Banis J C, Rich N, Whelan T J
Am J Surg. 1977 Jul;134(1):131-9. doi: 10.1016/0002-9610(77)90296-3.
Nine cases of microemboli of arterial origin to the upper extremity are reported. The source of emboli in five of these cases was in the subclavian artery compressed by osseous anomalies in the thoracic outlet. Three aneurysms, one in a subclavian vein graft and two traumatic false aneurysms in the hand, were also noted to be the sources of distal emboli. One unproved case of emboli from an atherosclerotic plaque of the subclavian artery is also reported. Chronicity of symptoms and delay in operation are often noted and lead to difficulties in surgical management. The compressing osseous structures causing the vascular lesion in the thoracic outlet syndrome must be resected, along with removal of the source of emboli. Cervicodorsal sympathectomy is often needed in cases of extensive thrombosis and/or long-standing ischemia. Embolectomy is usually a futile procedure when the main arterial trunk contains old, organized thrombus. Differential diagnostic problems between collagen vascular disease, vasculitis, vasospastic disease, and microembolic disease in cases of unilateral Raynaud's phenomenon are pointed out.
本文报告了9例上肢动脉源性微栓子病例。其中5例栓子来源为胸廓出口处骨异常压迫的锁骨下动脉。还发现3个动脉瘤是远端栓子的来源，1个位于锁骨下静脉移植物，2个位于手部的创伤性假性动脉瘤。本文还报告了1例未经证实的锁骨下动脉粥样硬化斑块所致栓子病例。症状的慢性化和手术延迟常被注意到，并导致手术治疗困难。必须切除导致胸廓出口综合征血管病变的压迫性骨性结构，同时清除栓子来源。在广泛血栓形成和/或长期缺血的病例中，通常需要进行颈胸交感神经切除术。当主要动脉干内含有陈旧的、机化的血栓时，栓子切除术通常是无效的。指出了单侧雷诺现象病例中胶原血管病、血管炎、血管痉挛性疾病和微栓塞性疾病之间的鉴别诊断问题。
