Torturous Subclavian Artery Dangers

[B.]

I saw a Vasc. surg. at JH for TOS, CTS, bi-lat.cerv. ribs & lump base of throat L side after episodes of tachy., hypervent., dizziness; swelling, loss of sensation, & L arm,wrist/hand pain, varied BP arm-to-arm, and no pulse w/arms lifted at shoulder level.  A torturous L subclavian artery was found.  The surg. ordered an ergo. wkstation & PT for TOS/CTS.  If no relief, scalene and trap blocks (surgery as the last resort) to relieve pressure off of artery and brach. plexus.  After concerns about the surgeon's abilities—not diagnosis—I sought a 2nd opinion at Hershey encase of surgery.  H’s specialist, a neurosurg., ordered an EMG & MRA.  Tests negative (a slight martin gruber anastomosis in the right arm). The neurosurg. didn’t feel that I have TOS or CTS, but that scalenes and traps are compressing arter. and nerves—couldn’t find the tort. subc.  When I provided JH’s colored scans of the Subc.—told that no more could be done—to  worry only if P.T. didn’t elleviate symptoms (it does to a point) or if L arm swells again or becomes discolored.  Can a tort. subc. cause Subclavian Steal Syndrome? Can min. surg. correct a tort. subc. or is careful mgmt the only course of action?  I can’t walk while swinging L arm w/out small attacks, can’t be gripped L shoulder in a hug or wear a seat belt across lump. I can run, but w/in ˝ hr the lump painfully thumps—Fam. phys. is concerned about some types of phys. exertion—no snowboarding this past Mar.  I’m 29 & want a full life, but feel limited—both by artery & lack of consensus on how to deal with it.  Any input or assist. appreciated.

[Cleveland Clinic]

B.

Difficult situation, and Im not entirely clear on some of your post.

Subclavian steal syndrome is different then what you describe and is associated with central neurologic symptoms associated with significant subclavian stenosis proximal to the takeoff of the vertebral artery.

I honestly would try to avoid surgery if possible unless there was definite vascular compromise.  Usually a tortuous vessel shouldnt really compromise circulation unless there is luminal stenosis or extrinsic compression.  If this is the case repair would either be none with an operation to decrease the external compression or some type of percutaneosu or bypass.

I would seek consulation with a vascular medicine specialist to clarify what is really going on.

good luck

[B.]

Thank you for responding.  The L tort. subclavian is slightly twisted and narrowed at a little more than 90 degree angle. I asked about Subclavian Steal because during all of this I have asked repeatedly if my blood might not be flowing correctly--the only response has been the warning about my arm swelling and information on how the traps and scalenes can compress the area and how PT can help reduce compression.  With my symptoms-especially the pain, thumping, and swelling of the lump at the L side of my throat, I'm convinced something is not working right. My fam. phys believes that given the tight traps and scalenes (and a history of TMJ as well) that when I overwork my muscles, or tighten them from anger, stress, repetitive typing, or during cool down from running--my muscles tense and tighten around the brachial plexus and arteries and cause my episodes.  She too recommended that I seek out another vascular surgeon.  I guess I just wanted another perpective before the search--I've been dealing with so many doctors over the past year or so--it has been extremely tiresome.  Thank you for your honesty and for information on other methods of treatment if the compression is severe--I don't want surgery either, but I also do not want to walk around damaging the artery with my activities or possibly causing an aneuyerism that could have been averted.

[Cleveland Clinic]

Theres an adage in medicine...to a hammer everthing looks like a nail.  

I think I would discuss your case with a vascular medicine specialist or cardiologist and not another surgeon.  If they think you need an operative procedure they could work together and if not they may be able to provide you with a little more structure to provide symptomatic relief.

good luck