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Coexistence of Arterial Compression in Patients With Neurogenic Thoracic Outlet Syndrome.
[thoracic outlet syndrome]
Patients
with
neurogenic
thoracic
outlet
syndrome
(
NTOS
)
may
have
signs
and
symptoms
of
arterial
compromise
without
thrombosis
or
aneurysm
.
To
evaluate
these
patients
'
presentation
,
duration
of
signs
and
symptoms
,
and
outcomes
of
immediate
surgical
operation
.
Demographic
and
clinical
data
for
patients
with
NTOS
and
signs
and
symptoms
of
arterial
compromise
without
arterial
thrombosis
or
aneurysm
were
extracted
from
a
prospectively
maintained
,
institutional
review
board-approved
database
and
patient
medical
records
between
May
22
,
2003
,
and
October
16
,
2012
,
in
the
Johns
Hopkins
Medical
Institutions
'
Department
of
Vascular
and
Endovascular
Surgery
.
A
ll
patients
received
immediate
first
rib
resection
and
scalenectomy
(
FRRS
)
(
n
=
15
)
,
cervical
rib
resection
and
FRRS
(
n
=
6
)
,
or
FRRS
and
second
rib
resection
due
to
fusion
(
n
=
1
)
.
Further
physical
therapy
or
anterior
scalene
block
was
not
considered
owing
to
arterial
compression
.
Surgical
intervention
relieved
arterial
and
neurogenic
symptoms
,
and
abnormal
duplex
velocities
returned
to
normal
in
adduction
.
Twenty
-
two
patients
(
13
women
and
9
men
;
mean
age
,
25
years
[
range
,
12
-
41
years
]
)
presented
with
the
following
signs
and
symptoms
a
mean
of
37
months
(
range
,
1
-
144
months
)
after
developing
symptoms
of
NTOS
:
arm
discoloration
(
n
=
15
)
,
infraclavicular
bruit
with
arm
abduction
(
n
=
9
)
,
more
than
50
%
change
in
subclavian
artery
velocity
in
abduction
by
duplex
scan
(
n
=
12
)
,
cervical
rib
(
n
=
6
)
,
abnormal
first
rib
(
n
=
3
)
,
and
/
or
history
of
embolization
(
n
=
2
)
.
In
addition
,
2
patients
had
venous
thrombosis
.
The
mean
follow-up
time
was
11
months
(
range
,
1
-
34
months
)
,
and
all
patient
outcomes
improved
in
the
postoperative
period
.
Arterial
compression
can
coexist
with
NTOS
and
can
be
elucidated
in
most
patients
by
medical
record
review
and
physical
examination
,
along
with
confirmation
by
a
duplex
scan
.
Those
with
evidence
of
arterial
compression
and
for
whom
physical
therapy
has
failed
should
receive
surgery
to
alleviate
their
symptoms
.
Prompt
surgical
intervention
affords
good
outcomes
in
these
patients
.
Outcomes
for
patients
with
NTOS
and
arterial
compression
following
immediate
surgical
intervention
were
previously
unknown
.
Diseases
Validation
Diseases presenting
"for whom physical therapy has failed should receive surgery to alleviate their symptoms"
symptom
thoracic outlet syndrome
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