Thoracic Outlet Syndrome (TOS)
Thoracic Outlet Syndrome (TOS) encompasses various disorders affecting the upper extremities due to compression of the brachial plexus, subclavian artery, or subclavian vein as they exit the thoracic outlet. At Premier Vascular in Macon, GA, our specialized vascular surgeons are experienced in diagnosing and treating both arterial and venous forms of this condition.
Vascular Thoracic Outlet Syndrome (VTOS)
VTOS often affects young athletes engaged in repetitive overhead activities, such as swimming or baseball. This condition arises from the compression of vascular structures by bone, soft tissue, or muscular anomalies.
Arterial Thoracic Outlet Syndrome
Arterial TOS is caused by compression of the subclavian artery as it branches from the aortic arch and traverses the space between the anterior and middle scalene muscles, the first rib, and under the clavicle.
Symptoms:
- Arm fatigue
- Distal ischemia (reduced blood supply) affecting the hand
- Raynaud’s phenomenon
- Stroke
These symptoms often result from thromboembolization, where clots form and dislodge, causing blockages. The condition is frequently linked to bony abnormalities, such as a cervical rib or an elongated C7 transverse process.
Diagnosis: A thorough physical examination is critical, often supplemented with imaging studies like CT angiogram, MR angiogram, or conventional angiography. Dynamic views, with the affected arm elevated, help assess arterial compression.
Treatment: Surgical intervention involves removing the compressing bone or tissue and repairing the subclavian artery. Procedures may include decompression, aneurysm repair, revascularization, or sympathectomy.
Venous Thoracic Outlet Syndrome
Also known as Paget-Schroetter syndrome or subclavian vein effort thrombosis, Venous TOS occurs due to extrinsic compression of the subclavian vein, leading to stenosis and thrombosis.
Symptoms:
- Swelling
- Heaviness or aching
- Cyanosis
- Prominent, distended veins in the upper chest and shoulder
- Rarely, pulmonary embolism
Diagnosis: Diagnosis involves a detailed history and physical examination, with potential findings of arm swelling, cyanosis, and distended veins. Imaging studies like ultrasound or MRI and conventional venography in dynamic positions may be utilized.
Treatment: Restoring normal blood flow involves anticoagulation therapy and possibly thrombolytic therapy, followed by balloon angioplasty or stenting. Surgical decompression, including the removal of the first rib, may be necessary to alleviate compression.
Contact Premier Vascular
If you are experiencing symptoms of Thoracic Outlet Syndrome, contact Premier Vascular in Macon, GA, for expert evaluation and treatment. Our dedicated team of vascular surgeons is here to provide you with comprehensive care.