Safety and efficacy of early surgical decompression of the thoracic outlet for Paget-Schroetter syndrome.

The surgical treatment of Paget-Schroetter syndrome has evolved to include early thrombolytic therapy and an interval period of anticoagulation, followed by late surgical decompression of the thoracic outlet. More recently, we have developed an abbreviated course of therapy in which the thrombolytic therapy is followed by early surgical decompression during the same admission, then a period of anticoagulation. We compared early surgical decompression with the standard management protocol to determine safety and efficacy of the early treatment algorithm.

Selective botulinum chemodenervation of the scalene muscles for treatment of neurogenic thoracic outlet syndrome.

Patients with thoracic outlet syndrome (TOS) who improve temporarily after anesthetic blockade of the anterior scalene muscles have been shown to improve after ultimate surgical decompressions at the interscalene triangle. Anesthetic blockade of the scalene muscles, even with the addition of steroids, however, rarely produces any prolonged relief as patients are awaiting definitive surgery. The present study was undertaken to determine if more effective and prolonged relief might be obtained with electrophysiologically and fluoroscopically guided selective injection of the scalene muscles with botulinum toxin, which has been used in the past for treating conditions associated with spasm of cervical muscles.

Endovascular, transperitoneal, and retroperitoneal abdominal aortic aneurysm repair: results and costs.

Purpose: Contemporary treatment of abdominal aortic aneurysms (AAA) includes transabdominal (TA), retroperitoneal (RP), and endovascular (EV) repair. This study compares the cost and early (30-day) results of a consecutive series of AAA repair by means of these three methods in a single institution.

Methods: A total of 125 consecutive AAA repairs between February 1993 and August 1997 were reviewed.

Thoracic outlet neurovascular compression: approaches to anatomic decompression and their limitations.

Surgical management of thoracic outlet syndrome (TOS) has evolved to include multiple approaches for anatomic decompression. The relevant anatomy and review of different operative approaches are presented. The supraclavicular and transaxillary approaches are the most commonly used, and each has relative advantages.

Diagnosis of thoracic outlet syndrome using electrophysiologically guided anterior scalene blocks.

There is no "gold standard" for diagnosing thoracic outlet compression syndrome (TOS), however, anesthetic blocks of the anterior scalene muscle (ASM) have been used as a means of predicting which patients may benefit from surgical decompression. The standard technique of using surface landmarks often results in inadvertent somatic block and sympathetic block because there is no reliable verification of needle tip localization. The present study was undertaken to determine if needle tip localization can be improved by using electrophysiological guidance.

Diagnosis and management of arterial compression at the thoracic outlet.

Neurovascular compression syndromes at the thoracic outlet generally present with predominantly arterial, venous, or neurogenic symptoms. The arterial abnormalities produce unique problems in diagnosis and management, and usually affect young, otherwise healthy, active individuals. Between 1984 and 1995 23 patients presented to our facility, with acute symptoms of arterial occlusion or embolization, found to be originating from the axillosubclavian arterial segment.

Intraoperative vascular endoscopy: early and late results.

In a prospective study, 60 consecutive cases of vascular endoscopy were analyzed to examine the role of angioscopy in infrainguinal vascular procedures. A total of 52 patients had 60 separate vascular endoscopy procedures performed as an adjunct to various vascular procedures; results of intraoperative arteriography were available in 38 of 60 cases. All patients were followed for at least 42 months.

Posterior exposure of the popliteal artery in reoperative vascular surgery.

Reoperative vascular surgical procedures play an important role in the successful salvage of ischemic limbs. Such secondary procedures frequently involve difficult situation where the surgical incisions and the vascular anatomy have been compromised by infection of prior surgery. In such instances an alternative surgical approach may provide a significant advantage and aid in successful revascularization.

Carotid-subclavian bypass for brachiocephalic occlusive disease. Choice of conduit and long-term follow-up.

Background And Purpose: Atherosclerotic disease of the proximal brachiocephalic circulation may produce disabling symptoms referable to cerebral or upper extremity hypoperfusion and embolization. Bypass of occlusive lesions can provide durable relief of symptoms with minimal complications. The ideal conduit for carotid-to-subclavian and subclavian-to-carotid bypass remains controversial, and it is not clear whether the outflow vessel influences patency and survival.

Thoracoscopic cervicodorsal sympathectomy: preliminary results.

Purpose: The purpose of this study was to determine the feasibility, safety, and efficacy of thoracoscopic cervicodorsal sympathectomy.

Methods: From March 1990 to December 1993, we performed 21 thoracoscopic sympathectomies in 19 patients. There were 13 women and six men; age 17 to 64 years, mean 37 years.

Thoracic outlet syndromes: new concepts from a century of discovery.

