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[PMID]: 29401331
[Au] Autor:White JM; Soo Hoo AJ; Golarz SR
[Ad] Address:Division of Vascular Surgery, The Department of Surgery at Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889.
[Ti] Title:Supraclavicular Thoracic Outlet Decompression in the High-Performance Military Population.
[So] Source:Mil Med;183(1-2):e90-e94, 2018 Jan 01.
[Is] ISSN:1930-613X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Background: Neurogenic thoracic outlet syndrome (nTOS) is a relatively common disorder and often affects younger, physically active populations. The modern American military is a population at risk for the development of nTOS given the intense physical training requirements. The purpose of this study is to determine functional recovery in the active duty military population resulting in full, unrestricted return-to-duty status following supraclavicular thoracic outlet decompression with partial first rib resection, partial anterior scalenectomy, and brachial plexus neurolysis. Methods: This retrospective study was approved by the Institutional Review Board at Walter Reed National Military Medical Center, Bethesda, Maryland to evaluate functional recovery following the surgery management of nTOS. In accordance with the Walter Reed National Military Medical Center Institutional Review Board, patient informed consent was obtained for this study. An institutional procedural database (Walter Reed National Military Medical Center Surgery Scheduling System) was queried for consecutive patients who underwent supraclavicular thoracic outlet decompression from January 2011 to May 2015. This study involved the completion of two survey instruments: the Disabilities of the Arm, Shoulder, and Hand survey and the Cervical Brachial Symptoms Questionnaire. Patients were asked to complete the preoperative surveys and the postoperative surveys. Results: Twenty responses were obtained with a 57% (20/35) overall response rate. Due to the low sample size, results were reported as a median rather than a mean to reduce the bias of outliers. Of the 20 patients who underwent supraclavicular thoracic outlet decompression, 85% reported improved functional recovery, 10% demonstrated no improvement but maintained stable functional and symptomatic deficits, and 5% demonstrated worsening of their functional and symptomatic status. The median total preoperative Disabilities of the Arm, Shoulder, and Hand score was calculated at 112 (interquartile range [IQR] 94-122) with an overall score reduction demonstrated by the median total postoperative Disabilities of the Arm, Shoulder, and Hand score of 50 (IQR 40-71). The median total score reduction of 57 (IQR 28.5-72) represented improved clinical and functional recovery (p < 0.001). The median total preoperative Cervical Brachial Symptoms Questionnaire score was 96 (IQR 74-111) with an overall score reduction revealed by the median total postoperative Cervical Brachial Symptoms Questionnaire score of 28 (IQR 19-45). The median total score reduction of 60 (IQR 23-77) reflected significant functional recovery consistent with clinical improvement (p < 0.001). Around 89% of patients had a predecompression temporary profile secondary to physical debilitation directly related to nTOS. Following surgery, temporary profile status was reduced to 39%. Around 61% of patients were able to complete and pass their service-specific physical fitness testing. Around 56% of patients demonstrated a full return-to-duty status without limitations. Conclusion: Supraclavicular partial first rib resection, partial anterior scalenectomy, and brachial plexus neurolysis results in significant improvement in functional recovery in the military active duty patient population. Prospective studies are warranted to further characterize and define nTOS functional recovery after surgery in this population.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1093/milmed/usx010

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[PMID]: 29504475
[Au] Autor:Jubbal KT; Zavlin D; Harris JD; Liberman SR; Echo A
[Ad] Address:1 Loma Linda University, CA, USA.
[Ti] Title:Morbidity of First Rib Resection in the Surgical Repair of Thoracic Outlet Syndrome.
[So] Source:Hand (N Y);:1558944718760037, 2018 Mar 01.
[Is] ISSN:1558-9455
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Thoracic outlet syndrome (TOS) is a complex entity resulting in neurogenic or vascular manifestations. A wide array of procedures has evolved, each with its own benefits and drawbacks. The authors hypothesized that treatment of TOS with first rib resection (FRR) may lead to increased complication rates. METHODS: A retrospective case control study was performed on the basis of the National Surgical Quality Improvement Program database from 2005 to 2014. All cases involving the operative treatment of TOS were extracted. Primary outcomes included surgical and medical complications. Analyses were primarily stratified by FRR and secondarily by other procedure types. RESULTS: A total of 1853 patients met inclusion criteria. The most common procedures were FRR (64.0%), anterior scalenectomy with cervical rib resection (32.9%), brachial plexus decompression (27.2%), and anterior scalenectomy without cervical rib resection (AS, 8.9%). Factors associated with increased medical complications included American Society of Anesthesiologists (ASA) classification of 3 or greater and increased operative time. The presence or absence of FRR did not influence complication rates. CONCLUSIONS: FRR is not associated with an increased risk of medical or surgical complications. Medical complications are associated with increased ASA scores and longer operative time.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:Publisher
[do] DOI:10.1177/1558944718760037

