Functional Results of Cervical Rib Resection for Thoracic Outlet Syndrome: Impact on Professional Activity.

Background: The aim of this study is to report long-term functional results following cervical rib (CR) resection for thoracic outlet syndrome (TOS).

Methods: This monocentric study included all cases of resection of CR for TOS performed between January 2004 and December 2016. Data were retrospectively collected from the hospital electronic database including preoperative symptoms and the evaluation of occupational well-being, intraoperative data, and early clinical evaluation and occupational well-being during the postoperative period.

Endovascular Reconstruction of Subclavian Artery Aneurysms in Patients with Arterial Thoracic Outlet Syndrome.

Background: Subclavian artery aneurysms associated with thoracic outlet syndrome (TOS) have traditionally been managed by open surgical reconstruction. Endovascular subclavian artery reconstruction is novel in the setting of arterial TOS (aTOS). Our objective is to report our results with endovascular subclavian artery reconstruction in aTOS patients over a 10-year period with attention to surgical approach and late results.

Outcomes of Brachial Artery Access for Endovascular Interventions.

Background: A percutaneous brachial artery (BA) approach is a suitable or even favorable alternative to femoral artery access when performing certain endovascular interventions. However, this approach may have a higher complication rate compared to femoral artery access. We analyzed our results using percutaneous BA approach for noncardiac endovascular interventions.

The distance of the primary intimal tear from the left subclavian artery predicts aortic growth in uncomplicated type B aortic dissection.

Objective: Controversy exists about the optimal treatment of acute uncomplicated type B aortic dissection (auTBAD). Optimal medical therapy (OMT) provides excellent short-term outcomes, but long-term results are poor. Ideally, auTBAD patients who will fail to respond to OMT in the chronic phase could be identified and undergo thoracic endovascular aortic repair.

[Vertebrobasilar territory embolisms due to the ununited fracture of the right clavicle from 35 years ago].

A 61-year-old man, with a history of right clavicular fracture 35 years prior, visited our hospital due to the sudden onset of vertigo and tinnitus following weakness and numbness in his left arm and leg. He also had a 6-month history of right arm pain with overuse. Brain MRI showed acute brain infarcts in the right posterior cerebral artery territory.

3D CT cinematic rendering of mycotic aneurysms.

Mycotic aneurysms are uncommon but emergent conditions in which infection of a vessel leads to a contained rupture. Progression to frank rupture, thrombosis, distal embolization, and death can occur. The widespread availability of computed tomography (CT) and its ability to obtain high-resolution, contrast-enhanced, volumetric images rapidly has made it the modality of choice for evaluating mycotic aneurysms.

Simultaneous thoracic aortic endovascular graft and transfemoral transcatheter aortic valve replacement in a patient with a descending aortic thrombus.

Severe descending thoracic and abdominal aortic pathology can deter consideration of transfemoral (TF) access for transcatheter aortic valve replacement (TAVR) in adults with severe symptomatic aortic stenosis (AS) and may lead to utilization of alternative access sites. We report a case of an 88-year-old frail woman with severe symptomatic AS referred for TAVR with demonstration of a large thrombus in the descending thoracic aorta immediately distal to the left subclavian artery. Given concerns of thrombus embolization with femoral advancement of the transcatheter valve, coverage with a thoracic aortic endograft was planned immediately prior to the TAVR.

Post-operative Infection of Prosthetic Materials or Stents Involving the Supra-aortic Trunks: A Comprehensive Review.

Objective: The aim of this paper was to provide recommendations for diagnosis and management in the setting of infection following open or endovascular reconstructions of the supra-aortic trunks.

Methods: A review of the Medline database was performed from 1997 to 2017 by a combined strategy of MeSh terms.

Results: The literature search identified 49 publications: 36 studies addressing prosthetic material infections and 13 studies addressing stent infections.

Hybrid Treatment of a True Right Subclavian Artery Aneurysm Involving the Vertebral Artery using a Covered Stent.

