Route Change Operation for Arterial Thoracic Outlet Syndrome

Abstract

A 39-year-old man had weakness and numbness in his left upper limb. A CT scan revealed arterial thoracic outlet syndrome with anomalous left first rib adhered to left second rib. Left subclavian artery was pinched by left first rib and left clavicle, got stenosis and aneurysmal degeneration. In addition, thromboembolism of left brachial artery was detected. Thrombectomy successfully improved blood flow, however, first rib could not be resected due to adhesion with surrounding tissues. So, we performed route change operation by interposition with expanded polytetrafluoroethylene graft. Traditional first rib resection can cause complications such as nerve injury or pleural injury or, thus this method can be effective and safe operation in some cases.