Vascular Thoracic Outlet Syndrome

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Presentation transcript:

Vascular Thoracic Outlet Syndrome Mohamad Anas Hussain, MD, Badr Aljabri, MD, FRCSC, Mohammed Al-Omran, MD, MSc, FRCSC Seminars in Thoracic and Cardiovascular Surgery Volume 28, Issue 1, Pages 151-157 (March 2016) DOI: 10.1053/j.semtcvs.2015.10.008 Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 1 Illustration of the thoracic outlet showing the 3 common sites of vascular compression: scalene triangle, costoclavicular space, and pectoralis minor space. The subclavian artery is most commonly compressed in the scalene triangle with the presence of an accessory cervical rib, leading to arterial TOS (A). Venous TOS commonly occurs due to compression of the subclavian vein in the costoclavicular space between the costoclavicular ligament, first rib and subclavius tendon (B). (Adapted with permission from Oomen et al.) Seminars in Thoracic and Cardiovascular Surgery 2016 28, 151-157DOI: (10.1053/j.semtcvs.2015.10.008) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 2 Duplex arterial ultrasound with waveforms of a 21-year-old patient with aTOS showing normal flow in the left subclavian artery at rest (A), and complete cessation of flow with arm abduction 45 degrees above the shoulder (B). Seminars in Thoracic and Cardiovascular Surgery 2016 28, 151-157DOI: (10.1053/j.semtcvs.2015.10.008) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 3 CT angiogram with 3-dimensional reconstruction of the neck and chest showing bilateral cervical ribs (arrowheads), severe stenosis of the left subclavian artery with poststenotic dilatation (solid arrow), and occlusion of the left brachial artery distally (dashed arrow) in a patients with aTOS. Seminars in Thoracic and Cardiovascular Surgery 2016 28, 151-157DOI: (10.1053/j.semtcvs.2015.10.008) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 4 Supraclavicular exposure of the thoracic outlet with divided scalenus anterior and medial muscles. SA, subclavian artery; BP, brachial plexus; LP, lung pleura; PN, phrenic nerve; LTN, long thoracic nerve. Seminars in Thoracic and Cardiovascular Surgery 2016 28, 151-157DOI: (10.1053/j.semtcvs.2015.10.008) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 5 Treatment approach to venous TOS based on clinical presentation. Seminars in Thoracic and Cardiovascular Surgery 2016 28, 151-157DOI: (10.1053/j.semtcvs.2015.10.008) Copyright © 2016 Elsevier Inc. Terms and Conditions

Arterial TOS: subclavian artery compression in the scalene triangle by a cervical rib. Seminars in Thoracic and Cardiovascular Surgery 2016 28, 151-157DOI: (10.1053/j.semtcvs.2015.10.008) Copyright © 2016 Elsevier Inc. Terms and Conditions