Right Arterial TOS (Thoracic Outlet Syndrome) Decompression by Cervical Rib Excision for Acute Upper Limb Ischemia

Background

A 29 year old male, active smoker, presented with a cold right hand with severe pain and bluish discoloration of all fingers since 2 days.

Diagnosis And Treatment:

Patient had outside arterial doppler report showing right radial artery occlusion. His X-ray chest was showing right sided complete cervical rib. On suspicion of arterial TOS (Thoracic Outlet Syndrome), CT Angiogram was done, which was suggestive of right subclavian artery (SCA) compression by cervical rib.

After diagnosing this patient with arterial TOS, he was taken for right cervical rib excision and TOS decompression with brachial artery embolectomy surgery. During surgery, scalenus anterior and medius muscles were also excised with cervical rib. Patient was pain free in immediate post op period with palpable radial pulse and warm pink hand.

Patient was also started on antiplatelets and oral anticoagulants. Patient was discharged on 3rd POD without any complaints and is on follow up

Conclusion

In all TOS cases, neurogenic TOS is most common (97%) due to brachial plexus compression while arterial TOS is very rare and seen in less than 1% patients. In all young patients presenting with acute or chronic upper limb ischemia, TOS should be considered as one of the differential diagnosis.

About Author –

Dr. Bhavin L. Ram, Consultant Vascular & Endovascular Surgery, Yashoda Hospital, Hyderabad. 
MS, DNB (Vascular Surgery)