Indian Journal of Vascular and Endovascular Surgery (Jan 2018)

Management and outcomes of patients with chronic upper limb ischemia secondary to arterial thoracic outlet syndrome

  • Sandeep Mahapatra,
  • Pinjala Ramakrishna,
  • Muneer Ahmad Para,
  • Venugopal Mustyala,
  • Praveen Kumar Nookala

DOI
https://doi.org/10.4103/ijves.ijves_10_18
Journal volume & issue
Vol. 5, no. 2
pp. 100 – 104

Abstract

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Introduction: Post stenotic dilation of the subclavian artery by cervical rib compression is generally seen in young patients with upper limb ischemia. Materials and Methods: We conducted a retrospective study on 26 consecutive patients who underwent surgical decompression for arterial thoracic outlet syndrome (aTOS) with subclavian artery repair from 2010 to 2015. Supraclavicular decompression of the thoracic outlet with cervical rib excission, scalenectomy with subclavian artery reconstruction by aneurysmorrhaphy was performed as per Scher staging of aTOS. The management and post operative outcome with regards to objective changes in the upper limb arterial pressure was studied & followed for 1 year with clinical examination, duplex scan and non invasive segmental vascular pressure. Result: The average age at presentation was 32 years, with equal gender distribution. However, symptomatic right: left aTOS at presentation was 18:8. The Scher classification system for aTOS based on subclavian artery compression identified 14 patients in stage III, 10 patients in stage II and 2 in stage I .8 out of 26 patients had digital ischemia with minor tissue loss and were managed medically by intravenous Alprostadil (Prostaglandin E1) postoperatively for 6 months .The mean above elbow pressure (AEP) before surgery has improved from 62.08±12.97 to 108.46±16.81& the below elbow pressure (BEP) has improved from 48.00±13.13 to 93.46± 32.02 . Above elbow pressure improvement is found statistically significant (p value0.037) across all Scher stages. Complete relief of vascular symptoms was seen in all patients immediately or gradually over a period of 6 months. Minor amputation was carried out in 8 patients of Scher stage 2 & 3 aTOS during follow of 6 months. Conclusion: This study finds its uniqueness in demonstrating the objective improvement of pressure with respect to different Scher stages which which is not reported in the literature.

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