A case report of thoracic outlet syndrome with acute limb-threatening ischemia: Options of management

A young, otherwise healthy man was referred to our vascular service because of severe left arm ischaemia of three weeks duration. Chest X-ray showed a left cervical rib that was attached to the first rib. Dynamic angiography revealed left subclavian artery occlusion with distal embolization. We performed resection of the left cervical and first rib, scalenotomy and thromboendarterectomy of the subclavian artery with dacron patch angioplasthy by the supraclavicular approach. Catheter embolectomy was performed via brachial arteriotomy and wrist pulses recovered. The treatment was curative, with complete resolution of symptoms. Vascular thoracic outlet syndrome is rare but we emphasise the importance of early diagnosis to avoid the loss of the limb.