Folks,

Ok well I ran up to Lahey Clinic today to grab all my test results. This would include my MRA, Doppler Wave Form, and Arterial Exam. I'm going to document the results below.

What I'm looking for help with is:

1. Follow-up strategy. That is, what questions would you ask here in order to feel comfortable with a course of action?
2. Interpretation: I know you're not doctors, but I assume some of the language and findings below are familiar to you. If you have any thoughts on severity, feel free to chime in.

Here's the results:

MRA

* Focal kinking of right distal subclavian/proximal axillary artery with arms down.
* With arms elevated, there is high grade stenosis versus occlusion of the artery just distal to the point of kinking.
* Proximal subclavian veins are patent bilaterally with arms down but developed high grade stenosis with arms elevated.
* No evident arterial or venous thrombosis, aneurysm, or dissection.

Doppler

* Normal arterial flow is noted with arms in neutral position at sides.
* Obliteration of waveforms noted during Adson's maneuver with head turned to both the right and left side.
* Obliteration of waveforms during costoclavicular maneuver.
* Obliteration of waveforms noted during hyperabduction both 90 and 180 degrees.

Arterial Exam

* Normal arterial flow in the right and left upper extremeties.
* Triphasic waveforms throughout.


It would seem to me that a) I do have a pretty severe narrowing of the artery, but b) it hasn't yet created any thrombosis or worse.

Maybe this has been caught early?

It's my understanding from various readings that many with ATOS don't catch this until the severe symptoms emerge after clotting and such has taken place.

Some follow-up questions I have:

1. Is it possible that this was caught early enough to avoid surgery?
2. Could it be that through PT and such that the artery could heal on its own?
3. How severe is the narrowing? What percentage blocked vs normal?
4. Are there any additional tests that can be done to determine what exact damage has been done to the artery? Wouldn't this inform the exact procedure?
5. Most with ATOS have a cervical rib involved...don't see anything here. Are any anomolies contributing to the situation? Wouldn't knowing this help inform the exact procedure if need be?

Any other thoughts are welcome. I'm following up with the vascular surgeon at Lahey AND Dr Donaghue at Mass General next Wed. Hoping to have all ducks / questions in a row at that point.

Thanks in advance.

KY