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Chandu Vemuri, MD, Lauren N. McLaughlin, ACNP, Ahmmad A

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1 Clinical presentation and management of arterial thoracic outlet syndrome 
Chandu Vemuri, MD, Lauren N. McLaughlin, ACNP, Ahmmad A. Abuirqeba, BA, Robert W. Thompson, MD  Journal of Vascular Surgery  Volume 65, Issue 5, Pages (May 2017) DOI: /j.jvs Copyright © 2016 The Authors Terms and Conditions

2 Fig 1 Flow diagram describes the presenting characteristics, bony abnormalities, and arterial abnormalities in 40 patients treated for arterial thoracic outlet syndrome (TOS). Rxn, Resection. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 The Authors Terms and Conditions

3 Fig 2 A 28-year-old right-handed man presented with right hand digital ischemia caused by a subclavian artery aneurysm. A, A right upper extremity arteriogram demonstrated a subclavian artery aneurysm, thromboembolic occlusion of the distal brachial artery, and multiple embolic digital artery occlusions. Magnified arteriographic views of the (B) affected right hand and (C) normal left hand illustrate the differences in perfusion. D, Ischemic fingertip lesions in the right hand. E, Brachial artery thromboembolectomy and patch angioplasty repair was initially performed. F, Operative specimens of the cervical and first ribs removed during supraclavicular thoracic outlet decompression several days after thrombectomy. G, Subclavian artery aneurysm (SCA) viewed from right supraclavicular exposure. H, The excised specimen of the subclavian artery aneurysm demonstrated intimal ulceration with thrombus. I, Subclavian artery repair with interposition bypass graft. Reprinted with permission from Thompson RW. Management of digital emboli, vasospasm, and ischemia in ATOS. In: Illig KA, Thompson RW, Freischlag JA, Donahue DM, Jordan SE, Edgelow PI, editors. Thoracic Outlet Syndrome. London: Springer; 2013: Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 The Authors Terms and Conditions

4 Fig 3 Imaging of arterial thoracic outlet syndrome (TOS). A and B, Plain chest radiograph illustrates a right cervical rib. C and D, Contrast-enhanced computed tomography (CT) scan with three-dimensional reconstruction demonstrates a right cervical rib and a poststenotic subclavian artery aneurysm with no mural thrombus. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 The Authors Terms and Conditions

5 Fig 4 Subclavian artery reconstruction is shown in a 20-year-old woman with an asymptomatic right subclavian artery aneurysm (all views from the right side with supraclavicular exposure). A, Subclavian artery (SCA) aneurysm is demonstrated after scalenectomy and resection of the cervical and first ribs. After mobilization of the distal artery into the supraclavicular exposure, clamps were placed and the aneurysmal segment was excised in preparation for an interposition bypass using a cryopreserved femoral artery graft. B, Distal anastomosis. C, Proximal anastomosis. D, Completed bypass graft. BP, Brachial plexus; Clav, clavicle. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 The Authors Terms and Conditions

6 Fig 5 Preoperative and follow-up functional outcomes measures are shown for 40 patients with arterial thoracic outlet syndrome (TOS), comparing patients with vascular and nonvascular presentations and the entire group. A, Disability of the Arm, Hand and Shoulder (DASH) scores. B, Cervical-Brachial Symptom Questionnaire (CBSQ) scores. C, McGill Pain scores. Data represent the mean ± standard error of the mean (SEM) for each group. Comparisons were made by two-tailed, unpaired t-tests with the Welch correction. NS, Not significant. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 The Authors Terms and Conditions

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