Subclavian artery aneurysms (SAAs) are rare but potentially life- and limb-threatening. We present the case of a 69-year-old man with a true right SAA; the vertebral artery branched off the aneurysm and was the dominant one. A hybrid (combined open surgical and endovascular) repair was performed; the vertebral artery was anastomosed end to side to the common carotid artery through a right supraclavicular incision, then using a percutaneous high brachial artery access, a covered stent was deployed to exclude the SSA.

Outcomes of Stentless Thoracic Endovascular Aortic Repair for Chronic DeBakey IIIb Aneurysms.

Background: We introduce a new endovascular procedure for favorable aortic remodeling in patients with chronic DeBakey IIIb (CDIIIb) aneurysms and present outcomes.

Methods: This study included 19 patients who underwent stentless thoracic endovascular aortic repair (TEVAR) for CDIIIb aneurysms between 2014 and 2016. Stentless TEVAR is defined as an endovascular procedure involving closure of communicating channels or obliteration of the false lumen itself using various materials.

Technical Aspects of Using the AngioVac System for Thrombus Aspiration From the Ascending Aorta.

Purpose: To present the technique for removing mural thrombus from the ascending aorta using the AngioVac System.

Technique: The technique is demonstrated in a 66-year-old woman who presented with free-floating mural thrombus in the ascending aorta and was considered unsuitable for either open (comorbidities) or endovascular approaches (high risk of stroke). Because of the free-floating thrombus, the Angiovac system was suggested, although it is approved for only the venous system.

Acute subclavian artery occlusion with associated clavicle fracture managed with bypass graft alone.

Subclavian artery injury is a rare consequence of clavicle fracture. It most often results from penetrating trauma but can result from blunt trauma with adjacent bone fragments causing rupture, pseudoaneurysm, dissection or thrombosis of the artery. If flow through the subclavian artery is compromised there is a risk of ipsilateral upper limb ischaemia.

Concomitant Hybrid Arch Vessel Reconstruction and Intracranial Clot Retrieval in Takayasu's Arteritis Presenting with Acute Cerebral Ischemia: A Case Report.

Background: Type 1 Takayasu's arteritis (TA) predominantly affects the supra-aortic branches. Occlusive disease can cause catastrophic complications such as stroke and death. Open and endovascular techniques of revascularization are described for extracranial disease.

A Case of Posterior Circulation Ischemic Stroke Caused by Heparin-Induced Thrombocytopenia after Detaining Hepatic Arterial Infusion Catheter.

In Japan, hepatic arterial infusion chemotherapy (HAIC) using reservoir system is recommended for patients with hepatocellular carcinoma (HCC) whose hepatic spare ability is favorable. Arterial infusion catheter is commonly detained in hepatic artery via femoral or brachial artery. In our hospital, catheter is often inserted by puncturing the left subclavian or brachial artery considering the patient's activities of daily living (ADL) during long-term detaining.

Natural history of aneurysmal aortic arch branch vessels in a single tertiary referral center.

Objective: Little is known about the natural history and management of aneurysmal aortic arch branch vessels (AABVs). The objectives of this study were to assess the natural history of aneurysmal AABVs and to examine the outcomes of operative intervention.

Methods: A retrospective review of the Yale radiologic database from 1999 to 2016 was performed.

Delayed Subclavian Artery Aneurysm Following Fixation of a Clavicular Fracture.

Aneurysms of the subclavian artery are rare phenomena that have the potential for limb and life-threatening complications. Delayed diagnosis increases the risk of life-threatening complications or at the very least may result in a detrimental effect to both functional capacity and quality of life; primary care offers a vital opportunity to screen for such rare vascular complications and should be a consideration in all patients with evolving peripheral nerve or vascular symptoms with a history of localized clavicular trauma. We present the case of a left subclavian artery aneurysm with radial artery thrombotic sequelae following an injury and screw-plate fixation of his left clavicle.

