Abstract
Thoracic Outlet Syndrome (TOS) is a clinical condition due to compression of the neurovascular structures, such as brachial plexus and subclavian vessels, during their course between the neck and axilla. Different etiological factors including cervical rib are involved in this diverse group of disorder. Depending on these factors, patients presents with either neurological or vascular compromise. Multiple disciplinary team effort and appropriate surgical technique such as the supraclavicular approach to eliminate the definitive element defines cure in terms of long term functional capacity. We report a case of a 27 year old female who presented with complain of progressive left upper limb pain and paresthesias. We planned an excision of cervical rib with thrombectomy and stenting of the subclavian artery though a supraclavicular approach.
Highlights
IntroductionTel: +966 565 978939 travelling from the thoraco-cervical region to the axilla, are compressed due to narrowing of the spaces in the thoracic outlet
Thoracic Outlet Syndrome (TOS) is an entrapment syndromeTel: +966 565 978939 travelling from the thoraco-cervical region to the axilla, are compressed due to narrowing of the spaces in the thoracic outlet
We report a case of a 27 years old female who was referred to the Vascular Surgery Department of King Fahd Military Medical Complex from a peripheral hospital where she presented with complain of progressive left upper limb pain and paresthesias that started 4 weeks prior to presentation after elevating an object at home
Summary
Tel: +966 565 978939 travelling from the thoraco-cervical region to the axilla, are compressed due to narrowing of the spaces in the thoracic outlet. Initial workup showed left brachial artery thrombus for which she underwent brachial artery embolectomy With this procedure her pain started improving but it did not subside and the numbness persisted in the left hand. CT angiogram revealed a filling defect measuring 40 x 11.5 mm at the second part of subclavian artery suggestive of thrombus due to cervical rib compression with non-visualized proximal segment of brachial artery (clavicle to the mid humerus), with narrowed and attenuated left axillary, brachial and radial arteries (Figure 1). Thereafter patient and family members were counseled regarding our plan of excision of cervical rib with thrombectomy and stenting of the subclavian artery, to which they agreed She underwent the above mentioned surgical procedure though a supraclavicular approach by the Neurosurgery team. On follow up after 3 months patient is symptom free with warm hands, good capillary refilling and ulnar systolic pressure of 104 mmHg
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