Arteriographic Studies of Thoracic Outlet Syndrome

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Abstract
Arteriographic studies were carried out in nine patients with presumed thoracic outlet syndrome. The examinations were always done with the affected upper limb in the positions in which symptoms were experienced. In seven patients, the injections were made with the symptomatic arm in 90 deg. abduction and the head and neck in neutral position, turned to one side and then the other. Narrowing or complete obstruction of the subclavian artery occurred in all of these patients with at least one of the positions tested. In two patients, extrinsic compression was observed when the “symptomatic arm” was held in downward traction. Since compression of neural and vascular structures in the thoracic outlet may occur in asymptomatic individuals, arteriography was performed in the same manner in 22 controls who were being studied because of cerebrovascular insufficiency. In the control group, turning the head and neck toward the abducted arm did not cause the compression of the subclavian artery seen in the symptomatic group. From these observations we have concluded that neurovascular compression in the thoracic outlet is related to the size of the costoclavicular space. The anterior scalene muscle may contribute to the production of symptoms by further narrowing the space in some patients. Resection of a segment of the first rib and scalenotomy is considered the most suitable treatment.