Arterial Thoracic Outlet Syndrome: Symptoms, Causes, Treatments, & Prognosis

Arterial thoracic outlet syndrome is the least common form of  thoracic outlet syndrome (TOS) . It is a rare but severe condition which affects 1%-5% of TOS patients.

Arterial TOS is caused by artery compression below the clavicle. Common symptoms include tingling and discomfort in the fingers, hands, or arms. Surgery and chiropractic care are two common treatments.

Arterial thoracic outlet syndrome (ATOS) describes compression of an artery in the scalene triangle, between your clavicle bone and    first rib  . (The scalene triangle is one of 3 regions of the thoracic outlet: scalene triangle, costoclavicular space, and  pectoralis minor   space.)

 Thoracic outlet syndrome , in general, refers to trauma within the thoracic region between your collarbone and first rib.  There are  3 main types of TOS :

ATOS specifically can lead to blood clots (thrombus) in the subclavian artery (beneath the clavicle). These blood clots may break off and progress down your arm. In the most serious cases, these blood clots can travel into the lungs, resulting in pulmonary embolism, which is potentially deadly.

How rare is arterial TOS?  Arterial TOS is very rare. Lower estimates put the incidence rate of ATOS at less than 1% of individuals dealing with general TOS. However, it may occur in as many as 5% of general TOS patients.

Arterial TOS is observed at a higher-than-average rate in overhead-throwing athletes, like baseball pitchers.

What are the symptoms of arterial TOS?  The symptoms of arterial TOS include the following:

ATOS may also be asymptomatic, but it still requires treatment.

Arterial TOS is the most dangerous form of TOS. Without treatment, ATOS can lead to serious health complications — potentially life-threatening.

Arterial TOS is  caused by  an aneurysm (widening) or stenosis (narrowing) of the subclavian artery (the major blood vessel beneath your clavicle bone). If a blood clot forms then breaks off, it could block a distal artery, resulting in ATOS symptoms like pain and numbness.

Below are the greatest  risk factors  that don’t  always  result in ATOS but greatly increase your risk of developing ATOS:

ATOS can bring on sudden and severe symptoms. A healthcare professional should  diagnose ATOS  right away. Here’s what a diagnosis might look like, step by step:

You may want to ask your doctor what nonsurgical treatments and lifestyle changes may improve your symptoms while you wait for follow-up appointments.

The most common treatment options for ATOS include:

For severe cases of ATOS, further surgical intervention may include:

Most patients can expect to return to normal life after successful treatment without much change to quality of life.

For anyone with restricted blood flow to the arms (upper extremity ischemia), immediate surgical removal of blood clots may be necessary.

Does arterial TOS require surgery?  No, arterial TOS does not  always  require surgery, but surgery is a common and effective treatment, such as first rib resection. More conservative treatment usually precedes surgical intervention. Symptomatic ATOS may require immediate surgical decompression. Prevention methods may mitigate the need for surgical treatment.

Here are the best ways to prevent arterial thoracic outlet syndrome:

If you’re already showing symptoms of ATOS, you likely need immediate treatment. The presence of symptoms indicate the condition has progressed too far for prevention methods alone to replace treatment.

Arterial thoracic outlet syndrome is a highly dangerous type of TOS. Untreated ATOS can lead to these potential health complications:

The long-term outlook for ATOS is good with an early diagnosis.

What is the prognosis for arterial TOS?  Without treatment, ATOS may result in major blood clots, loss of fingers, and stroke. Fortunately, ATOS treatment is often successful, and early treatment usually leads to recovery.