Outcomes After Treatment of Arterial Thoracic Outlet Syndrome

Abstract

Although the least common form of the group, without recognition and timely treatment, the ischemic complications of arterial thoracic outlet syndrome (ATOS) can lead to tissue loss and thus may cause the most severe and disabling sequelae of all. ATOS can present as a single ischemic event due to acute thrombotic occlusion of the subclavian or axillary artery, or it may present more insidiously with extremity pain and fatigue or subtle signs and symptoms of digital ischemia. Effective and successful treatment of arterial TOS and its direct relative, positional axillary artery compression or its branches, requires a high level of suspicion and early recognition. As demonstrated in numerous series as well as our own, excellent outcomes are achieved with prompt correction of the compressive mechanism and appropriate adjunctive revascularization as needed. Failures arise with the delay in diagnosis and treatment due to the development of fixed occlusive lesions in the runoff arterial beds. Results are excellent in patients with subclavian arterial lesions at the first rib but poorer in those with positional axillary artery compression due to non-first rib pathology.