Upper extremity ischemia from subclavian artery aneurysm caused by bony abnormalities of the thoracic outlet

Archives of Surgery
M R NehlerJ M Porter

Abstract

To describe our experience with surgical therapy for upper extremity ischemia incident to emboli from aneurysms of the subclavian artery. Retrospective review case series. Vascular surgery practice at a university hospital-based tertiary referral center. All patients treated for upper extremity ischemia caused by embolism from a subclavian artery aneurysm from January 1, 1990, to July 31, 1996. All patients underwent detailed history and physical examination, screening for immunologic and hypercoaguable disorders, noninvasive vascular laboratory evaluation, and arteriography of the aortic arch in both arms and hands. Surgical treatment consisted of rib excision or fracture plating, aneurysm excision, and interposition vein grafting, with additional saphenous vein bypasses to brachial or forearm arteries as needed to provide uninterrupted circulation to the wrist. Twelve patients (6 males; mean age, 37 years) were treated. All had episodic upper extremity ischemia with an initial misdiagnosis of primary vasospastic disorder. Rest pain and/or ischemic ulceration developed in 3. Duration of symptoms before correct diagnosis averaged 7 months (range, 1-36 months). All patients had bony abnormalities of the thoracic outlet (8 cervic...Continue Reading

Citations

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