This is a case of arterial thoracic outlet syndrome (aTOS) seen on both CTA and left upper extremity angiography. On the catheter angiography study, images were obtained both at neutral (arm adducted) and abducted positions. On the abducted images, the severe stenosis can be seen, compatible with arterial thoracic outlet syndrome. Given the association, occlusion of the radial artery is thought to be secondary to the aTOS.

Following a left carotid subclavian bypass, the patient needed fasciotomies intraoperatively due to gangrene. Patient overall did well at a follow-up outpatient visit, with improved range of motion and decreased pain and edema.

CO-AUTHORS:
Alannah McCann
Bilal Arif, MD
Travis Bevington, MD