Multidisciplinary Management and Staged Surgical Treatment for Chronic Thromboembolic Pulmonary Hypertension and Subclavian Vein Thrombosis Caused by Venous Thoracic Outlet Syndrome.

Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of deep vein thrombosis (DVT) and pulmonary embolism (PE), occurring in 3-5% of patients despite therapeutic anticoagulation. Venous thoracic outlet syndrome (VTOS) causing subclavian vein (SCV) thrombosis is also an uncommon condition, not frequently associated with clinically significant PE. In this report, we present two patients with CTEPH and SCV thrombosis caused by VTOS who had successful multidisciplinary management and staged surgical treatment for both conditions.

Ultrasonographic changes in the anterior scalene muscle in neurogenic thoracic outlet syndrome.

Background: Thoracic outlet syndrome (TOS) encompasses multiple symptoms produced by compression of the neurovascular bundle within the thoracic outlet. The subtypes of thoracic outlet are termed for the major affected structure including neurogenic TOS (nTOS), venous TOS, and arterial TOS. nTOS accounts for >95% of TOS cases and occurs from compression of the brachial plexus.

T1 erector spinae plane block for first rib resections in patients with thoracic outlet syndrome: a case series.

An erector spinae plane block (ESPB), in which a local anesthetic is injected into the plane anterior to the erector spinae muscles, is a relatively new technique for delivering regional anesthesia and is typically performed in the mid-thoracic region. ESPBs demonstrate great potential to control regional neuropathic pain, and, accordingly, may be particularly effective at the T1 level for controlling pain in patients undergoing first rib resections for thoracic outlet syndrome (TOS). Four patients undergoing first rib resections for TOS were administered an ultrasound-guided ESPB at the T1 level.

Performance and Return to Play After Surgery for Thoracic Outlet Syndrome in Professional Baseball Players: A Matched Cohort Analysis.

Background: Thoracic outlet syndrome (TOS) remains a rare diagnosis but is being recognized as a cause of upper extremity dysfunction in professional baseball players.

Purpose/hypothesis: The purpose was to determine performance and return-to-play (RTP) outcomes in professional baseball players after surgical treatment of TOS. The hypothesis was that there would be a high RTP rate in professional baseball players after TOS surgery with no statistical differences in performance between pitchers who had TOS surgery and matched controls.

Effects of radiation and MediPort placement on the development of thoracic outlet syndrome.

We present a patient who exemplifies the interplay of factors contributing to the development of venous-type thoracic outlet syndrome. The patient was treated with both radiation and chemotherapy for squamous cell carcinoma in the head and neck region; radiation and chemotherapy have been known to damage the vascular system. Multimodality treatment is necessary to achieve good long-term results in these complex patients.

Evaluation and treatment of thoracic outlet syndrome during the global pandemic due to SARS-CoV-2 and COVID-19.

The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources).

A novel surgical approach to symptomatic left renal vein aneurysm.

Visceral venous aneurysms are uncommon and renal vein aneurysms are among the rarest in this subset. Renal vein aneurysms are frequently asymptomatic, but patients may present with flank pain or hematuria. Complications of untreated visceral venous aneurysms include thrombus formation and, very rarely, rupture.

Case Report: A Durable Open Repair of a Rare Profunda Aneurysm.

Profunda femoris artery aneurysms (PFAAs) are rare and difficult to diagnose in the early stages of development due to location and encasement in the deep thigh musculature. We report the case of a 74-year-old male who was discovered to have a right PFAA during evaluation for progressively worsening short distance claudication. He had undergone an angioplasty of the left iliofemoral system several months ago with no improvement of his symptoms.

Performance Metrics in Professional Baseball Pitchers before and after Surgical Treatment for Neurogenic Thoracic Outlet Syndrome.

Background: High-performance throwing athletes may be susceptible to the development of neurogenic thoracic outlet syndrome (NTOS). This condition can be career-threatening but the outcomes of treatment for NTOS in elite athletes have not been well characterized. The purpose of this study was to utilize objective performance metrics to evaluate the impact of surgical treatment for NTOS in Major League Baseball (MLB) pitchers.

Surgical repair of renal artery aneurysms.

The pathogenesis of renal artery aneurysms (RAAs) is degenerative, which eventually leads to weakening of the vessel wall and, in extreme cases, rupture. RAAs are a rare occurrence. Patients generally are asymptomatic, with a small number presenting with uncontrollable hypertension or hematuria.

A hybrid repair of a superior mesenteric artery pseudoaneurysm using open mesenteric bypass and endovascular exclusion.

Superior mesenteric artery (SMA) aneurysms and pseudoaneurysms are uncommonly encountered in vascular surgery practice, but they typically require repair. Historically, they have been repaired with open aneurysmorrhaphy, bypass and exclusion, or simple ligation. More recently, endovascular repair with coil embolization and stent graft exclusion have been advocated.

