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Arterial Thoracic Outlet Syndrome (aTOS): a Case Series Analysis

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Abstract

Arterial thoracic outlet syndrome (aTOS) due to subclavian arterial compression at the thoracic outlet, represents the least common type of TOS (< 1%) among the three: neurogenic (nTOS), venous (vTOS), and arterial (aTOS), and it requires surgical intervention in almost all the cases, being a constant threat to limb if remains untreated. This study analyses all aTOS patients admitted and managed at two vascular centres, over a span of 8 years. In our study, we had twenty-four limbs with arterial TOS, distributed among 23 patients (bilateral cervical rib in one), mean age of presentation was 38.85 years with male predominance. Fourteen out of 24 limbs (58.33%) had chronic, eight (33.33%) had an acute presentation and two limbs (8.34%) were asymptomatic. Rest pain was the most common symptom seen in 10 (41.67%) limbs. Complete/partial cervical rib was observed in 37.5% (9/24) and 62.5% (15/24) of cases, respectively. All patients of aTOS underwent thoracic outlet decompression (TOD): as a standalone procedure in five, combined with reinforced synthetic interposition graft in 10, and with thrombectomy by Seldinger technique using a Fogarty catheter, in eight patients. Three patients (12.5%) developed post-op complications: arm haematoma, Graft Thrombosis, and haemothorax; however, no limb loss or mortality was observed during the period of follow-up. Considering the unusual and varied presentation, limb and life-threatening complications of aTOS, early detection, and appropriate management (Open/Endovascular/Hybrid) is of paramount importance for optimal outcome.

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Authors and Affiliations

  1. Department of Vascular and Endovascular Surgery, Army Hospital (Research and Referral), New Delhi, India

    Vikram Patra & Suresh Reddy Thupakula

  2. Department of Vascular and Endovascular Surgery, INHS Asvini, Mumbai, Maharashtra, India

    Rakesh Kumar Jha

  3. INHS Asvini, Mumbai, India

    R. Shankaran

  4. Department of Vascular and Endovascular Surgery, Command Hospital (EC), Kolkata, India

    Girija Nandan Tripahy

  5. Department of Vascular and Endovascular Surgery, Command Hospital (SC), Pune, India

    Rohit Mehra

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  1. Vikram Patra
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  4. R. Shankaran
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Contributions

(a) Conceptualization: Dr. Vikram Patra, Dr. Rakesh Kumar Jha, Dr. Suresh Reddy Thupakula

(b) Design: Dr. Vikram Patra, Dr. Rakesh Kumar Jha, Dr. R Shankaran

(c) Definition of intellectual content: Dr. Rakesh Kumar Jha, Dr. Rohit Mehra, Dr. Suresh Reddy Thupakula, Dr. R Shankaran

(d) Literature search: Dr. Rakesh Kumar Jha, Dr. Suresh Reddy Thupakula, Dr. GN Tripathy, Dr. Rohit Mehra

(e) Clinical studies: Dr. Vikram Patra, Dr. Rakesh Kumar Jha, Dr. Suresh Reddy Thupakula, Dr. GN Tripathy, Dr. Rohit Mehra

(f) Experimental studies: Dr. Vikram Patra, Dr. Rakesh Kumar Jha, Dr. Suresh Reddy Thupakula, Dr. R Shankaran

(g) Data acquisition, data analysis& statistical analysis: Dr. Vikram Patra, Dr. Rakesh Kumar Jha, Dr. Suresh Reddy Thupakula, Dr. R Shankaran, Dr. Rohit Mehra

(h) Manuscript preparation: Dr. Rakesh Kumar Jha, Dr. Vikram Patra, Dr. Suresh Reddy Thupakula, Dr. GN Tripathy

(i) Manuscript editing and manuscript review: Dr. Vikram Patra, Dr. Rakesh Kumar Jha, Dr. R Shankaran, Dr. Rohit Mehra

Corresponding author

Correspondence to Rakesh Kumar Jha.

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Ethical Approval

The research was performed after taking approval from Institutional Ethical and Research Committee and obtaining written informed consent from patients included in the study. The authors affirm that the participant provided informed consent for the publication of images in Figs. 2 and 3.

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The authors declare no competing interests.

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Patra, V., Jha, R.K., Thupakula, S.R. et al. Arterial Thoracic Outlet Syndrome (aTOS): a Case Series Analysis. Indian J Surg 85 (Suppl 2), 364–370 (2023). https://doi.org/10.1007/s12262-022-03646-3

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  • DOI: https://doi.org/10.1007/s12262-022-03646-3

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