Treatment of Arterial Thoracic Outlet Syndrome with Objective Subclavian Artery Abnormality and Symptomatic Arm Ischemia or Embolization

Arterial thoracic outlet syndrome (ATOS) involves an objective abnormality of the subclavian artery caused by extrinsic compression and subsequent damage from an anomalous first rib, cervical rib, or fibrous band at the base of the scalene triangle. This protocol applies when that abnormality is symptomatic — presenting as arm ischemia or embolization.

Clinical Scenario

The structural driver is an anomalous first rib or analogous structure (cervical rib or band) at the scalene triangle base, producing extrinsic compression and subsequent arterial damage. The subclavian artery abnormality becomes clinically manifest through ischemia or embolization of the affected arm. The abnormality may also present asymptomatically as aneurysm, occlusion, or silent embolization.

Treatment Approach

Management in this setting involves catheter-directed thrombolysis as the primary interventional approach to restore arterial patency.

Complete procedural details — technique selection, access approach, and sequencing — are in the full structured regimen.

Treatment Goal

Fully successful thrombolysis with a normal residual arterial bed.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jvs.2016.04.039

ATOS is defined as an objective abnormality of the subclavian artery caused by extrinsic compression and subsequent damage by an anomalous first rib or analogous abnormal structure (cervical rib or band) at the base of the scalene triangle.
Such an abnormality can be symptomatic (ischemia or embolization) or asymptomatic (aneurysm, occlusion, or silent embolization).
Catheter-directed thrombolysis.
Fully successful with normal residual arterial bed.

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