Arterial disorders in patients with an additional cervical rib

The article examines the nature of arterial disorders in patients with an accessory cervical rib in order to improve the results of surgical treatment. From 2009 to 2015, we monitored 88 patients with an accessory cervical rib, including 74 (84.1%) women and 14 (15.9%) men. Arterial disorders were observed in 48 (54.5%) patients with an accessory cervical rib. Thromboembolism and subsequently ascending thrombosis in the proximal segments of the arteries were observed in 6 (6.8%) patients with the development of clinical signs of critical arm ischemia in the form of pre-gangrene. All patients (n=6) underwent emergency surgery involving simultaneous rib resection and thromboembolectomy from the subclavian, axillary, and brachial arteries. In one case, resection of the subclavian artery aneurysm was carried out to form an end-to-end anastomosis, and in 3 cases, after rib resection and thrombectomy, selective cervicothoracic sympathectomy was performed. In most cases, ischemia of the upper extremities regressed, and blood circulation was compensated. There were no amputations or deaths. In 33 (37.5%) patients out of 88, secondary Raynaud's syndrome was noted. Moreover, Raynaud's syndrome was noted on both sides in 24 patients with bilateral cervical rib. In rare cases, in 2 patients with a unilateral cervical rib, Raynaud's syndrome was noted on one side. The fact that in 7 patients with a unilateral cervical rib, the clinical manifestations of Raynaud's syndrome were on both sides remains inexplicable. Thus, the cause of thromboembolic complications in this group of patients is chronic trauma to the subclavian artery, which contributes to the development of organic changes with the formation of mural thrombi or the development of aneurysms, which become a source of peripheral embolism.