Abstract
Thoracic outlet syndrome (TOS) can interrupt blood flow to upper limbs by vascular compression. We report a case of a 52-year-old man who presented left subclavian artery malperfusion due to TOS during total vertebrectomy (Th2–4) in the prone position for invasive lung cancer. At the time of resection of the vertebral bodies, his left radial systolic blood pressure had begun to drop intermittently and we noticed an interarm pressure difference. Accordingly, we began to monitor the right radial artery pressure and found that only the left radial artery pressure decreased as a result of compressive force from the surgical site. The operation was continued with intermittent malperfusion of the left arm, and when it was prolonged, we asked the surgeons to release the compression. No symptoms of ischemia or nerve injuries in the left arm were observed after the surgery. Retrospective review of his preoperative enhanced computed tomography images suggested a slightly compressed left subclavian artery in the costoclavicular space. Combination of the prone position and a specific upper limb position may be a risk factor for intraoperative TOS. An interarm blood pressure difference is a clue to detect accidental arterial TOS during general anesthesia.
Highlights
Thoracic outlet syndrome (TOS) is a condition that occurs when the neurovascular bundle is compressed in the thoracic outlet space formed by the first rib, the clavicle, and the scalene muscles
We report a case of left subclavian artery malperfusion suspected to be caused by TOS during thoracic total vertebrectomy in the prone position for invasive lung cancer
Complete tumor resection was planned via right upper lobectomy and total vertebrectomy (Th2–4) with corresponding costectomy
Summary
Thoracic outlet syndrome (TOS) is a condition that occurs when the neurovascular bundle is compressed in the thoracic outlet space formed by the first rib, the clavicle, and the scalene muscles. We report a case of left subclavian artery malperfusion suspected to be caused by TOS during thoracic total vertebrectomy in the prone position for invasive lung cancer. We reviewed enhanced computed tomography scans of the patient, and a slightly compressed left subclavian artery between the first rib and anterior scalene muscle was pointed out (Fig. 2). He had never felt any clinical symptoms previously. His condition was diagnosed as accidental arterial TOS resulting from the surgical procedure and his position during the operation Further diagnostic test such as CT angiography was not performed because of its little value for his postoperative treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