From March of 1861 to the present day there has been a striking evolution in the understanding of the neurovascular compressive disorders arising at the thoracic outlet. In 1958, Rob and Standeven reported the clinical characteristics of a group of patients with upper-extremity arterial complications. They suggested the commonality of the various compressive abnormalities by introducing the term, 'Thoracic Outlet Compression Syndrome' to the surgical literature.

A comparative study of intravenous versus intralymphatic interleukin-2, with assessment of effects of interleukin-2 on both peripheral blood and thoracic-duct lymph.

Recombinant human interleukin-2 (IL-2) was administered by the intravenous (i.v.) or intralymphatic (i.

Unilateral upper extremity edema. A case report.

A case report of a 28-year-old Hispanic male with a 5-month history of left arm, face and supraclavicular edema is presented. Chest radiography revealed bilateral pleural effusions. Thoracentesis was negative for malignant cells.

Evaluation of a new treatment strategy for Paget-Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein.

Purpose: The purpose of this study was to evaluate the efficacy of a staged, multimodal algorithm of therapy for durable correction of Paget-Schroetter syndrome.

Methods: Fifty consecutive patients were entered into a sequential treatment program for spontaneous axillary-subclavian vein thrombosis. Forty-three had initial thrombolytic or anticoagulant treatment followed by longer-term warfarin sodium therapy.

Developmental anomalies at the thoracic outlet: an analysis of 200 consecutive cases.

Anatomic observations were made during 200 consecutive transaxillary surgical procedures performed in 175 patients because of unremitting signs and symptoms of nerve or vascular compression at the thoracic outlet. There were 160 cases of brachial plexus compression and 40 cases of arterial or venous occlusion. In 132 (66%) of these cases, single or multiple abnormalities were recognized that represented developmental variations previously described in anatomic dissections or in embryologic studies.

Long-term results of infrainguinal revascularization with polytetrafluoroethylene: a ten-year experience.

Two hundred fifty-eight patients underwent 322 infrainguinal revascularizations with use of polytetrafluoroethylene (PTFE) between 1978 and 1988. The indication was limb salvage in 190 (59%) reconstructions. Two hundred nineteen (68%) were above-knee, and 75 (23%) were below-knee femoropopliteal bypasses.

An unusual cause of transient ischemic attacks: case report.

A 42-year-old black man, a physician, presented with a three week history of intermittent right arm and leg numbness and weakness, lasting about five minutes. This was not associated with headache, visual changes, seizures, aphasia or loss of consciousness. There was no history of head trauma, migraines, or previous attacks.

Effort thrombosis of the axillosubclavian vein: a disabling vascular disorder.

In the natural history of this disorder, resumption of normal activity after a period of recuperation (following an episode of thrombosis) frequently leads to symptoms of upper extremity venous hypertension exacerbated by using the arms in the overhead position. This position can be demonstrated venographically to further occlude collateral vessels in thoracic outlet. A number of patients develop more extensive symptoms of neurogenic thoracic outlet syndrome.

Massive splenomegaly. Superior results with a combined endovascular and operative approach.

Splenectomy for massive splenomegaly (drained splenic weight, greater than 1000 g) has an uncommonly high morbidity and mortality because of technical challenges and problems of hemostasis. In a group of 10 patients with massive splenomegaly due to myeloproliferative disorders (average splenic weight, 4193 g), we developed a management algorithm based on preoperative angiographic embolization of the splenic artery. Average operating time was 1.

The natural history of a traumatic vertebral artery aneurysm: case report.

A vertebral artery aneurysm resulting from stab wounds to the neck underwent spontaneous resolution during a period of observation. The natural history of such lesions appears to be previously undescribed.

Intraoperative infusion of lytic drugs for thrombotic complications of revascularization.

Between August 1983 and December 1987, 23 patients received a 30-minute intraoperative, intraarterial infusion of streptokinase (seven patients) or urokinase (16 patients) because of residual thrombus or persistent ischemia or both after thromboembolectomy. Ages ranged from 21 to 77 years (mean, 58 years). In 15 patients intraoperative lytic therapy was part of the initial operation, whereas in eight patients intraoperative lytic therapy was performed during a secondary operation to treat thrombosis of a recently placed graft.

Treatment of Paget-Schroetter syndrome. A staged, multidisciplinary approach.

A comprehensive approach to management of Paget-Schroetter syndrome was developed and applied to 25 consecutive patients. We studied 14 men and 11 women with an average age of 29 years, 17 of whom were either competitive athletes or industrial workers with onset of symptoms related to physical stress. Venous compression or thrombosis at the thoracic outlet was demonstrated in all patients, with similar abnormalities in the contralateral vein visualized in 12 of 15 patients studied.