Originally Posted by usavla

I have been diagnosed with arterial TOS, caused by bilateral cervical ribs.
The left side is at risk of developing an aneurysm in the subclavian artery, so needs to be operated upon, to resect the cervical rib and possibly the first rib and scalene muscle.

I met Dr. Jason Lee at Stanford and Dr. Charles Eichler at UCSF. I am confused about the right place to get my surgery done. I'm fairly new to the Bay Area and the US and I was hoping someone could share their experiences with either of the doctors, or help with recommendations on doctors, or even share suggestion on choosing one.



Some background to explain my confusion:
Just before I moved the US, I underwent surgery for the right side to remedy an aneurysm on the subclavian artery that had already developed because the same reasons. The right cervical rib was resected and a PTFE graft used to replace the aneurysm. A few months after moving to the US, a scan showed that the graft was completely occluded. Luckily several collaterals had formed which kept the blood supply to the arm going and I had almost no symptoms other than some fatigue in the arm if strained. Blood pressure in the right arm consistently shows up 10 to 15 points below the left and I have a mild pulse in the right wrist.

Dr. Lee was much too eager to correct this surgically by creating a bypass to the occluded graft by having a new graft from the carotid to the subclavian.
Dr. Eichler, in my opinion, gave us a better picture of the surgery. He confirmed that the surgical option presented by Dr. Lee was accurate, but not necessary. He explained that with every intervention surgery gets more complicated (in case complication arise again after the corrective surgery) and suggested not doing anything with the right arm till real symptoms become evident, which might be never. This opinion was echoed by other doctors (in the family) who we consulted on phone.


To clarify, I'm seeking help for deciding on the preventive surgery on the left side. There is no doubt in anyone's mind that surgery is needed on the left and both surgeons have a pretty identical opinion on how it needs to be done - take out the cervical rib and first rib. I find a lot of references to Dr. Lee on the Internet and he seems to be a skilled surgeon, though my interactions with him make me less comfortable with his opinions on the corrective surgery on the other side. I felt much more comfort with Dr. Eichler, both in terms of communicating with him and his opinions, but I can see zilch written about him on the Internet.

Suggestions are greatly appreciated.