Surgical Intervention for Arterial Thoracic Outlet Syndrome: A Retrospective Observational Study on Post-operative Outcomes and Quality of Life; Single Center Experience from Karachi Pakistan

Abstract

 Objective: Thoracic outlet syndrome results from compression of the brachial plexus and/or subclavian vessels. Arterial
thoracic outlet syndrome carries the most severe consequences. To assess the surgical outcomes and its impact on quality
of life in patients with aTOS undergoing surgical treatment.
Study design and Setting: A retrospective study was conducted on patients undergoing surgical decompression with/without
arterial reconstruction at the Department of Vascular & Endovascular Surgery SMBBIT, Karachi from July 2019 to December
2023.
Methodology: Limb salvage, complication rates and QoL using DASH score were assessed retrospectively. P-value of
less than 0.05 was considered significant
Results: A total of 22 patients underwent surgery for aTOS over the past five years. The cohort was predominantly male
(59.1%) with a mean age of 32.05 ± 14.3 years. All patients presented with Acute or acute on chronic limb ischemia, the
most common symptoms being pain (90.9%), numbness (45.5%) and blackish discoloration (27.3%). Imaging showed
post-stenotic aneurysm as the most prevalent arterial pathology (54.5%). All patients had a cervical rib, and the supraclavicular
approach was used exclusively for surgery with infraclavicular incision for axillary artery control and distal anastomosis
where needed. Arterial reconstruction was performed in 90.5% of patients. Postoperative complications occurred in 27.3%
of patients. No in-hospital or 30-day mortality was observed. Limb salvage was achieved in 95.5% of patients. Followup data showed a progressive improvement in post operative DASH scores (p= <0.001).
Conclusion: Surgical decompression of aTOS with/without arterial reconstruction is associated with high limb salvage
rates and QoL improvement