  3 / 2441 MEDLINE  
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[PMID]: 29444598
[Au] Autor:Bongiolatti S; Massi D; Maio V; Gonfiotti A; Viggiano D; Voltolini L
[Ad] Address:1 Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
[Ti] Title:Venous outlet syndrome caused by capillary hemangioma of the subclavian vein.
[So] Source:Asian Cardiovasc Thorac Ann;26(3):224-226, 2018 Mar.
[Is] ISSN:1816-5370
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:We report a case of intravenous lobular capillary hemangioma in the subclavian vein, causing venous thoracic outlet syndrome. A 32-year-old woman was referred to our unit with facial and left arm oedema. Ultrasound evaluation, computed tomography and magnetic resonance imaging showed a hypervascular mass in the middle portion of the subclavian vein, with arrest of venous flow. Through an infraclavicular approach, we excised the venous axis with the endovascular palpable tumour that extended from the axillary-subclavian junction to the jugular-subclavian junction, without reconstruction. The postoperative period was uneventful. The patient recovered well without recurrence at one year from surgery.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180301
[Lr] Last revision date:180301
[St] Status:In-Process
[do] DOI:10.1177/0218492318760693

  4 / 2441 MEDLINE  
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[PMID]: 29477681
[Au] Autor:Archie MM; Rollo JC; Gelabert HA
[Ad] Address:Ronald Reagan UCLA Medical Center, Department of Surgery, Division of Vascular Surgery. 200 Medical Plaza Suite 526, Los Angeles, CA 90095. Electronic address: Marchie@mednet.ucla.edu.
[Ti] Title:Surgical Missteps in the Management of Venous Thoracic Outlet Syndrome Which Lead to Reoperation.
[So] Source:Ann Vasc Surg;, 2018 Feb 22.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Surgical management of spontaneous subclavian thrombosis due to venous thoracic outlet syndrome (vTOS) results in durable relief of symptoms. The need to re-operate is rare. We report our experience with re-operation for vTOS. METHODS: Patients evaluated for vTOS between 1996 and 2016 were identified in a prospective database. Data recorded included demographics, initial presentation, initial surgery, recurrent presentation, re-operation, and final outcomes. RESULTS: In all, 261 patients were evaluated for vTOS, of these 246 underwent first rib resections. Ten (3.8%) patients required evaluation for recurrent vTOS symptoms. Prior management included thrombolysis (4), anticoagulation alone (6). Prior surgical approaches included infraclavicular (2), supraclavicular (2), and transaxillary (6). One operation was complicated by a hemothorax, and one a brachial plexus injury. Indication for re-operation included congestive symptoms (6), and recurrent thrombosis (4). Evaluation included chest-x-rays (10), venogram (8), IVUS (2), and CT venography (3). Significant compression by remaining rib segments were identified in all: inadequate resection of the anterior first rib (7), inadequate resection of posterior rib segment (1) and erroneous resection of second rib (2). Re-operations include 7 trans-axillary approaches, 1 medial claviculectomy, and 1 paraclavicular decompression. One phrenic nerve palsy occurred following paraclavicular decompression. All underwent post-op venography and angioplasty. At final evaluation 8 veins are patent and congestive symptoms resolved, 1 crushed stent could not be re-opened despite decompression. CONCLUSION: The incidence of re-operation for first rib resection in cases of vTOS is low and appears largely due to missteps during the initial operation. Awareness of potential errors including inadequacy of resection, intraoperative disorientation, and misunderstanding of the limitations of surgical approaches will result in fewer re-operations.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180225
[Lr] Last revision date:180225
[St] Status:Publisher

