Subclavian artery aneurysm and critical upper limb ischemia in thoracic outlet syndrome

Rationale. Given the rarity of the pathology, the risks associated with it, and the variability of treatment methods, as well as the absence of similar reported cases in scientific databases, we found it necessary to share our experience in treating a patient with thoracic outlet syndrome in combination with an additional cervical rib on the left, aneurysm of the left subclavian artery, thrombosis of the subclavian and axillary arteries on the left, and critical ischemia of the left upper limb. Objective: demonstration of a case of surgical treatment of a patient with thoracic outlet syndrome in combination with aneurysm of the left subclavian artery, thrombosis of the subclavian, axillary and brachial arteries on the left, critical ischemia of the left upper limb. Methods. A 36-year-old woman was admitted to the vascular surgery department complaining of pain in her left upper limb at rest, numbness and coldness of the fingers of her left hand. During the examination, according to the results of multispiral computed tomography with intravenous contrast, additional cervical ribs, compression of the left subclavian artery by the median stair muscle, occlusion of the left subclavian, axillary and brachial arteries, as well as an aneurysm of the left subclavian artery measuring 11x15 mm are determined. Results. Resection of the accessory cervical rib, resection of the subclavian artery aneurysm with autovenous prosthetics, and arterio-arterial plasty of the brachial artery on the left were performed. The postoperative period was complicated by thrombosis of the brachial artery in the middle and distal third of the shoulder on the left, and therefore thrombectomy was performed from the arteries of the left upper limb, resection of the distal third of the brachial artery with autovenous prosthetics on the left. In the control multispiral computed tomography with intravenous contrast, the autovenous prosthesis is passable. The brachial, ulnar, and radial arteries contrast homogeneously throughout. Conclusion. The above clinical case demonstrates the successful result of simultaneous surgical treatment of a patient with thoracic outlet syndrome combined with an additional cervical rib, subclavian artery aneurysm and arterial thrombosis of the left upper limb. The arterial form of thoracic outlet syndrome is the rarest of the described, but it can be the most dangerous in the prospect of limb preservation. With untimely surgical treatment, the aneurysm lumen may thrombose and cause embolization of the distal bed with a clinical picture of acute limb ischemia.