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Arterial thoracic outlet syndrome: a 32-year experience.
[thoracic outlet syndrome]
Clinical
manifestations
of
thoracic
outlet
syndrome
(
TOS
)
differ
depending
on
the
compromised
anatomic
structure
.
Arterial
TOS
is
the
least
common
(
1
-
5
%
of
all
cases
of
TOS
)
,
yet
the
most
threatening
,
due
to
the
risk
of
limb
loss
.
We
conducted
a
retrospective
review
of
consecutive
patients
treated
for
arterial
TOS
between
January
1979
and
June
2012
.
Medical
records
and
diagnostic
images
were
reviewed
,
and
follow-up
was
obtained
.
Nineteen
procedures
were
performed
in
18
patients
for
symptomatic
arterial
TOS
.
The
average
age
was
34
years
(
range
16
-
69
years
)
,
and
12
patients
were
female
(
63
.
2
%
)
.
Surgical
indications
were
upper
limb
critical
ischemia
in
8
(
acute
in
5
cases
and
acute
-on-
chronic
in
3
cases
)
and
claudication
in
11
.
Imaging
studies
revealed
a
subclavian
aneurysm
in
7
patients
,
stenosis
in
4
patients
,
and
2
patients
with
subclavian
artery
occlusion
.
The
6
remaining
cases
had
symptoms
caused
by
arterial
compression
in
dynamic
studies
without
arterial
wall
damage
at
rest
.
All
limbs
underwent
surgery
with
outlet
decompression
;
in
addition
,
13
underwent
arterial
reconstruction
,
and
7
were
treated
for
distal
embolic
complications
.
There
were
no
deaths
,
amputations
,
or
early
reoperations
;
1
patient
was
readmitted
2
weeks
after
surgery
for
chylothorax
,
which
resolved
with
conservative
measures
.
During
a
mean
follow-up
of
155
.
8
±
103
.
1
months
,
1
patient
underwent
successful
reintervention
at
4
months
for
bypass
occlusion
.
Arterial
TOS
is
an
infrequent
but
relevant
manifestation
of
TOS
.
An
accurate
and
early
diagnosis
allows
for
timely
surgery
and
adequate
results
,
as
shown
in
this
group
of
patients
.
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"early diagnosis"
symptom
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