University of São Paulo, Ribeirão Preto Medical School, Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, Ribeirão Preto, São Paulo, Brazil.
University of São Paulo, Ribeirão Preto Medical School, Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, Ribeirão Preto, São Paulo, Brazil.
Ann Vasc Surg. 2021 Jul;74:42-52. doi: 10.1016/j.avsg.2021.01.078. Epub 2021 Feb 5.
Arterial thoracic outlet syndrome (aTOS) is characterized by compression of the subclavian artery as it exits the thoracic girdle. Chronic and repetitive compression leads to several degrees of arterial wall damage. The treatment is varied and depends on the presentation severity. This study aimed to describe the contemporary experience in managing arterial thoracic outlet syndrome at a large tertiary hospital.
We conducted a single-institution retrospective review of aTOS cases from January 2009 to January 2020. Demographic data, clinical presentation, medical images, operative notes, and outcomes were assessed.
Thirteen aTOS cases were identified. The mean age was 43 ± 10 years, and 11 (85%) were women. Both sides were equally affected: right (7 cases, 54%) and left (6 cases, 46%). The most common clinical presentation was arm claudication (7 cases, 54%). Other presentations were: acute arm ischemia, pulsatile neck mass and distal embolization. Cervical ribs were identified by plain X-rays in most cases. All patients were submitted to surgical decompression through the supraclavicular approach. Patients with early disease stages were not submitted to arterial reconstruction and were followed with duplex scan. Arterial reconstruction was done in advanced disease stages (5 cases, 38%): end-to-end anastomosis, interposition graft, and bypass graft. The mean follow-up duration was 32,6 ± 25 months. In all patients, the subclavian artery/graft was patent, and the vascular symptoms were entirely resolved. There were no deaths or amputations.
Arterial thoracic outlet syndrome has a varied clinical presentation. Cervical ribs are the most common anatomic abnormalities. The diagnosis was based on history, physical examination, and imaging exams. Surgery consisted of supraclavicular decompression, arterial resection, and vascular reconstruction, according to the disease stage. The outcomes were excellent.
动脉型胸廓出口综合征（aTOS）的特征是锁骨下动脉在离开胸廓出口时受到压迫。慢性和反复的压迫会导致动脉壁的几个程度的损伤。治疗方法多种多样，取决于表现的严重程度。本研究旨在描述在一家大型三级医院管理动脉型胸廓出口综合征的当代经验。
我们对 2009 年 1 月至 2020 年 1 月期间的 aTOS 病例进行了单机构回顾性研究。评估了人口统计学数据、临床表现、医学影像、手术记录和结果。
共发现 13 例 aTOS 病例。平均年龄为 43 ± 10 岁，11 例（85%）为女性。双侧发病率相等：右侧（7 例，54%）和左侧（6 例，46%）。最常见的临床表现是手臂跛行（7 例，54%）。其他表现包括：急性手臂缺血、颈脉动性肿块和远端栓塞。大多数情况下，颈椎肋骨在普通 X 光片中被识别出来。所有患者均通过锁骨上入路接受手术减压。早期疾病阶段的患者未进行动脉重建，仅通过双功超声进行随访。在晚期疾病阶段进行了动脉重建（5 例，38%）：端对端吻合术、中间移植术和旁路移植术。平均随访时间为 32.6 ± 25 个月。所有患者的锁骨下动脉/移植物均通畅，血管症状完全缓解。无死亡或截肢。
动脉型胸廓出口综合征临床表现多样。颈椎肋骨是最常见的解剖异常。诊断基于病史、体格检查和影像学检查。根据疾病阶段，手术包括锁骨上减压、动脉切除和血管重建。结果优良。
