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01-08-2020 | Thoracic Outlet Syndrome | Original Article

Costoclavicular ligament as a novel cause of venous thoracic outlet syndrome: from anatomic study to clinical application

Authors: Guangchao Gu, Jinping Liu, Yanze Lv, Hui Huang, Fangda Li, Mengyin Chen, Yuexin Chen, Jiang Shao, Bao Liu, Changwei Liu, Xiaodong Zhang, Yuehong Zheng

Published in: Surgical and Radiologic Anatomy | Issue 8/2020

Abstract

Purpose

Venous thoracic outlet syndrome (VTOS) is a compressive disorder of subclavian vein (SCV); we aimed to investigate the role of costoclavicular ligament (CCL) in the pathogenesis of VTOS.

Methods

A cadaver study was carried out to investigate the presence and morphology of CCL in thoracic outlet regions, as well as its relationship with the SCV. Six formalin-fixed adult cadavers were included, generating 12 dissections of costoclavicular regions (two sides per cadaver). Once CCL was identified, observation and measurement were made of its morphology and dimensions, and its relationship with SCV was studied. To take a step further, a clinical VTOS case was reported to prove the anatomical findings.

Results

Two out of twelve costoclavicular regions (2/12, 16.7%) were found to possess CCLs. Both ligaments were located in the left side of two male cadavers and were closely attached to the lateral aspect of sternoclavicular joint capsules. The lateral fibers of the ligament proceed in a superolateral-to-inferomedial manner, while the medial fibers proceed more vertically. Both ligaments were tightly adherent to the SCV, causing significant compression on the vein. In the clinical case, multiple bunches of CCLs were found to compress the SCV tightly intraoperatively. After removing the ligaments, the patient’s symptom kept relief during a follow-up period of 2 years.

Conclusion

Our study demonstrated that CCL could be a novel cause of VTOS by severe compression of SCV. Patients diagnosed with this etiology could get less invasive surgical treatment by simply removing the ligament.

Cave AJ (1961) The nature and morphology of the costoclavicular ligament. J Anat 95(2):170PubMedPubMedCentral

Deweese JA, Adams JT, Gaiser DL (1970) Subclavian venous thrombectomy. Circulation 41(5 Suppl):158–164. https://doi.org/10.1161/01.CIR.41.5S2.II-158 CrossRef

De Leon RA, Chang DC, Hassoun HT, Black JH, Roseborough GS, Perler BA et al (2009) Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome. Surgery 145(5):500–507. https://doi.org/10.1016/j.surg.2008.09.017 CrossRefPubMed

Elia S, Cerioli A, Fiaschetti V, Granai AV (2005) Infraclavicular subpectoral lipoma causing thoracic outlet syndrome. Int J Surg Case Rep 9:101–104. https://doi.org/10.1016/j.ijscr.2015.02.047 CrossRef

Gockel M, Vastamäki M, Alaranta H (1994) Long-term results of primary scalenotomy in the treatment of thoracic outlet syndrome. J Hand Surg Br Eur 19(2):229–233. https://doi.org/10.1016/0266-7681(94)90174-0 CrossRef

Hussain MA, Aljabri B, Al-Omran M (2016) Vascular thoracic outlet syndrome. Semin Thorac Cardiovasc Surg 28(1):151–157. https://doi.org/10.1053/j.semtcvs.2015.10.008 CrossRefPubMed

Illig KA, Doyle AJ (2010) A comprehensive review of Paget-Schroetter syndrome. J Vasc Surg 51(6):1538–1547. https://doi.org/10.1016/j.jvs.2009.12.022 CrossRefPubMed

Kallio E, Rokkanen P (1965) Effect of scalenotomy in the so-called scalenus anticus syndrome. Acta Orthop Scand 35(1–4):59–66. https://doi.org/10.3109/17453676508989339 CrossRef

Koudela K, Koudelová Jana, Koudela K, Zeman P (2015) Concave impressio ligamenti costoclavicularis (“rhomboid fossa”) and its prevalence and relevance to clinical practice. Surg Radiol Anat 37(3):239–245. https://doi.org/10.1007/s00276-014-1342-2 CrossRefPubMed

10.

Lindgren SHS, Ribbe EB, Norgren LEH (1989) Two year follow-up of patients operated on for Thoracic Outlet Syndrome. Effects on sick-leave incidence. Eur J Vasc Surg 3(5):411. https://doi.org/10.1016/S0950-821X(89)80047-7 CrossRefPubMed

11.

Moore R, Wei Lum Y (2015) Venous thoracic outlet syndrome. Vasc Med 20(2):182–189. https://doi.org/10.1177/1358863X14568704 CrossRefPubMed

12.

Roos DB (1982) The place for scalenectomy and first-rib resection in thoracic outlet syndrome. Surgery 92(6):1077–1085PubMed

13.

Sanders RJ, Hammond SL (2005) Subclavian vein obstruction without thrombosis. J Vasc Surg 41(2):285–290. https://doi.org/10.1016/j.jvs.2004.12.022 CrossRefPubMed

14.

Sanders RJ, Monsour JW, Gerber WF, Adams WR, Thompson N (1979) Scalenectomy versus first rib resection for treatment of the thoracic outlet syndrome. Surgery 85(1):109–121 (PMID: 758710) PubMed

15.

Schneider DB, Dimuzio PJ, Martin ND, Gordon RL, Wilson MW, Laberge JM et al (2004) Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty. J Vasc Surg 40(4):599–603. https://doi.org/10.1016/j.jvs.2004.07.028 CrossRefPubMed

16.

Tubbs RS, Shah NA, Sullivan BP, Marchase ND, Comert A, Acar HI et al (2009) The costoclavicular ligament revisited: a functional and anatomical study. Rom J Morphol Embryol. 50(3):475PubMed

17.

Urschel HC, Patel AN (2008) Surgery remains the most effective treatment for Paget-Schroetter syndrome: 50 years’ experience. Ann Thorac Surg 86(1):254. https://doi.org/10.1016/j.athoracsur.2008.03.021 CrossRefPubMed

18.

Vemuri C, Salehi P, Benarroch-Gampel J, McLaughlin LN, Thompson RW (2016) Diagnosis and treatment of effort-induced thrombosis of the axillary subclavian vein due to venous thoracic outlet syndrome. J Vasc Surg Venous Lymphatic Disord 4(4):485–500. https://doi.org/10.1016/j.jvsv.2016.01.004 CrossRef

19.

Zampieri D, Marulli G, Mammana M, Calabrese F, Schiavon M, Rea F (2016) An Unusual Cause of Thoracic Outlet Syndrome. Heart Lung Circ 25(12):e162–e164. https://doi.org/10.1016/j.hlc.2016.06.1207 CrossRefPubMed

Title: Costoclavicular ligament as a novel cause of venous thoracic outlet syndrome: from anatomic study to clinical application
Authors: Guangchao Gu
Jinping Liu
Yanze Lv
Hui Huang
Fangda Li
Mengyin Chen
Yuexin Chen
Jiang Shao
Bao Liu
Changwei Liu
Xiaodong Zhang
Yuehong Zheng
Publication date: 01-08-2020
Publisher: Springer Paris
Keyword: Thoracic Outlet Syndrome
Published in: Surgical and Radiologic Anatomy / Issue 8/2020
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-020-02479-7

At a glance: The STEP trials

Springer Medicine

Costoclavicular ligament as a novel cause of venous thoracic outlet syndrome: from anatomic study to clinical application

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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