Botulinum Toxin Type A Improves Blood Flow in Vascular Thoracic Outlet Syndrome

Abstract

A 28-yr-old man, diagnosed with vascular thoracic outlet syndrome, had his right anterior scalene muscle injected with botulinum toxin type A under ultrasound guidance. Subclavian artery flow rates were measured with Doppler ultrasound before and 3 wks after the injection. At 3 wks, symptoms had improved. The reduction in subclavian artery flow rate associated with the arm abducted to the side with 90-degree external rotation decreased from 132.8 to 87.7 cm/sec preinjection compared with a smaller decrease postinjection from 132.8 to 119.1 cm/sec. An improved subclavian artery flow was seen after scalene muscle chemodenervation for vascular thoracic outlet syndrome. This suggests its potential as a diagnostic test, treatment option, and predictor for surgical intervention.

The Effect of Botulinum Neurotoxin-A on Blood Flow in Rats: A Potential Mechanism for Treatment of Raynaud Phenomenon

“…[1][2][3][4][5][6] In addition, botulinum toxin is emerging as a treatment modality for Raynaud phenomenon. [7][8][9][10] The mechanism of action of BoNTA at the neuromuscular junction and the functional recovery of the nerve and muscle are well established [11][12][13][14][15][16][17][18] ; however, little information is available regarding toxin effects on the local vasculature.…”

Surgical and Functional Outcomes After Thoracic Outlet Syndrome Decompression via Supraclavicular Approach: A 10-Year Single Centre Experience

“…Physiotherapy manoeuvres such as postural exercises and the first rib mobilisation aim to reduce the pressure on the neurovascular structures within the thoracic outlet [16,17]. Other conservative measures include the anterior scalene block with the Botulinum toxin type A (BTA) or local anaesthetic injection under ultrasound, computed tomography or electromyography guidance [5,18]. Relief of symptoms could be viewed as a "pre operative" assessment whether the patients would benefit from the first rib resection with scalenectomy [5,12].…”

A Review of Thoracic Outlet Syndrome and the Possible Role of Botulinum Toxin in the Treatment of This Syndrome

“…These include anesthetic agents [7,36], steroids [7], and botulinum toxin type A (BTX-A) [3,37,38,39]. The use of scalene muscle injections with local anesthetics is very short-lived and as such will only provide adjunctive support to one’s clinical diagnosis and possible prognosis regarding the reversibility of symptoms.…”