  5 / 2441 MEDLINE  
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[PMID]: 28459919
[Au] Autor:Noyes AM; Dickey J
[Ad] Address:Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI.
[Ti] Title:The Arm is Not the Leg: Pathophysiology, Diagnosis, and Management of Upper Extremity Deep Vein Thrombosis.
[So] Source:R I Med J (2013);100(5):33-36, 2017 May 01.
[Is] ISSN:2327-2228
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Upper extremity deep venous thrombosis (UEDVT) involves thrombosis of the deep veins of the arm as they enter the thorax. They are increasing in frequency, largely due to the rising use of central venous catheters and implantable cardiac devices, and represent more than 10% of all DVT cases, Upper extremity deep venous thrombosis has been historically misunderstood when compared to lower extremity deep vein thrombosis (LEDVT). Their associated disease states may carry devastating complications, with mortality rates often higher than that of LEDVT. Thus, education on recognition, classification and management is critical to avoid long-term sequelae and mortality from UEDVT. [Full article available at http://rimed.org/rimedicaljournal-2017-05.asp].
[Mh] MeSH terms primary: Upper Extremity Deep Vein Thrombosis/diagnosis
Upper Extremity Deep Vein Thrombosis/therapy
[Mh] MeSH terms secundary: Humans
Upper Extremity Deep Vein Thrombosis/physiopathology
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180221
[Lr] Last revision date:180221
[Js] Journal subset:IM
[Da] Date of entry for processing:170502
[St] Status:MEDLINE

  6 / 2441 MEDLINE  
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[PMID]: 29421422
[Au] Autor:Ohman JW; Abuirqeba AA; Jayarajan SN; Balderman J; Thompson RW
[Ad] Address:Center for Thoracic Outlet Syndrome, Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
[Ti] Title:Influence of Body Weight on Surgical Treatment for Neurogenic Thoracic Outlet Syndrome.
[So] Source:Ann Vasc Surg;, 2018 Feb 05.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:BACKGROUND: Body weight affects outcomes of surgical treatment for various conditions, but its effects on the treatment of neurogenic thoracic outlet syndrome (NTOS) are unknown. The purpose of this study was to evaluate the influence of body weight on technical and functional outcomes of surgical treatment for NTOS. METHODS: A retrospective review of prospectively collected data was conducted for 265 patients who underwent supraclavicular decompression for NTOS between January 1, 2014 and March 31, 2016. Patients were grouped according to 6 standard body mass index (BMI) categories. The influence of BMI on measures of surgical outcome was analyzed using Pearson correlation statistics, analysis of variance (ANOVA), and multivariate logistic regression. RESULTS: Mean patient age was 33.3 ± 0.7 years (range, 12-70), and 208 (78%) patients were women. Mean BMI was 27.2 ± 0.4 (range 16.8-49.9), with 7 underweight (3%), 95 normal (36%), 84 overweight (32%), 47 obese-I (18%), 15 obese-II (6%), and 17 obese-III (6%). There was a slight but significant association between BMI and age (Pearson P < 0.0001, r = 0.264; ANOVA P = 0.0002), but no correlations between BMI and other preoperative variables. There were no differences between BMI groups for intraoperative, immediate postoperative, or 3-month outcomes. Multivariate logistic regression demonstrated that BMI had no significant effect on functional outcome as measured by the extent of improvement in Disability of the Arm, Shoulder, and Hand score at 3 months (P = 0.429). CONCLUSIONS: There was no substantive influence of BMI on preoperative characteristics or intraoperative, postoperative, or 3-month outcomes for patients with NTOS, and no indication of an "obesity paradox" for this condition. Supraclavicular decompression for NTOS achieves similar outcomes across the BMI spectrum.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180219
[Lr] Last revision date:180219
[St] Status:Publisher

