A complex surgical procedure was performed in the Clinic of Vascular Surgery

 For the first time, a surgical team of physicians of the Clinic of Vascular Surgery of the Clinical Centre Banja Luka independently performed a complex surgical procedure i.e. reconstruction of subclavian artery due to compression caused by supernumerary cervical rib. It is a complex surgical procedure which is performed exclusively in the high-level health care institutions. The surgical procedure included a removal of a supernumerary cervical rib which caused the occurrence of a thrombosed aneurysm of subclavian artery and a sudden cessation of blood flow in arteries of the right arm of the patient.

Existing of the compression of blood vessels and nerves between collarbone and first rib is called thoracic outlet syndrome or TOS syndrome. The most frequent causes of TOS syndrome are supernumerary cervical rib, muscular and ligament anomalies, scars occurred after reuniting of the fractured collarbone and first rib as well as tumour processes of the mentioned region. The patient was hospitalized in the Clinic of Vascular Surgery due to acute ischaemia of the right arm which was manifested in hypothermia, absent pulses and weakness in the right arm. The Diagnostic analysis found thrombosis on the area where subclavian artery becomes brachial artery, aneurism of subclavian artery and the existence of supernumerary cervical rib. The surgical procedure consisted of aneurysm resection with interposition of synthetic graft and resection of cervical rib. Controlling MSCT angiography showed a free-flowing synthetic graft and also the existing thrombosis on the area where axillary artery becomes brachial artery. With regard to the fact that the patient is stating the subjective improvement and that the arm is functional, the Clinical Case Conference decided not to perform additional revascularization for the time being regardless of absence of peripheral pulses. An eventual additional revascularization of the right arm was indicated in the case of an adverse clinical report. The complex surgical procedure was performed by Milanko Maksić MD, subspecialist in vascular surgery, Vladimir Keča MD and Tatjana Šutilović MD, residents in general surgery, Ljubiša Tomić MD, a resident in anaesthesia, Danka Kljajić, a surgical technician and Mladen Peulja, an anaesthetic technician