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Management of Digital Emboli, Vasospasm, and Ischemia in ATOS

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Thoracic Outlet Syndrome

Abstract

Unilateral digital ischemia is one of the most common presenting problems in patients with arterial TOS, leading to numbness, tingling, cold and painful sensations, cyanotic or pale discoloration, delayed capillary refill in the fingers, and non-healing fingertip ulceration. Diagnostic evaluation requires differentiation between proximal and distal arterial sources of thromboembolism, localized digital artery occlusion, and primary vasospasm. Digital emboli typically accompany arterial TOS as a result of mural thrombus formed within an area of aneurysmal degeneration in the subclavian (or axillary) arteries. While there are a variety of medical treatments to help reduce local symptoms of digital ischemia and vasospasm, definitive management depends on surgical control of the proximal source of thromboembolism. Additional interventions, such as thromboembolectomy and intra-arterial infusion of thrombolytic agents and/or vasodilators, are valuable adjuncts toward achieving optimal outcomes.

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References

  1. Criado E, Berguer R, Greenfield L. The spectrum of arterial compression at the thoracic outlet. J Vasc Surg. 2010;52:406–11.

    Article  PubMed  Google Scholar 

  2. Durham JR, Yao JS, Pearce WH, Nuber GM, McCarthy Jr W. Arterial injuries in the thoracic outlet syndrome. J Vasc Surg. 1995;21:57–69.

    Article  PubMed  CAS  Google Scholar 

  3. Herrick AL. Contemporary management of Raynaud’s phenomenon and digital ischaemic complications. Curr Opin Rheumatol. 2011;23(6):555–61.

    Article  PubMed  Google Scholar 

  4. Nichols AW. Diagnosis and management of thoracic outlet syndrome. Curr Sports Med Rep. 2009;8(5):240–9.

    PubMed  Google Scholar 

  5. Thompson RW, Driskill MR. Neurovascular problems in the athlete’s shoulder. Clin Sports Med. 2008;27:789–802.

    Article  PubMed  Google Scholar 

  6. Thompson RW, Petrinec D, Toursarkissian B. Surgical treatment of thoracic outlet compression syndromes. II. Supraclavicular exploration and vascular reconstruction. Ann Vasc Surg. 1997;11(4):442–51.

    Article  PubMed  CAS  Google Scholar 

  7. Duwayri YM, Emery VB, Driskill MR, Earley JA, Wright RW, Paletta GAJ, Thompson RW. Axillary artery compression causing upper extremity thrombosis and embolism in the elite overhead throwing athlete: spectrum of pathology and outcomes of treatment. J Vasc Surg. 2011;53:1329–40.

    Article  PubMed  Google Scholar 

  8. Sanders RJ, Hammond SL. Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome. J Vasc Surg. 2002;36(1):51–6.

    Article  PubMed  Google Scholar 

  9. Coveliers HM, Hoexum F, Nederhoed JH, Wisselink W, Rauwerda JA. Thoracic sympathectomy for digital ischemia: a summary of evidence. J Vasc Surg. 2011;54(1):273–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Section of Vascular Surgery, Center for Thoracic Outlet Syndrome, Washington University, Barnes-Jewish Hospital, Campus Box 8109/Suite 5101 Queeny Tower 660 S Euclid Ave, St. Louis, MO, 63110, USA

    Robert W. Thompson MD

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  1. Robert W. Thompson MD
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Correspondence to Robert W. Thompson MD .

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Editors and Affiliations

  1. , Division of Vascular Surgery, University of South Florida, Tampa General Circle, STC 7016 2, Tampa, 33606, Florida, USA

    Karl A. Illig

  2. Barnes-Jewish Hospital, Department of Surgery, Washington University, Queeny Tower Campus Box, St. Louis, 63110, Missouri, USA

    Robert W. Thompson

  3. , Department of Surgery, John Hopkins Medical Institutions, Rutland Avenue - Ross 759 729, Baltimore, 21205, Maryland, USA

    Julie Ann Freischlag

  4. , Department of Thoracic Surgery, Blake 15, Massachusetts General Hospital, Fruit Street 55, Boston, 02114, Massachusetts, USA

    Dean M. Donahue

  5. Neurological Associates of West LA, Wilshire Blvd, Suite 790 2811, Santa Monica, 90403, California, USA

    Sheldon E. Jordan

  6. , Graduate Program in Physical Therapy, UCSF/SFSU, Balmoral Street 2429, Union City, 94587, California, USA

    Peter I. Edgelow

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© 2013 Springer-Verlag London

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Thompson, R.W. (2013). Management of Digital Emboli, Vasospasm, and Ischemia in ATOS. In: Illig, K., Thompson, R., Freischlag, J., Donahue, D., Jordan, S., Edgelow, P. (eds) Thoracic Outlet Syndrome. Springer, London. https://doi.org/10.1007/978-1-4471-4366-6_79

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  • DOI: https://doi.org/10.1007/978-1-4471-4366-6_79

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4365-9

  • Online ISBN: 978-1-4471-4366-6

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