Arterial thoracic outlet syndrome (ATOS) involves an objective abnormality of the subclavian artery caused by extrinsic compression from an anomalous first rib, cervical rib, or fibrous band at the base of the scalene triangle — presenting with symptomatic arm ischemia or embolization. When an initial thrombolysis attempt does not fully restore a normal arterial bed, a defined next-line protocol applies.
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 — presenting as ischemia or embolization — requiring prompt escalation of care when initial treatment falls short.
Catheter-directed thrombolysis — delivered via a transfemoral or transbrachial approach, by conventional infusion or pharmacomechanical technique — is the first-line intervention. Escalation to the next protocol is indicated when thrombolysis has not achieved fully successful thrombolysis with a normal residual arterial bed.
Operative management is the indicated step, addressing both the damaged subclavian artery and the underlying structural cause at the thoracic outlet. The full surgical strategy — including the extent of arterial and distal intervention — is detailed in the structured protocol.
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).
Operative management includes repair/replacement of the damaged subclavian artery (local disease) and correction of the original inciting cause at the thoracic outlet (cause).
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