Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Cervical rib as a cause of thoracic outlet syndrome and subclavian arteryaneurysm complicated by distal thromboembolism

Authors: V.S. Arakelyan 1, R.G. Bukatsello 1, 2, M.V. Shumilina 1, D.I. Kolesnik 1

Company:
1 Bakoulev National Scientific and Practical Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;
2 Institute of Vocational Education, Sechenov First Moscow State Medical University, ul. Trubetskaya, 8, stroenie 2, Moscow, 119991, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2017-14-3-163-169

UDC: 616.743.9:616.833.4:616.134-007.64:616-005.7

Link: Clinical Physiology of Blood Circulaiton. 2017; 14 (3): 163-169

Quote as: Arakelyan V.S., Bukatsello R.G., Shumilina M.V., Kolesnik D.I. Cervical rib as a cause of thoracic outlet syndrome and subclavian artery aneurysm complicated by distal thromboembolism. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2017; 14 (3): 163–9 (in Russ.). DOI: 10.24022/1814-6910-2017-14-3-163-169

Received / Accepted:  31.07.2017/13.08.2017

Full text:  

Abstract

An cervical rib is a congenital bone anomaly, which is one of the causes (up to 4.5% of cases) of the thoracic outlet syndrome (TOS). The musculoskeletal anomaly and its pathological effects on the neurovascular bundle often become a source of severe thromboembolic complications. In addition, the congenital nature of the pathology and long-term low-symptom course promotes the formation of complex pathophysiological mechanisms that are difficult to treat, including surgical, even if the pathogenetically substantiated and radical operation is performed. Nevertheless, the detection of such a bone anomaly, especially in combination with a complicated course, is an absolute indication for surgical treatment, since only surgical intervention avoids the development of irreversible and dramatic thromboembolic vascular complications. And as practice shows, the earlier the operation is performed, the better the treatment prognosis, especially with the arterial TOS.

