Arterial injuries in the thoracic outlet syndrome

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Presentation transcript:

Arterial injuries in the thoracic outlet syndrome Joseph R. Durham, MD, James S.T. Yao, MD, PhD, William H. Pearce, MD, Gordon M. Nuber, MD, Walter J. McCarthy, MD Journal of Vascular Surgery Volume 21, Issue 1, Pages 57-70 (January 1995) DOI: 10.1016/S0741-5214(95)70244-X Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, PA radiograph demonstrates bilateral anomalous first ribs (arrow). B, Angiogram of site of impingement (arrow) on superior aspect of right subclavian artery by anomalous, incomplete first rib with abnormal attachment to underlying second rib during hyperabduction maneuver. Note mild poststenotic dilation. Journal of Vascular Surgery 1995 21, 57-70DOI: (10.1016/S0741-5214(95)70244-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, PA radiograph demonstrates bilateral anomalous first ribs (arrow). B, Angiogram of site of impingement (arrow) on superior aspect of right subclavian artery by anomalous, incomplete first rib with abnormal attachment to underlying second rib during hyperabduction maneuver. Note mild poststenotic dilation. Journal of Vascular Surgery 1995 21, 57-70DOI: (10.1016/S0741-5214(95)70244-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Right subclavian-axillary angiogram of weight-lifter in neutral position. Note generous size of circumflex humeral arteries (arrows) and arterial loop they form around surgical neck of humerus. B, Angiogram of same patient during hyperabduction-external rotation maneuver. Note beaklike occlusion of axillary artery at level of humeral head. Circumflex humeral arteries are also occluded. Journal of Vascular Surgery 1995 21, 57-70DOI: (10.1016/S0741-5214(95)70244-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Right subclavian-axillary angiogram of weight-lifter in neutral position. Note generous size of circumflex humeral arteries (arrows) and arterial loop they form around surgical neck of humerus. B, Angiogram of same patient during hyperabduction-external rotation maneuver. Note beaklike occlusion of axillary artery at level of humeral head. Circumflex humeral arteries are also occluded. Journal of Vascular Surgery 1995 21, 57-70DOI: (10.1016/S0741-5214(95)70244-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Diagrammatic representation of axillary artery, its major branches, and adjacent bony structures in neutral position. B, Depiction of compression of axillary artery and posterior circumflex humeral artery by humeral head as arm is abducted and externally rotated. Branch arteries tether axillary artery in fixed position, leading to compression by downward displacement of humeral head. Note arterial loop that is formed by anterior and posterior circumflex humeral arteries. Journal of Vascular Surgery 1995 21, 57-70DOI: (10.1016/S0741-5214(95)70244-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Operative positioning of patient: supine position with upper extremity abducted and prepared into operative field. Note site of transverse incision just below axillary hairline. Journal of Vascular Surgery 1995 21, 57-70DOI: (10.1016/S0741-5214(95)70244-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Diagrammatic representation of third part of axillary artery and its branches as exposed through described axillary incision approach. Journal of Vascular Surgery 1995 21, 57-70DOI: (10.1016/S0741-5214(95)70244-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 A, Axillary arteriogram in neutral position depicts intimal fracture of third portion of axillary artery. B, Same patient during abduction with accentuation of intraluminal irregularity that had resulted in distal embolization. Note that posterior humeral circumflex artery has become occluded during maneuver. Journal of Vascular Surgery 1995 21, 57-70DOI: (10.1016/S0741-5214(95)70244-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 A, Axillary arteriogram in neutral position depicts intimal fracture of third portion of axillary artery. B, Same patient during abduction with accentuation of intraluminal irregularity that had resulted in distal embolization. Note that posterior humeral circumflex artery has become occluded during maneuver. Journal of Vascular Surgery 1995 21, 57-70DOI: (10.1016/S0741-5214(95)70244-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions