Arterial Thoracic Outlet Syndrome

What is arterial thoracic outlet syndrome?

Arterial thoracic outlet syndrome (ATOS) is a disorder that affects the artery between your ribs and collarbone (clavicle). This space between your ribs and collarbone is the thoracic outlet.

Your arteries carry blood from your heart to the rest of your body. People with ATOS have a squeezed (compressed) artery in their thoracic outlet.

If you don’t get treatment, ATOS can cause serious health problems. In some people, the wall of their artery expands and weakens (aneurysm). If you have any symptoms of ATOS, it’s important to see a healthcare provider. They can run tests to diagnose or rule out ATOS.

Who might get arterial thoracic outlet syndrome?

All types of thoracic outlet syndrome are more common in women ages 20 to 50. Usually, compression of your artery in your thoracic outlet happens because you were born with an extra rib (a “cervical rib”), or a rib in the wrong place.

What are the complications of arterial thoracic outlet syndrome?

Arterial thoracic outlet syndrome is the most dangerous type of thoracic outlet syndrome. Without treatment, ATOS can cause severe blood clots in your arteries. The clots can affect blood flow to your arm and hand. Rarely, the blood clots can also travel to your brain and cause strokes.

If you have signs of thoracic outlet syndrome, it’s important to get treatment early.

How common is arterial thoracic outlet syndrome?

All types of thoracic outlet syndrome (TOS) are rare. Experts don’t know exactly how many people have it. And arterial TOS is the least common type of TOS. Fewer than 1 in 100 cases of thoracic outlet syndrome are arterial thoracic outlet syndrome.

What causes arterial thoracic outlet syndrome?

Many people with ATOS were born with an extra rib above their collarbone. This rib, called the cervical rib, sits above what is most people’s first rib.

Between your arm and your clavicle, an artery called the subclavian artery, carries blood to your arms, hands, neck and head. The extra cervical rib can compress your subclavian artery, blocking blood flow and allowing blood clots to form. These blood clots may break off and travel through your arm, getting in the way of proper blood flow.

Other causes of arterial thoracic outlet syndrome can include:

• Obesity, which puts extra pressure on your joints.
• Physical trauma, such as an injury from a car accident.
• Poor posture.
• Pregnancy.
• Repetitive movements, such as swinging a tennis racket, throwing a softball or baseball or lifting boxes overhead.

What are the symptoms of arterial thoracic outlet syndrome?

Arterial thoracic outlet syndrome causes symptoms that affect your fingers, hands or entire arm. The most common sign is a dull ache or numbness in one arm. Symptoms are worse when you use your arm and better when you rest. Usually, people with ATOS don’t have any symptoms in their neck or shoulder.

ATOS can decrease your blood circulation. As a result, your fingers, hand or arm may have:

• Coldness.
• Numbness or tingling.
• Pain.
• Pale discoloration.
• Slow-healing wounds.

How is arterial thoracic outlet syndrome diagnosed?

If you have signs of arterial thoracic outlet syndrome, your healthcare provider will visually examine your neck and shoulder area. You may perform specific movements so they can check your range of motion.

Your healthcare provider will also take your blood pressure and ask you about your symptoms. If they suspect ATOS, you may have more tests to evaluate your thoracic outlet.

What tests might I have to diagnose arterial thoracic outlet syndrome?

Arterial thoracic outlet diagnosis may involve imaging tests. To view your arteries, blood flow and internal structures, you may have:

• Ultrasound: Using sound waves to look inside of your body, including looking at blood flow. This is most often the first test used to look for this diagnosis.
• Arteriogram: Placing a small, hollow tube (catheter) and contrast dye in your arteries, then taking an X-ray.
• CT scan: Using multiple X-rays to create detailed images.
• MRI: Using radio waves and magnets to get a detailed picture.
• X-ray: Using targeted, safe doses of radiation to get images.

How is arterial thoracic outlet syndrome treated?

Arterial thoracic outlet syndrome treatment almost always involves surgery. Before the operation, your healthcare provider may give you medication such as warfarin (Coumadin®) or heparin (Hep-Lock™) to break up blood clots. They may also try to remove clots that are already there, either by injecting medication or by performing a procedure.

During arterial thoracic outlet syndrome surgery, your healthcare provider may:

• Remove part of your extra rib to relieve pressure.
• Replace a damaged artery with part of a healthy artery from another part of your body (arterial graft).
• Replace a damaged artery with an artificial tube to redirect blood flow.

How can I reduce my risk of arterial thoracic outlet syndrome?

There’s no guaranteed way to prevent ATOS. But you can lower your risk of compression injuries with a few lifestyle changes:

• Achieve and maintain a healthy weight for your body type, age and sex.
• Avoid carrying heavy bags on one shoulder.
• Limit repetitive overhead movements.
• Strengthen your shoulders with weight lifting or resistance exercises.
• Stretch your neck, shoulders and chest daily.

What is the outlook for ATOS?

Without treatment, arterial thoracic outlet syndrome can cause severe complications such as blood clots, wounds on your hand or (in extreme cases) loss of fingers. Thankfully, early treatment increases your chances of a successful outcome. If you have any symptoms that could point to ATOS, see your healthcare provider right away.

What else should I ask my doctor?

You may want to ask your healthcare provider:

• What’s the most likely cause of ATOS symptoms?
• What tests do I need for diagnosis?
• What are the treatment options?
• Will nonsurgical treatments improve my symptoms?
• What lifestyle changes can I make to improve symptoms?

A note from Cleveland Clinic

Arterial thoracic outlet syndrome (AOTS) is a condition that affects the subclavian artery in your thoracic outlet in your chest. ATOS squeezes (compresses) this artery, causing blood clots to form. These clots may break off and travel into your arms, causing pain, tingling or numbness. Early treatment can decrease your chances of complications. If you have ATOS symptoms, see your healthcare provider right away.