  7 / 2441 MEDLINE  
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[PMID]: 29289365
[Au] Autor:Nuutinen H; Riekkinen T; Aittola V; Mäkinen K; Kärkkäinen JM
[Ad] Address:Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
[Ti] Title:Thoracoscopic Versus Transaxillary Approach to First Rib Resection in Thoracic Outlet Syndrome.
[So] Source:Ann Thorac Surg;105(3):937-942, 2018 Mar.
[Is] ISSN:1552-6259
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:BACKGROUND: This study assessed the feasibility of fully endoscopic thoracoscopic first rib resection (FRR) in the treatment of neurogenic thoracic outlet syndrome by comparing early outcomes of the thoracoscopic technique against the traditional transaxillary FRR. METHODS: Between 2009 and 2016, 60 consecutive FRRs were performed on 47 patients with neurogenic thoracic outlet syndrome (13 bilateral procedures). The first 30 procedures were performed using the traditional transaxillary technique, and the novel thoracoscopic technique was used in the next 30 operations with the same indications for operative repair. All data were collected retrospectively by independent investigators. The main issues were operation time, learning curve, hospital length of stay, complications, and clinical follow-up status at 3 months. RESULTS: The groups were similar at baseline. The mean operation time was 83 ± 27 minutes in the thoracoscopic group and 48 ± 12 minutes in the transaxillary group (p < 0.001). The first thoracoscopic procedures were 2 hours long, after which, a steady 1-hour procedure time was achieved. Differences regarding the hospital stay or the need for postoperative pain medication were not significant. Two-thirds reported good or excellent recovery at follow-up in both groups. There were no immediate complications. Plexus neuralgia developed in 1 patient 3 weeks after the thoracoscopic operation, and 3 patients were diagnosed with superficial wound infection after the transaxillary procedure. CONCLUSIONS: This study showed that FRR for neurogenic thoracic outlet syndrome can be done safely with a fully endoscopic approach. However, the technique requires experience with thoracoscopic surgery, and there is a learning curve to the procedure.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180219
[Lr] Last revision date:180219
[St] Status:In-Data-Review

  8 / 2441 MEDLINE  
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[PMID]: 29445946
[Au] Autor:Prezerakos GK; Sayal P; Kourliouros A; Pericleous P; Ladas G; Casey A
[Ad] Address:Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. gprezerakos@gmail.com.
[Ti] Title:Paravertebral tumours of the cervicothoracic junction extending into the mediastinum: surgical strategies in a no man's land.
[So] Source:Eur Spine J;, 2018 Feb 14.
[Is] ISSN:1432-0932
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: Cervicothoracic paravertebral neoplasms extending into the mediastinum pose a surgical challenge due the complex regional anatomy, their biological nature, rarity and surgeon's unfamiliarity with the region. We aim to define a surgical access framework addressing the aforementioned complexities whilst achieving oncological clearance. METHODS: We carried out a retrospective review of 28 consecutive patients operated in two tertiary referral centres between 1998 and 2015. Pathology was located paravertebrally from C6 to T4 with superior mediastinum invasion. Patients were operated jointly by a spinal and a thoracic surgeon. RESULTS: Tumours were classified according to subclavian fossa involvement as anteromedial, anterolateral and posterior and according to histology in benign nerve sheath tumour group (n = 10) and malignant bone or soft tissue tumours (n = 18). Three surgical routes were utilised: (1) median sternotomy (n = 11), (2) anterior cervical transsternal approach (n = 7) and (3) high posterolateral thoracotomy (n = 10). Resection was en bloc with wide margins in 22 cases, marginally complete in 3 and incomplete in 3. Complications included Horner's syndrome (n = 3), infection (n = 2) and transient neurological deficit (n = 4). In the nerve sheath tumour group, no recurrence or reoperation took place with a median follow-up of 4.5 years. In the malignant bone and soft tissue group, 96% of the patients were alive at 1 year, 67% at 2 years and 33% at 5 years. No vascular injuries or operative related deaths were observed. CONCLUSIONS: Classification of cervicothoracic paravertebral neoplasms with mediastinal extension according to the relationship with the subclavicular fossa and dual speciality involvement allows for a structured surgical approach and provides minimal morbidity/maximum resection and satisfactory oncological outcomes. These slides can be retrieved under Electronic Supplementary Material.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180215
[Lr] Last revision date:180215
[St] Status:Publisher
[do] DOI:10.1007/s00586-018-5512-5

