title: Arterial thoracic outlet syndrome: a 32-year experience.
abstract: BACKGROUND
  Clinical manifestations of thoracic outlet syndrome (TOS) differ depending on the compromised anatomic structure. Arterial TOS is the least common (1-5% of all cases of TOS), yet the most threatening, due to the risk of limb loss.
  
  
  METHODS
  We conducted a retrospective review of consecutive patients treated for arterial TOS between January 1979 and June 2012. Medical records and diagnostic images were reviewed, and follow-up was obtained.
  
  
  RESULTS
  Nineteen procedures were performed in 18 patients for symptomatic arterial TOS. The average age was 34 years (range 16-69 years), and 12 patients were female (63.2%). Surgical indications were upper limb critical ischemia in 8 (acute in 5 cases and acute-on-chronic in 3 cases) and claudication in 11. Imaging studies revealed a subclavian aneurysm in 7 patients, stenosis in 4 patients, and 2 patients with subclavian artery occlusion. The 6 remaining cases had symptoms caused by arterial compression in dynamic studies without arterial wall damage at rest. All limbs underwent surgery with outlet decompression; in addition, 13 underwent arterial reconstruction, and 7 were treated for distal embolic complications. There were no deaths, amputations, or early reoperations; 1 patient was readmitted 2 weeks after surgery for chylothorax, which resolved with conservative measures. During a mean follow-up of 155.8±103.1 months, 1 patient underwent successful reintervention at 4 months for bypass occlusion.
  
  
  CONCLUSIONS
  Arterial TOS is an infrequent but relevant manifestation of TOS. An accurate and early diagnosis allows for timely surgery and adequate results, as shown in this group of patients.
authors: Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. Electronic address: marinepolo@yahoo.com.
authors: Leopoldo
authors: L
authors: Marine
authors: Francisco
authors: F
authors: Valdes
authors: Renato
authors: R
authors: Mertens
authors: Albrecht
authors: A
authors: Kramer
authors: Michel
authors: M
authors: Bergoeing
authors: Jesus
authors: J
authors: Urbina
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002677:Chile; D002908:Chronic Disease; D002916:Chylothorax / Q000209:etiology / Q000628:therapy; D016638:Critical Illness; D019299:Decompression, Surgical / Q000009:adverse effects; D017128:Embolectomy; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D013349:Subclavian Steal Syndrome / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014680:Veins / Q000637:transplantation*; D055815:Young Adult
chemical_list: D000925:Anticoagulants