Hi! I'm meeting with a vascular surgeon in mid December regarding my left arm. Based on my clinical presentation, I was sent directly from my orthopedic doctor's office the other day for vascular studies. The studies showed problems with both the artery and vein (but no clots!!) so I've been referred me to this doctor by both my PCP and orthopedic doctor. I've already had my other 1st rib removed 4 years ago for neurogenic TOS.

My arm is swollen continually now and has a darker color to it. At times, the hand does turn purplish blue. I do not have nerve pain or paresthesthias. EMG was negative for nerve involvement.

I am researching to be prepared for the appointment. Since a lot of my questions arise from experiences, I am hoping you can share some thoughts.

Questions:
Can they do anything conservatively if it is primarily vascular TOS?
At what point do they consider surgery necessary for the vascular form of TOS?
Are you only considered to have the vascular form if you develop clots?
Besides the scalene block which lasts only a few hours and Botox, are there other shots they can do into the brachial plexus?

I am hoping to avoid surgery!