  9 / 2441 MEDLINE  
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[PMID]: 29203316
[Au] Autor:Henry BM; Vikse J; Sanna B; Taterra D; Gomulska M; Pekala PA; Tubbs RS; Tomaszewski KA
[Ad] Address:Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland. Electronic address: bmhenry55@gmail.com.
[Ti] Title:Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations.
[So] Source:World Neurosurg;110:e965-e978, 2018 Feb.
[Is] ISSN:1878-8769
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Cervical ribs (CR) are supernumerary ribs that arise from the seventh cervical vertebra. In the presence of CR, the boundaries of the interscalene triangle can be further constricted and result in neurovascular compression and thoracic outlet syndrome (TOS). The aim of our study was to provide a comprehensive evidence-based assessment of CR prevalence and their association with TOS as well as surgical approach to excision of CR and surgical patients' characteristics. METHODS: A thorough search of major electronic databases was conducted to identify any relevant studies. Data on the prevalence, laterality, and side of CR were extracted from the eligible studies for both healthy individuals and patients with TOS. Data on the type of TOS and surgical approach to excision of CR were extracted as well. RESULTS: A total of 141 studies (n = 77,924 participants) were included into the meta-analysis. CR was significantly more prevalent in patients with TOS than in healthy individuals, with pooled prevalence estimates of 29.5% and 1.1%, respectively. More than half of the patients had unilateral CR in both the healthy and the TOS group. The analysis showed that 51.3% of the symptomatic patients with CR had vascular TOS, and 48.7% had neurogenic TOS. Most CR were surgically excised in women using a supraclavicular approach. CONCLUSIONS: CR ribs are frequent findings in patients with TOS. We recommended counseling asymptomatic patients with incidentally discovered CR on the symptoms of TOS, so that if symptoms develop, the patients can undergo prompt and appropriate workup and treatment.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180213
[Lr] Last revision date:180213
[St] Status:In-Data-Review

  10 / 2441 MEDLINE  
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[PMID]: 29388461
[Au] Autor:Samoila G; Twine CP; Williams IM
[Ad] Address:Cardiff and Vale University Health Board , UK.
[Ti] Title:The infraclavicular approach for Paget-Schroetter syndrome.
[So] Source:Ann R Coll Surg Engl;100(2):83-91, 2018 Feb.
[Is] ISSN:1478-7083
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Introduction Paget-Schroetter syndrome is a rare effort thrombosis of the axillary-subclavian vein, mainly occurring in young male patients. Current management involves immediate catheter directed thrombolysis, followed by surgical decompression of the subclavian vein. This has been invariably performed using a transaxillary or supraclavicular approach. However, the subclavian vein crosses the first rib anteriorly just behind the manubrium and can also be accessed via an infraclavicular incision. Methods MEDLINE and Embase™ were searched for all studies on outcomes in patients undergoing infraclavicular first rib resection for treatment of Paget-Schroetter syndrome. Measured outcomes included freedom from reintervention, secondary patency and symptom resolution. Studies on neurogenic, arterial and iatrogenic venous thoracic outlet syndrome were not included. Findings Six studies (involving 268 patients) were eligible. The overall secondary venous patency rate was 98.5%. There was freedom from reintervention in 89.9% of cases and among those patients with reocclusion, 84.0% had chronic thrombosis (symptom duration >14 days), with 76.2% having a venous segment stenosis of >2cm. Only 3 of the 27 patients remained occluded despite reintervention. The infraclavicular approach provides excellent exposure to the subclavian vein and allows reconstruction when required. Moreover, this approach enables complete resection of the extrinsic compression that precipitated the initial thrombotic event, with excellent long-term patency rates. In conclusion, the infraclavicular route may have significant advantages compared with the transaxillary or supraclavicular approaches for successful and durable treatment of Paget-Schroetter syndrome.
[Mh] MeSH terms primary: Decompression, Surgical/methods
Subclavian Vein/surgery
Upper Extremity Deep Vein Thrombosis/surgery
[Mh] MeSH terms secundary: Adult
Female
Humans
Male
Thoracic Outlet Syndrome/surgery
Thrombolytic Therapy/methods
Upper Extremity Deep Vein Thrombosis/diagnosis
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180209
[Lr] Last revision date:180209
[Js] Journal subset:IM
[Da] Date of entry for processing:180202
[St] Status:MEDLINE
[do] DOI:10.1308/rcsann.2017.0154


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