Dzieciuchowicz Łukasz, Włodarczyk Wojciech, Oszkinis Grzegorz
Department of General and Vascular Surgery, Medical University, Poznań.
Pol Przegl Chir. 2012 Mar;84(3):158-62. doi: 10.2478/v10035-012-0025-0.
A case of a progressive ischemia of the right upper extremity in a 57-year-old male caused by primarily undiagnosed compression of a subclavian artery by an accessory cervical rib is presented. Critical limb ischemia persisting for 7 years despite conservative treatment and a thrombectomy of upper extremity arteries and thoracic sympathectomy, led to a loss of three fingers and development of a non-healing ulceration of right upper extremity. Eventually a cervical rib resection together with a subclavio-brachial venous bypass graft permanently reversed the critical limb ischemia and allowed the ulceration to heal. The presented case underscores the importance of an early surgical intervention in patients with upper limb ischemia and anatomic abnormalities in a thoracic outlet.
本文报告一例57岁男性右上肢进行性缺血病例，其病因主要是未被诊断出的副颈肋压迫锁骨下动脉。尽管进行了保守治疗、上肢动脉血栓切除术和胸交感神经切除术，但严重肢体缺血仍持续了7年，导致三根手指丧失，右上肢出现不愈合溃疡。最终，颈肋切除术联合锁骨下-肱静脉旁路移植术永久性地逆转了严重肢体缺血，使溃疡得以愈合。该病例强调了对上肢缺血且胸廓出口存在解剖异常的患者进行早期手术干预的重要性。
