surgery?
  5. Are there any alternative treatment options to surgery that could be considered?
  6. How frequently will follow-up appointments be needed after surgery?
  7. Will there be any long-term effects or restrictions on physical activities after surgery?
  8. How experienced is the surgical team in performing thoracic outlet syndrome surgery?
  9. What type of anesthesia will be used during the surgery?
  10. Are there any specific pre-operative instructions or preparations that need to be followed before the surgery?

Reference

Authors: Dalio MB, Filho ERDS, Barufi MB, Ribeiro MS, Joviliano EE. Journal: Ann Vasc Surg. 2021 Jul;74:42-52. doi: 10.1016/j.avsg.2021.01.078. Epub 2021 Feb 5. PMID: 33556514