title: Coexistence of arterial compression in patients with neurogenic thoracic outlet syndrome.
abstract: OBJECTIVE
  Patients with neurogenic thoracic outlet syndrome (NTOS) may have signs and symptoms of arterial compromise without thrombosis or aneurysm.
  
  
  OBJECTIVE
  To evaluate these patients' presentation, duration of signs and symptoms, and outcomes of immediate surgical operation.
  
  
  METHODS
  Demographic and clinical data for patients with NTOS and signs and symptoms of arterial compromise without arterial thrombosis or aneurysm were extracted from a prospectively maintained, institutional review board-approved database and patient medical records between May 22, 2003, and October 16, 2012, in the Johns Hopkins Medical Institutions' Department of Vascular and Endovascular Surgery.
  
  
  METHODS
  All patients received immediate first rib resection and scalenectomy (FRRS) (n = 15), cervical rib resection and FRRS (n = 6), or FRRS and second rib resection due to fusion (n = 1). Further physical therapy or anterior scalene block was not considered owing to arterial compression.
  
  
  METHODS
  Surgical intervention relieved arterial and neurogenic symptoms, and abnormal duplex velocities returned to normal in adduction.
  
  
  RESULTS
  Twenty-two patients (13 women and 9 men; mean age, 25 years [range, 12-41 years]) presented with the following signs and symptoms a mean of 37 months (range, 1-144 months) after developing symptoms of NTOS: arm discoloration (n = 15), infraclavicular bruit with arm abduction (n = 9), more than 50% change in subclavian artery velocity in abduction by duplex scan (n = 12), cervical rib (n = 6), abnormal first rib (n = 3), and/or history of embolization (n = 2). In addition, 2 patients had venous thrombosis. The mean follow-up time was 11 months (range, 1-34 months), and all patient outcomes improved in the postoperative period.
  
  
  CONCLUSIONS
  Arterial compression can coexist with NTOS and can be elucidated in most patients by medical record review and physical examination, along with confirmation by a duplex scan. Those with evidence of arterial compression and for whom physical therapy has failed should receive surgery to alleviate their symptoms. Prompt surgical intervention affords good outcomes in these patients. Outcomes for patients with NTOS and arterial compression following immediate surgical intervention were previously unknown.
authors.affiliation: Department of Vascular and Endovascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Kendall
authors.initials: K
authors.lastname: Likes
authors.affiliation: Department of Vascular and Endovascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Danielle H
authors.initials: DH
authors.lastname: Rochlin
authors.affiliation: Department of Vascular and Endovascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Diana
authors.initials: D
authors.lastname: Call
authors.affiliation: Department of Vascular and Endovascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland2Editor, JAMA Surgery.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Freischlag
mesh_terms: D000293:Adolescent; D000328:Adult; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D055815:Young Adult