Avoidance of lower-limb amputation by surgical implantation of autologous stem cells.

A 69-year-old Caucasian man was referred to Baylor University Medical Center at Dallas with resting lower-extremity pain and a nonhealing sore above his right ankle (Rutherford chronic ischemia stage 5 of 6) after having failed multiple attempts at revascularization. He was enrolled in a clinical research trial using adult autologous stem cells for treatment of critical limb ischemia. Autologous stem cells from the patient's pelvic bone marrow were harvested, concentrated in the operating room, and reinjected into the lower leg along the vasculature below the level of complete occlusion of the popliteal artery and around the ulcer.

Thermoregulatory catheter-associated inferior vena cava thrombus.

The use of thermoregulatory catheters (TRCs) in critically ill patients has become increasingly popular. TRCs have been shown to be effective in regulating patient body temperature with improved outcomes. Critically ill patients, especially multitrauma patients and those with femoral catheters, are at high risk for deep vein thrombosis (DVT).

Treatment of proximal vertebral artery disease.

Vertebral arterial disease (VAD) is a less commonly recognized and treated source of cerebrovascular ischemia compared with carotid artery disease. Patients are often referred for treatment after they have developed symptoms in the form of transient ischemic attacks or had a posterior hemispheric stroke. Traditional treatment of VAD has been surgical.

Early results and lessons learned from a multicenter, randomized, double-blind trial of bone marrow aspirate concentrate in critical limb ischemia.

Objectives: Despite advances in endovascular therapies, critical limb ischemia (CLI) continues to be associated with high morbidity and mortality. Patients without direct revascularization options have the worst outcomes. We sought to explore the feasibility of conducting a definitive trial of a bone marrow-derived cellular therapy for CLI in this "no option" population.

The role of amputation as an outcome measure in cellular therapy for critical limb ischemia: implications for clinical trial design.

Background: Autologous bone marrow-derived stem cells have been ascribed an important therapeutic role in No-Option Critical limb Ischemia (NO-CLI). One primary endpoint for evaluating NO-CLI therapy is major amputation (AMP), which is usually combined with mortality for AMP-free survival (AFS). Only a trial which is double blinded can eliminate physician and patient bias as to the timing and reason for AMP.

Endovascular treatment of an aberrant right subclavian artery aneurysm with use of the Zenith iliac plug.

Aberrant right subclavian artery aneurysms are rare but demonstrate a propensity toward rupture; thus, early elective repair is mandated. Novel endovascular modalities are available to offer less-invasive treatment for a patient population with increasing comorbidities. We report a case of a 65-year-old woman with an aberrant right subclavian artery aneurysm causing dysphagia lusoria.

Frequency and extent of media in the internal carotid artery in "endarterectomy" specimens.

Carotid endarterectomy has been performed now for approximately 50 years. No report, however, has described the presence of media in these "endarterectomy" specimens. From January 1997 through May 2003, 147 carotid endarterectomy specimens were examined histologically.

Relation of weights of intraaneurysmal thrombi to maximal right-to-left diameters of abdominal aortic aneurysms.

We determined the weight of operatively excised thrombi within abdominal aortic aneurysms (AAAs) in 42 patients aged 52 to 92 years (mean 73 +/- 9). The thrombi in the 32 men ranged in weight from 12 to 586 g (mean 162 +/- 135) and in the 10 women, from 12 to 351 g (mean 94 +/- 102). The maximal right-to-left diameter of the AAA by computed tomography immediately preoperatively in the 32 men ranged from 5.

Comparison of weights of carotid endarterectomy specimens in the same patient among patients undergoing bilateral procedures at different times.

We analyzed weights of carotid endarterectomy specimens in 17 patients who underwent bilateral procedures. Although we assumed that both arterial systems would be the same size, the weight of the carotid endarterectomy specimens was similar in only 4 of the 17 patients; the carotid endarterectomy specimen was larger at the second operation in 5 patients and smaller at the second operation in 8 patients.

Weights of carotid endarterectomy specimens in patients undergoing unilateral procedures.

Analysis of 273 unilateral carotid endarterectomy specimens showed those in the men to be larger than those in the women (1.4 vs 0.96 g).

Comparison of ages between men and women and their distribution across five age decades among patients undergoing carotid endarterectomy.

Analysis of 486 patients who underwent carotid endarterectomy from January 1996 to June 2002 showed similar mean ages in the 269 men and 217 women, whereas the reported mean ages at the time of abdominal aortic aneurysmal resection and at the time of coronary artery bypass grafting were usually significantly different between the 2 genders.