Vascular thoracic outlet syndrome: Registry of 30-years of patient’s outcomes at King Saud University Medical City, Riyadh, Saudi Arabia

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Figure 1
- Plain thoracic inlet films showing: A) bilateral cervical ribs, B) anomalous first rib, and C) unilateral cervical rib.
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Figure 2
- Duplex scans showing: A) flow in right subclavian artery during rest, B) duplex scan showing right subclavian artery with absent flow during provocative maneuver.
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Figure 3
- Conventional angiogram image showing: A) a compressed subclavian artery with post-stenotic dilatation, B) a compressed subclavian artery with post-stenotic dilatation, and C) cessation of blood flow distal to brachial artery.

Table 1

- Investigations and findings.

Imaging	n (%)
Plain thoracic inlet and cervical spine x-ray	90 (100)
Cervical rib	76 (84.4)
Anomalous 1^st rib	12 (12.1)
Prominent 7^th cervical transverse process	2 (2.2)
Duplex scan (rest and provocation)	90 (100)
Post-stenotic dilatation	9 (10)
Subclavian artery aneurysm	10 (11.1)
Arterial thrombosis	7 (7.8)
Computed tomography angiography (rest and provocation)	56 (62.2)
Conventional angiogram (rest and provocation)	27 (30.0)
Venogram	9 (10.0)

Values are presented as number and precentage (%).

Table 2

- Operative details.

Extent of resection	n (%)
Decompression surgery
Total cervical rib alone	54 (60.0)
Cervical rib and first rib	21 (23.3)
First rib and fibrous band resection	12 (13.3)
Partial cervical rib and fibrous band	2 (2.2)
Elongated C7 transverse process and fibrous band	2 (2.2)
Vascular procedure
Arterial repair	18 (20.0)
Repair of subclavian artery aneurysms	10 (11.1)
Resection and interposition graft repair	7 (5.6)
Venous (GSV) graft	4 (4.4)
Synthetic (PTFE) grafts	3 (3.3)
Resection and end to end anastomosis	3 (3.3)
Revascularization surgery	8 (8.9)
Axillary-brachial bypass (using vein)	1 (1.1)
Axillary-distal thrombectomy	7 (7.8)
Venous repair	2 (2.2)
Endovenous intervention
Catheter directed thrombolysis and stent of subclavian vein	2 (2.2)

Values are presented as a number and precentage (%). GSV: great saphenous vein, PTFE: polytetrafluoroethylene

Table 3

- Post-operative complication outcomes after 1, 6, and 12 months.

Postoperative complications	n (%)	Presence of complications
Postoperative complications	n (%)	1 month	6 months	12 months
Wound hematoma	2 (2.2)	0 (0.0)	0 (0.0)	0 (0.0)
Sensorimotor symptoms	9 (10.0)	8 (8.9)	0 (0.0)	0 (0.0)
Pneumothorax	4 (4.4)	0 (0.0)	0 (0.0)	0 (0.0)
Chylothorax	2 (2.2)	0 (0.0)	0 (0.0)	0 (0.0)
Supraclavicular lymphocele	1 (2.2)	0 (0.0)	0 (0.0)	0 (0.0)