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Costoclavicular ligament as a novel cause of venous thoracic outlet syndrome: from anatomic study to clinical application

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Abstract

Purpose

Venous thoracic outlet syndrome (VTOS) is a compressive disorder of subclavian vein (SCV); we aimed to investigate the role of costoclavicular ligament (CCL) in the pathogenesis of VTOS.

Methods

A cadaver study was carried out to investigate the presence and morphology of CCL in thoracic outlet regions, as well as its relationship with the SCV. Six formalin-fixed adult cadavers were included, generating 12 dissections of costoclavicular regions (two sides per cadaver). Once CCL was identified, observation and measurement were made of its morphology and dimensions, and its relationship with SCV was studied. To take a step further, a clinical VTOS case was reported to prove the anatomical findings.

Results

Two out of twelve costoclavicular regions (2/12, 16.7%) were found to possess CCLs. Both ligaments were located in the left side of two male cadavers and were closely attached to the lateral aspect of sternoclavicular joint capsules. The lateral fibers of the ligament proceed in a superolateral-to-inferomedial manner, while the medial fibers proceed more vertically. Both ligaments were tightly adherent to the SCV, causing significant compression on the vein. In the clinical case, multiple bunches of CCLs were found to compress the SCV tightly intraoperatively. After removing the ligaments, the patient’s symptom kept relief during a follow-up period of 2 years.

Conclusion

Our study demonstrated that CCL could be a novel cause of VTOS by severe compression of SCV. Patients diagnosed with this etiology could get less invasive surgical treatment by simply removing the ligament.

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Acknowledgements

This work was supported by grants from the Natural Science Foundation of China (81770481), the Major Research Program of Natural Science Foundation of China (51890892), and the CAMS Innovation Fund for Medical Sciences (CIFMS, 2017-I2M-1-008). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China

    Guangchao Gu, Yanze Lv, Fangda Li, Mengyin Chen, Yuexin Chen, Jiang Shao, Bao Liu, Changwei Liu & Yuehong Zheng

  2. Tsinghua University School of Medicine, Medical Science Building A, Room 117, Haidian District, Beijing, 100084, China

    Guangchao Gu, Jinping Liu, Hui Huang & Xiaodong Zhang

Authors
  1. Guangchao Gu
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  2. Jinping Liu
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  3. Yanze Lv
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  4. Hui Huang
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  5. Fangda Li
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  6. Mengyin Chen
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  7. Yuexin Chen
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  8. Jiang Shao
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  9. Bao Liu
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  10. Changwei Liu
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  11. Xiaodong Zhang
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  12. Yuehong Zheng
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Contributions

GG: project development, data collection, data analysis, and manuscript writing. JL, YL and HH: project development and data collection. FL, MC, YC, JS, BL, and CL: data analysis and manuscript editing. XZ and YZ: project development, data analysis, and manuscript editing.

Corresponding authors

Correspondence to Xiaodong Zhang or Yuehong Zheng.

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Ethical approval

This study was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written consent for the procedure has been obtained from the patient.

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The authors declare that there is no conflicts of interest.

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Gu, G., Liu, J., Lv, Y. et al. Costoclavicular ligament as a novel cause of venous thoracic outlet syndrome: from anatomic study to clinical application. Surg Radiol Anat 42, 865–870 (2020). https://doi.org/10.1007/s00276-020-02479-7

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  • DOI: https://doi.org/10.1007/s00276-020-02479-7

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