Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.009617
Jornal Vascular Brasileiro
Case Report

Compressão da artéria subclávia por pseudoartrose de clavícula: apresentação na quinta década de vida

Late presentation of critical upper limb ischemia caused by pseudarthrosis of the clavicle

Marcio Miyamotto, Lucas Vasconcelos Sanvido, Luan Facttore Brendolan, Amilton Cezar, Giana Caroline Strack Neves, Izara Castro de Souza, Ricardo César Rocha Moreira

Downloads: 2
Views: 1367

Resumo

A compressão da artéria subclávia no desfiladeiro torácico é um fenômeno amplamente conhecido. Anormalidades ósseas, como a pseudoartrose da clavícula, podem raramente causar compressão arterial a esse nível. A pseudoartrose pode desenvolver-se em decorrência de um trauma, que é a forma mais comum, ou ser congênita. Os autores descrevem o caso de uma paciente de 44 anos com quadro de isquemia crítica de membro superior direito. Apresentava história de fratura não tratada de clavícula direita aos 9 meses de idade que evoluiu com pseudoartrose e compressão extrínseca com oclusão da artéria subclávia. O segmento da clavicula acometido pela pseudoartrose foi ressecado e realizada uma tromboembolectomia tardia das artérias subclávia, braquial e distais, com boa evolução.

Palavras-chave

artéria subclávia; síndrome do desfiladeiro torácico; isquemia crítica.

Abstract

Compression of the subclavian artery in the thoracic outlet is a well-known phenomenon. In rare cases, bone abnormalities, such as pseudarthrosis of the clavicle, can cause arterial compression at this level. Pseudarthrosis may develop as a result of trauma, which is the more common form, or it may be congenital. Here, the authors describe the case of a 44-year-old patient with critical ischemia of the right upper limb. She had a history of untreated right clavicle fracture at 9 months of age which had progressed to pseudarthrosis and extrinsic compression of the subclavian artery causing occlusion. The segment of the clavicle involved was resected and late thromboembolectomy of the subclavian, brachial, distal arteries was performed, with good results.

Keywords

subclavian artery; thoracic outlet syndrome; critical ischemia.

References

1. Mandal AK, Jordaan J, Missouris CG. Fractured clavicle and vascular complications. Emerg Med J. 2004;21(5):648. http://dx.doi.org/10.1136/emj.2003.009761. PMid:15333570.

2. Valooran GJ, Nair SK, Toms A. Posterior dislocation of clavicle with potential for great vessel injury. Asian Cardiovasc Thorac Ann. 2016;24(9):899. http://dx.doi.org/10.1177/0218492315588861. PMid:26038601.

3. Kirkwood ML, Valentine RJ. Thoracic outlet syndrome: arterial. In: Cronenwett JL, Johnston KW, editors. Rutherford’s vascular surgery. 8th ed. Philadelphia: Elsevier; 2016. p. 1969-76.

4. Kieffer E. Arterial complications of thoracic outlet syndrome. In: Bergan JJ, Yao JST, editors. Evaluation and treatment of upper and lower extremity circulatory disorders. 1st ed. Orlando: Grune & Stratton; 1984. p. 249-75.

5. Sanders RJ, Haug C. Review of arterial thoracic outlet syndrome with a report of five new instances. Surg Gynecol Obstet. 1991;173(5):415-25. PMid:1948597.

6. Makhoul RG, Machleder HI. Developmental anomalies at the thoracic outlet: an analysis of 200 consecutive cases. J Vasc Surg. 1992;16(4):534-45. http://dx.doi.org/10.1016/0741-5214(92)90161-Z. PMid:1404675.

7. Garnier D, Chevalier J, Ducasse E, Modine T, Espagne P, Puppinck P. Arterial complications of thoracic outlet syndrome and pseudoarthrosis of the clavicle: three patients. J Mal Vasc. 2003;28(2):79-84. PMid:12750638.

8. Casbas L, Chauffour X, Cau J, et al. Post-traumatic thoracic outlet syndromes. Ann Vasc Surg. 2005;19(1):25-8. http://dx.doi.org/10.1007/s10016-004-0151-1. PMid:15714363.

9. Thomazinho F, Sardinha WE, Silvestre JM, Morais D Fo, Motta F. Complicações arteriais da síndrome do desfiladeiro torácico. J Vasc Bras. 2008;7(2):150-4. http://dx.doi.org/10.1590/S1677-54492008000200009.

10. Serrano JA, Rodriguez P, Castro L, Serrano P, Carpintero P. Acute subclavian artery pseudoaneurysm after closed fracture of the clavicle. Acta Orthop Belg. 2003;69(6):555-7. PMid:14748115.

11. Zehm S, Chemelli A, Jaschke W, Fraedrich G, Rantner B. Long-term outcome after surgical and endovascular management of true and false subclavian artery aneurysms. Vascular. 2014;22(3):161-6. http://dx.doi.org/10.1177/1708538113479514. PMid:23493279.

12. Rayan GM, Jensen C. Thoracic outlet syndrome: provocative examination maneuvers in a typical population. J Shoulder Elbow Surg. 1995;4(2):113-7. http://dx.doi.org/10.1016/S1058-2746(05)80064-3. PMid:7600161.

13. Milas ZL, Dodson TF, Ricketts RR. Pediatric blunt trauma resulting in major arterial injuries. Am Surg. 2004;70(5):443-7. PMid:15156954.

14. Davidovic LB, Kostic DM, Jakovljevic NS, Kuzmanovic IL, Simic TM. Vascular thoracic outlet syndrome. World J Surg. 2003;27(5):545-50. http://dx.doi.org/10.1007/s00268-003-6808-z. PMid:12715220.

15. Lozano P, Díaz M, Riera R, Gomez FT. Venous thoracic outlet syndrome secondary to congenital pseudoarthrosis of the clavicle: presentation in the fourth decade of life. Eur J Vasc Endovasc Surg. 2003;25(6):592-3. http://dx.doi.org/10.1053/ejvs.2002.1864. PMid:12787706.

16. Yao JS, Pearce WH. Reconstructive surgery for chronic upper extremity ischemia. Semin Vasc Surg. 1990;3:258-66.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5cd1de710e8825cb71632f8e jvb Articles

J Vasc Bras

Share this page
Page Sections