Supraclavicular Versus Transaxillary First Rib Resection for Thoracic Outlet Syndrome.

Thoracic outlet syndrome (TOS) results from compression of neurovascular structures supplying the upper extremity as they exit the thoracic outlet. Depending on the clinical presentation, surgical decompression may be required. Transaxillary (TA) and supraclavicular (SC) approaches are both widely utilized and deemed effective.

Analysis of Aortic Growth Rates in Uncomplicated Type B Dissection.

Background: Uncomplicated type B dissections have historically been treated medically with hemodynamic control. Early progression of the disease and late aneurysmal dilation have been considered as indications for intervention. The aim of this study is to analyze growth rate patterns of type B dissections based on computed tomography (CT) measurements over time.

Endovascular Treatment of a Traumatic Thoracic Aortic Injury in an Eight-Year Old Patient: Case Report and Review of Literature.

Traumatic aortic injuries in children and adolescents are rare. Although endovascular repair has become the preferred approach for such injuries in adults, open repair has endured as the gold standard in children owing mainly to the smaller aortic and access vessel diameter and the scarcity of long-term follow-up data. We report a successful endovascular repair of a traumatic thoracic aortic injury in an 8-year-old girl using a Zenith Alpha thoracic endograft (Cook Medical, Bloomington, IN).

May-Thurner syndrome presenting as spontaneous left iliac vein rupture.

Spontaneous iliac vein rupture resulting in a retroperitoneal hematoma is extremely rare and can present as a life-threatening emergency. There is often a delay in diagnosis with no established treatment recommendations. We report the case of a 39-year-old woman who presented with hypovolemic shock, a large left retroperitoneal hematoma, and left lower extremity phlegmasia in the setting of a previously asymptomatic May-Thurner syndrome.

Possible genetic component to the etiology of perigraft hygromas.

Perigraft hygroma is a known complication of prosthetic graft implantation. The specific etiology of perigraft hygromas is still unknown. We report 2 brothers who underwent open abdominal aortic aneurysm repairs with polytetrafluoroethylene grafts that developed progressively enlarging perigraft hygromas.

Endovascular recanalization of total occlusions of the mesenteric and celiac arteries.

Objective: To evaluate our experience with the endovascular treatment of total occlusions of the mesenteric and celiac arteries.

Methods: We performed a retrospective review of endovascular stenting of 27 nonembolic total occlusions of the superior mesenteric artery (SMA) and celiac artery (CA) between July 2004 and July 2011 (26 patients, 16 females; mean age, 62 ± 13 years). A variety of demographic, lesion-related and procedure-related variables were evaluated for potential impact of technical success and patency.

Anatomic bifurcated reconstruction of chronic bilateral innominate-superior vena cava occlusion using the Y-stenting technique.

This article presents the case of a 42-year-old man who presented with superior vena cava (SVC) syndrome due to fibrosing mediastinitis with multiple failed attempts at recanalization. We initially treated him with unilateral sharp needle recanalization of the right innominate vein into the SVC stump followed by stenting. Although his symptoms improved immediately, they did not completely resolve.

A natural history of aortic aneurysm hygroma.

A 56-year-old man with a family history of aortic aneurysm underwent routine repair in 2003. A postoperative computed tomography scan showed a 6-cm perigraft hygroma. Sudden onset of abdominal pain 12 months later revealed a larger hygroma, with an additional anterior fluid collection suggestive of contained rupture.

Combined direct repair and inline inflow stenting in the management of aortoiliac disease extending into the common femoral artery.

Purpose: Describe a hybrid approach to simplify management of complex aortoiliac occlusive disease (AIOD) extending into the common femoral artery (CFA).

Methods: Retrospective review of 56 patients who underwent hybrid management of AIOD extending into CFA between January 2003 and February 2007. Two distinct hybrid approaches were compared: Inline (iliac stenting continuous with an open CFA reconstruction, 38 limbs in 37 patients) and tandem (noncontiguous stenting of an upstream iliac segment, 20 limbs in 19 patients).

Impact of aggressive endovascular recanalization techniques on success rate in chronic total arterial occlusions (CTOs).

Purpose: To report experience with aggressive recanalization approaches in chronic total arterial occlusion (CTO).

Methods: Chronic total arterial occlusion recanalization was attempted on 112 limbs in 99 consecutive patients between January 1999 and December 2006.

