Arterial Complications Associated with Thoracic Outlet Compression Syndrome

Six patients with major arterial lesions were encountered in a group of 40 patients undergoing operation for thoracic outlet compression syndrome. In each instance a bony abnormality was present: either a fully articulating cervical rib (Gruber type III) or an anomalous first rib articulating with the second rib at the site of the scalene muscle insertion. Two patients had brachial artery embolism, and another had a cerebrovascular accident secondary to retrograde vertebral artery embolism and associated with subclavian artery thrombosis. Two patients had subclavian artery aneurysms, one of which proved to be a difficult surgical problem. A brief discussion of each patient is given, with emphasis on the importance of distinguishing between patients who have osseous abnormalities and those who do not when patients are evaluated for operation for thoracic outlet syndrome.