Positional occlusion of the descending scapular artery in a thoracic outlet syndrome with neurological symptoms

We report a thoracic outlet syndrome revealed by neurological complications . Angiography of the subclavian artery depicted an isolated positional occl usion of the descending scapular artery. This side branch of the subclavian artery is anatomically located close to and supplies the brachial plexus. Surgical treatment led to improvement of most symptoms and post-operative c ontrol angiography was normal. Not previously described, this sign illustra tes the objective compression of the brachial plexus. Ischemia is perhaps i ntricated with compression, a well-known pathophysiological mechanism of ne urological complications in this syndrome. This artery feeding the brachial plexus is usually ligated during surgical neurolysis but must be preserved in order to improve recovery of neurological function and prevent surgical failures.