Regarding "Arterial injuries in the thoracic outlet syndrome"

Abstract

The excellent and comprehensive study by Durham et al. (J Vasc Surg 1995;21:57-69) reminded me of happy occasions when I worked with the late Dr. Louis M. Rosati. He was an excellent clinical surgeon, but far more, he was a keen student of surgical anatomy. In the Clinical Symposia, published in 1958 and referred to by the authors, he was able to demonstrate to Dr. Frank Netter, the accomplished artist, and to me in dissections on fresh and fixed cadavers how the humeral head impinged on the axillary artery in positions of abduction and hyperabduction. The ingenious way the authors overcame the narrowing of the axillary artery in the area of the humeral head, by placing a saphenous vein patch, was successful in four patients. I want to suggest the simpler and safer operation of total claviculectomy with removal of the periosteum for patients with axillary arterial impingement but with no structural damage, aneurysmal or otherwise. The principles of the procedure are twofold: (1) the relief of pressure by the clavicle on the subclavian artery in the hyperabduction syndrome described by Wright, 1Wright IS The neurovascular syndrome produced by hyperabduction of the arms.Am Heart J. 1945; 29: 1-19Abstract Full Text PDF Scopus (173) Google Scholar and (2) the removal of the clavicle allows the shoulder to move inward 2 to 4 cm toward the midline, effectively lengthening the subclavian-axillary artery, as well as the brachial plexus. 2Lord Jr, JW Surgical management of shoulder girdle syndromes.Arch Surg. 1953; 66: 69-82Crossref Scopus (8) Google Scholar The function of the shoulder and arm is excellent, and the cosmetic result is more than acceptable by the patient. 3Lord Jr, JW Wright IS Total claviculectomy for neurovascular compression in the thoracic outlet.Surg Gynecol Obstet. 1993; 176: 609-612PubMed Google Scholar