Vascular manifestations of the thoracic outlet syndrome. A surgical urgency
J. Martin, D. J. Gaspard, P. W. Johnston, R. D. Kohl Jr and W. Dietrick
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
intraclavicular-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.