Results: There were 63 iliac arteries, 45 femoropopliteal arteries, and 4 occluded stents.

Residents' attitudes about the introduction of a surgical skills simulation laboratory.

Background: As surgical education programs develop surgical skills laboratories, it will be important to do so in the most efficient, cost-effective manner.

Methods: We distributed a brief written survey to all general surgery residents at the University of Iowa Hospitals and Clinics regarding their perceptions of the usefulness of a surgical skills laboratory in training of both open and laparoscopic techniques. For the initial survey, we used analysis of variance to compare differences across groups.

Long-term outcome following stent reconstruction of the aortic bifurcation and the role of geometric determinants.

We assessed the long-term patency of kissing stent reconstruction of the aortoiliac bifurcation and identified variables that may influence it. We retrospectively reviewed our experience with stent-reconstruction procedures of the aortoiliac bifurcation from January 1998 through June 2005. The impact of demographic variables, vascular risk factors, disease location and characteristics, stent material and design, and stenting configuration on stent patency was assessed using univariate and multivariate analysis.

Kissing stent reconstruction of the aortoiliac bifurcation.

Kissing stent reconstruction of the aortoiliac bifurcation is a widely used technique for the management of aortoiliac occlusive disease involving the aortic bifurcation or proximal common iliac arteries. New advances in delivery systems and stent design have enabled better anatomic results with kissing stenting. Long-term patency is generally excellent, although several factors may adversely affect patency and should be taken into account when devising the stenting configuration and selecting the device to be used.

Use of autogenous saphenous vein as a conduit for mesenterico-left portal vein bypass.

The authors describe a case of extrahepatic portal vein (EHPV) thrombosis and portal hypertension treated with a variant of mesenterico-left portal vein bypass (MLPVB) or Rex shunt. In this case, a segment of autogenous greater saphenous vein was used to bridge the distance between the left gastric vein inflow and the left portal vein. Use of such nontraditional conduit in similar circumstances may expand the application of portal revascularization/decompression procedures in treating these patients.

Balloon angioplasty as a treatment of failing infrainguinal autologous vein bypass grafts.

Purpose: The purpose of this study was to evaluate the role of balloon angioplasty in the treatment of failing infrainguinal vein bypass (IVB) grafts.

Methods: A retrospective chart review of patients undergoing revision of a failing IVB graft by vascular surgeons at a tertiary care center from 1990 to 2001 was performed. Failing bypass grafts were identified by routine duplex scan surveillance and physical examination.

Endovascular management of venous thrombotic and occlusive diseases of the lower extremities.

Acute complications of deep vein thrombosis (DVT) of the lower extremities include pulmonary embolism and venous ischemia. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Anticoagulation therapy is recognized as the mainstay of therapy in acute DVT.

Duplex saphenous vein mapping: venous occlusion and dependent position facilitate imaging.

The purpose of this study was to develop an optimal technique for greater saphenous vein distention during preoperative duplex assessment. An Acuson 128 scanner with a 7.5-MHz sector probe was used to assess the effects of venous occlusion and dependent position on the diameter of the greater saphenous vein in 20 male volunteers.

High-resolution multiphase contrast-enhanced three-dimensional MR angiography compared with two-dimensional time-of-flight MR angiography for the identification of pedal vessels.

Purpose: The authors prospectively evaluated optimized multiphase high-resolution (HR) Gadolinium (Gd)-enhanced three-dimensional (3D) magnetic resonance (MR) angiography and standard two-dimensional (2D) time-of-flight (TOF) MR angiography for their ability to delineate distal calf and pedal vessels.

Materials And Methods: Twelve patients (20 limbs) with limb-threatening peripheral arterial occlusive disease underwent HR Gd-enhanced and 2D TOF MR angiography to identify targets for distal bypass. Imaging of the region of the ankle and foot was performed on a 1.

Oxidative stress in human abdominal aortic aneurysms: a potential mediator of aneurysmal remodeling.

Abdominal aortic aneurysm (AAA) is an inflammatory disorder characterized by localized connective tissue degradation and smooth muscle cell (SMC) apoptosis, leading to aortic dilatation and rupture. Reactive oxygen species are abundantly produced during inflammatory processes and can stimulate connective tissue-degrading proteases and apoptosis of SMCs. We hypothesized that reactive oxygen species are locally increased in AAA and lead to enhanced oxidative stress.