ARTERIAL COMPLICATIONS OF THE THORACIC OUTLET SYNDROME

Objectives: Arterial complications due to compression of the thoracic outlet are uncommon. The objective of this study was to review our fai rly extensive experience with this problem with particular reference t o its management. Methods: Patients entered into the Vascular Clinic d atabase were reviewed over an 11 year period. Twenty six records were found. In 24 patients the vasculopathy was caused by a cervical rib (c omplete in 15) and in two by an anomaly of the first I ib. In all pati ents the basic arteriopathy teas a fibrous structure with a post-steno tic aneurysm in 13. Seventeen presented with a fixed pulse deficit; 13 had a palpable aneurysm and 12 had distal embolisation. Results: Two patients refused operation. In 22 with cervical rib, the rib was remov ed via a supraclavicular incision, an anterior scalenectomy was perfor med and the arterial pathology repaired on its merit, usually by vein graft replacement or bypass. In two with first rib anomalies these wer e resected by the transaxillary route. Twenty three patients have been followed for between 3 months and 10 years; 20 are cured and three ha ve residual claudication. Conclusions: Our results show that simple ex cision of the cervical rib via the supraclavicular route together with vascular reconstruction is adequate. This is in disagreement with the view of those who advocate routine excision of the first rib in addit ion to cervical rib excision.