References

1. Adson A., Coffey J. Cervical rib: a method of anterior
approach for relief of symptoms by division of the
scalenus anticus. Ann. Surg. 1927; 85: 839–57.
2. Spadliński L., Cecot T., Majos A., Stefańczyk L.,
Pietruszewska W., Wysiadecki G. et al. The epidemiological,
morphological, and clinical aspects of the cervical
ribs in humans. Biomed. Res. Int. 2016; 2016.
http://dx.doi.org/10.1155/2016/8034613
3. Fisher M. Eve's rib. Radiology. 1981; 140: 841.
4. Atasoy E. Thoracic outlet syndrome: anatomy. Hand
Clinics. 2004; 20 (1): 7–14.
5. Symonds C. Cervical rib: thrombosis of subclavian
artery. Contralateral hemiplegia of sudden onset, probably
embolic. Proc. R. Soc. Med. 1927; 20: 1244–5.
6. Gruber W. Ueber die Halsrippen des Menshen mit verglerchendanatomischen
Bermerkungen. Mem. Acad.
Imp. Sci. (St. Petersburg). 1869; 2: 7–27.
7. Thomazinho F., Sardinha W., Silvestre J., Filho D.,
Motta F. Arterial complications of thoracic outlet syndrome.
J. Vasc. Bras. 2008; 7 (1): 150–4.
8. Durham J., Yao J., Pearce W., Nuber G., McCarthy W.
Arterial injuries in the thoracic outlet syndrome. J. Vasc.
Surg. 1995; 21: 57–69.
9. Criado E., Berguer R., Greenfield L. The spectrum of
arterial compression at the thoracic outlet. J. Vasc. Surg.
2010; 52: 406–11.
10. Weber A., Criado E. Relevance of bone anomalies in
patients with thoracic outlet syndrome. Ann. Vasc. Surg.
2014; 28 (4): 924–32.
11. Cormier J., Amrane M., Ward A., Laurian C., Gigou F.
Arterial complications of the thoracic outlet syndrome:
fifty-five operative cases. J. Vasc. Surg. 1989; 9: 778–87.
12. Rodbard S., Ikeda K., Montes M. An analysis of mechanisms
of post stenotic dilatation. Angiology. 1967; 18:
349–67.
13. Crotty T. Poststenotic dilatation in arteries and the role
of turbulence. Med. Hypotheses. 1994; 42: 367–70.
14. Rutherford R.B. Vascular surgery. Philadelphia,
London, Toronto: W.B. Saunders; 1984: 747–8.
15. Thompson R. Challenges in the treatment of thoracic
outlet syndrome. Texas Heart Inst. J. 2012; 39 (6): 842–3.
16. Bouhoutsos J., Morris T., Martin P. Unilateral Raynaud’s
phenomenon in the hand and its significance.
Surgery. 1977; 82: 547–51.
17. Vemuri С., McLaughlin L.N., Abuirqeba A.A., Thompson
R.W. Clinical presentation and management of
arterial thoracic outlet syndrome. J. Vasc. Surg. 2017;
65 (5): 1429–39.
18. Molina J., D’Cunha J. The vascular component in neurogenic-
arterial thoracic outlet syndrome. Internat. J.
Angiol. 2008; 17 (2): 83–7.
19. Stapleton C., Herrington L., George K. Sonographic
evaluation of the subclavian artery during thoracic outlet
syndrome shoulder manoeuvres. Man. Ther. 2009;
14 (1): 19–27.
20. Molina J., Hunter D., Dietz C. Protocols for Paget-
Schroetter syndrome and late treatment of chronic subclavian
vein obstruction. Ann. Thorac. Surg. 2009; 87
(2): 416–22.
21. Demondion X., Vidal C., Herbinet P., Gautier C.,
Duquesnoy B., Cotten A. Ultrasonographic assessment
of arterial cross-sectional area in the thoracic outlet on
postural maneuvers measured with power Doppler
ultrasonography in both asymptomatic and symptomatic
populations. J. Ultrasound Med. 2006; 25 (2):
217–24.
22. Mangrulkar V., Cohen H., Dougherty D. Sonography
for diagnosis of cervical ribs in children. J. Ultrasound
Med. 2008; 27 (7): 1083–6.
23. Chang K., Likes K., Davis K., Demos J., Freischlag J.
The significance of cervical ribs in thoracic outlet syndrome.
J. Vasc. Surg. 2013; 57 (3): 771–5.
24. Watanabe T., Yanabashi K., Moriya K., Maki Y.,
Tsubokawa N., Baba H. Ultrasound-guided supraclavicular
brachial plexus block in a patient with a cervical
rib. Can. J. Anesth. 2015; 62: 671–3.
25. Moriarty J.M., Bandyk D.F., Broderick D.F., Cornelius
R.S., Dill K.E., Francois C.J. et al. ACR appropriateness
criteria imaging in the diagnosis of thoracic outlet
syndrome. J. Am. Coll. Radiol. 2015; 12 (5): 438–43.
26. Remy-Jardin M., Remy J., Masson P., Bonnel F.,
Debatselier P., Vinckier L. CT angiography of thoracic
outlet syndrome: evaluation of imaging protocols for
the detection of arterial stenosis. J. Comput. Assist.
Tomogr. 2000; 24 (3): 349–61.
27. Viertel V., Intrapiromkul J., Maluf F., Patel N.V.,
Zheng W. et al. Cervical ribs: a common variant overlooked
in CT imaging. Am. J. Neuroradiol. 2012;
33 (11): 2191–4.
28. Hasanadka R., Towne J., Seabrook G., Brown K.,
Lewis B., Foley W. Computed tomography angiography
to evaluate thoracic outlet neurovascular compression.
Vasc. Endovascular. Surg. 2007; 41 (4): 316–21.
29. Demondion X., Boutry N., Drizenko A., Paul C.,
Francke J., Cotten A. Thoracic outlet: anatomic correlation
with MR imaging. Am. J. Roentgenol. 2000;
175 (2): 417–22.
30. Aralasmak A., Cevikol C., Karaali K., Senol U.,
Sharifov R., Kilicarslan R., Alkan A. MRI findings in
thoracic outlet syndrome. Skeletal. Radiol. 2012; 41 (11):
1365–74.
31. Coote H. Exostosis of the left transverse process of
the seventh cervical vertebrae, surrounded by blood vessels
and nerves, successful removal. Lancet. 1861; 1:
350–1.
32. Sanders R., Hammond S. Management of cervical ribs
and anomalous first ribs causing neurogenic thoracic
outlet syndrome. J. Vasc. Surg. 2002; 36: 51.
33. Atasoy E. Recurrent thoracic outlet syndrome. Hand
Clin. 2004; 20: 99–105.
34. Urschel H., Razzuk M. The failed operation for thoracic
outlet syndrome: the difficulty of diagnosis and
management. Ann. Thorac. Surg. 1986; 42: 523–8.
35. Ambrad-Chalela E., Thomas G., Johansen K.
Recurrent neurogenic thoracic outlet syndrome. Am. J.
Surg. 2004; 187: 505–10.
36. Hempel G., Rusher A., Wheeler C., Hunt D., Bukhari H.
Supraclavicular resection of the first rib for thoracic
outlet syndrome. Am. J. Surg. 1981; 141: 213–5.
37. Sanders R., Hammond S. Supraclavicular first rib
resection and total scalenectomy: technique and results.
Hand Clin. 2004; 20: 61–70.
38. Hosseinian M., Loron A., Soleimanifard Y. Evaluation
of complications after surgical treatment of thoracic
outlet syndrome. Korean J. Thorac. Cardiovasc. Surg.
2017; 50 (1): 36–40.

About Authors

  • Arakelyan Valeriy Sergeevich, Dr. Med. Sc., Professor, Head of Department of Surgery of Arterial Pathology; orcid.org/0000-0002-0284-6793
  •  Bukatsello Roman Gennad’evich, Cand. Med. Sc., Senior Researcher; orcid.org/0000-0002-9751-4993
  • Shumilina Margarita Vladimirovna, Dr. Med. Sc., Chief of Group of Ultrasound Cardiovascular and Organ Pathology; orcid.org/0000-0001-9871-8173
  • Kolesnik Dmitriy Ivanovich, Researcher; orcid.org/0000-0001-9531-3410

 If you found mistakes, select text and press Alt+A