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A Surgical Urgency

Juan Martin, MD; Donald J. Gaspard, MD; Paul W. Johnston, MD; Roy D. Kohl, Jr, MD; William Dietrick, MD

Arch Surg. 1976;111(7):779-782.

Abstract
• Although the vascular manifestations of the thoracic outlet syndrome are infrequent, their presence is an ominous portent for the affected limb.

The cases of two recent patients indicate the importance of prompt recognition, urgent angiography, and definitive surgery. Regarding the surgical procedure, we used a two-incision approach—supraclavicular and infraclavicular—combining scalenotomy, resections of the cervical rib if present, the first thoracic rib, and the subclavian artery with retroclavicular interposition woven Dacron graft reconstruction. Preceding graft replacement, a Fogarty catheter thrombectomy of the distal brachial artery tree is done with completion arteriography to ensure freedom from retained distal thrombus. First rib resection is easily performed; subsequent vascular repair is also carried out, using this approach. We did not add sympathectomy to these cases, believing that early recognition and treatment will obviate its necessity. Follow-up has supported the efficacy of the treatment plan as presented.

(Arch Surg 111:779-782, 1976)

Author Affiliations
From the Department of Surgery, Huntington Memorial Hospital, Pasadena, Calif.

Footnotes
Accepted for publication March 5, 1976.

Read before the annual meeting of the Southern California Chapter of the American College of Surgeons, Newport Beach, Calif, Jan 16, 1976.

Reprint requests to 50 Bellefontaine, Suite 303, Pasadena, CA 91105 (Dr Gaspard).

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