Surgical Management of Arterial Thoracic Outlet Syndrome due to Cervical Rib in a 17‐Year‐Old Male With Gangrenous Ulcer on Fingertip Requiring Multiple Bypass: A Case Report

ABSTRACT Arterial thoracic outlet syndrome (ATOS) is a rare condition, affecting 1% to 5% of TOS cases, characterized by the compression of the subclavian artery, often due to anatomical anomalies like cervical ribs. Cervical ribs that are not a very common anatomical anomaly can give rise to arterial supply compromise needing surgical intervention to undo the compression is the highlight of this case report. A 17‐year‐old male presented with progressive numbness, pain, and a gangrenous ulcer on his right index finger, aggravated by exertion. Clinical examination revealed absent pulses in the right hand, with intact motor and sensory functions. Doppler ultrasound confirmed thrombosis extending from the brachial artery into the radial and ulnar arteries. A neck radiograph and CT angiogram revealed a cervical rib compressing the subclavian artery, leading to aneurysm formation. The patient was diagnosed with ATOS complicated by arterial thrombosis. Surgical intervention was performed, including right cervical rib excision, resection of the scalenus anterior muscle, and bypass procedures to restore blood flow. Thrombectomy was performed on the brachial, radial, and ulnar arteries. The postoperative course was uneventful, with restored pulses and improved circulation. Follow‐up Doppler ultrasounds confirmed patent grafts and resolution of ischemic symptoms. This case highlights the importance of early recognition and surgical management of ATOS, particularly in young patients with anatomical variations like cervical ribs. Surgical decompression and revascularization can lead to significant improvement in symptoms and vascular perfusion. Regular follow‐up is essential to monitor graft patency and prevent recurrence. Our case study is unique from previous studies as it presents a complicated case of ATOS with multiple thromboses in the brachial, radial, and ulnar arteries and an extensive treatment plan including surgical resection of cervical rib and scalenus muscle; furthermore, thrombectomy and brachio radial bypass to restore distal blood flow.