Endovascular repair of thrombosed-type acute Type A aortic dissection with critical renal artery malperfusion.

An 81-year-old woman was referred to our centre for emergency surgery with a suspected diagnosis of acute aortic dissection. Laboratory tests showed marked elevation of serum creatinine and blood urea nitrogen. Enhanced computed tomography (CT) demonstrated Type A aortic dissection with a thrombosed false lumen in the ascending aorta.

Effort thrombosis of the subclavian artery as a consequence of a unique anomaly.

Congenital anatomic anomalies and variations are frequent in the thoracic outlet and may be associated with clinical symptoms. Arterial thoracic outlet syndrome (TOS) is characterized by subclavian artery compression and vascular pathology, almost always in the presence of a bony abnormality. We describe here a patient with arterial thromboembolism following a fall on the outstretched arm, who was found to have subclavian artery stenosis and post-stenotic dilatation in the absence of a bony abnormality.

The effect of false lumen procedures during thoracic endovascular aortic repair in patients with chronic DeBakey type IIIB dissections.

Objective: Although thoracic endovascular aortic repair (TEVAR) is commonly used for chronic DeBakey type IIIB (CDIIIB) dissections, aortic remodeling outcomes after the procedure have been unsatisfactory. Persistent retrograde flow to the false lumen (FL) through re-entry tears commonly causes treatment failure. The aim of this study was to clarify the safety and effect of the FL procedure (FLP) for aortic remodeling in patients with CDIIIB dissections.

False lumen intervention to promote remodelling and thrombosis-The FLIRT concept in aortic dissection.

Objective: Thoracic endovascular aortic repair (TEVAR) has changed the management of aortic dissection by induced remodelling. Beyond reconstructing the true lumen, we describe the concept of False Lumen Intervention to promote Remodelling and Thrombosis (FLIRT) in both type A and B aortic dissection.

Methods: Between 2011 and 2017, 10 patients with aortic dissection (5 type A; 5 type B) underwent FLIRT using a combination of patent foramen ovale (PFO) or atrial septal defect (ASD) occluders, coils and glue.

Repeat left ventricular assist device exchange with inflow or outflow correction for recurrent pump thrombosis and cerebral haemorrhage through limited incisions.

Left ventricular assist devices (LVADs) may require subsequent pump exchange due to device thrombosis or thromboembolism. A limited left thoracotomy may offer advantages over standard full sternotomy in redo procedures by preserving pristine median access and decreasing the potential for re-entry injuries, postoperative bleeding and transfusion requirements. We describe repeat LVAD exchange via the left limited thoracotomy with outflow graft anastomosis to the left subclavian artery with the correction of LVAD inflow cannula angulation following recurrent LVAD thromboses.

Endovascular Repair of Incidentally Found Subclavian Artery Aneurysm: A Case Report From an Urban Level 1 Trauma Center.

Subclavian artery aneurysms (SAAs) are historically rare peripheral aneurysm. However, it can be associated with serious life-threatening complications including rupture, thrombosis, and embolism. The majority of such aneurysms are found incidentally.

Two Cases of Endovascular Repair with the Stent Graft for Retrograde Type A Acute Aortic Dissection with Complications.

Thoracic endovascular aortic repair (TEVAR) is used to treat retrograde type A acute aortic dissection (RTAAD). In case 1, a 52-year-old man, who was conservatively managed, reported worsening back pain. Emergency TEVAR was performed 7 days after onset.

Patent foramen ovale, paradoxical embolism and fatal coronary obstruction.

A 75-year-old woman was admitted to the emergency room with chest pain and vomiting. An electrocardiogram and laboratory results were suggestive for myocardial infarction of the posterior cardiac wall. Echocardiography was indicative of aortic dissection, and a CT scan of the thoracic arteries showed a massive pulmonary thromboembolism and thrombotic occlusion of the right coronary artery (RCA).