Unilateral Raynaud's phenomenon caused by cervical-first rib anomalies

Abstract Two cases of a complete cervical rib and one of an anomalous first rib causing subclavian artery thrombosis and distal arm thromboemboli are reported. In each case unilateral Raynaudis phenomenon, believed to be the consequence of small digital emboli, preceded serious thromboembolism by one year or longer. The vast majority of thromboembolic complications of the thoracic outlet syndromes are related to these two rib anomalies, which are usually identifiable on routine chest roentgenograms. Thromboembolism is an unusual complication of an incomplete cervical rib and the scalenus anticus syndrome. Diagnosis is made by arteriographic study of the subclavian artery and the distal circulation. The routine thoracic outlet maneuvers often contribute little to the diagnosis. Therapy consists of surgical removal of the subclavian artery thrombus and restoration of vascular integrity, excision of the cervical or anomalous first rib, transection of the scalenus anticus muscle, thoracocervical sympathectomy and an attempt to remove as much distal thrombus in the brachial-radial-ulnar vessels as possible. Results are optimal only if such surgery is performed before subclavian artery scarring and extensive distal embolization has occurred.