Vascular Thoracic Outlet Syndrome

Effective treatment of arterial thoracic outlet syndrome includes early recognition and timely correction, with sufficient decompression of the thoracic outlet. A 56-year-old female suffered recrudescent right upper extremity ischemia due to thromboembolic event, raising suspicion for arterial thoracic outlet syndrome and prompting further imaging studies for confirmation. Decompression of the thoracic outlet by first rib resection and scalenectomy, followed by stenting of the diseased subclavian artery, allowed for resolution of arterial thoracic outlet syndrome.

We present two cases of thoracic outlet decompression performed to facilitate hemodialysis through upper limb arteriovenous fistulas. In patients undergoing arteriovenous fistula formation for dialysis access, venous hypertension is a well-known complication. We used a supraclavicular approach in our two reported cases to remove the first rib to facilitate hemodialysis. Dialysis patients presenting with central venous stenosis should be assessed for evidence of extrinsic compression by the first rib as management options differ from those with central venous stenosis due to an intravenous catheter. (J Vasc Surg Cases 2016;2:111-3.)

Upper extremity deep vein thrombosis (UEDVT) may be the first manifestation of venous thoracic outlet syndrome (VTOS). It primarily affects young, physically active people. The clinical findings depend on the degree of obstruction of the subclavian vein. Correct diagnosis-aided by various imaging modalities-as well as rapid initiation of local thrombolytic therapy, surgical decompression of the thoracic outlet (when indications are present), and the immediate initiation of anticoagulation therapy aim at successfully restoring the patient's quality of life.