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thoracic outlet

Muharrem Yunce, Ashwyn Sharma, Evan Braunstein, Michael B Streiff, Ying Wei Lum
RATIONALE: Thoracic outlet syndrome (TOS) is a rare cause of upper extremity deep vein thrombosis (UEDVT). The treatment usually involves catheter directed thrombolysis followed by systemic anticoagulation. Surgical decompression is frequently recommended after anticoagulation for definitive therapy. PATIENT CONCERNS: We report two cases of UEDVT secondary to venous TOS with important clinical presentations. DIAGNOSES: Venous TOS. INTERVENTIONS: One patient was initially treated conservatively but had a recurrent UEDVT...
March 2018: Medicine (Baltimore)
Kevin T Jubbal, Dmitry Zavlin, Joshua D Harris, Shari R Liberman, Anthony Echo
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...
March 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
Amgad Hanna, Larry O'Neil Bodden, Gabriel R L Siebiger
Thoracic outlet syndrome (TOS) is caused by compression of the brachial plexus and/or subclavian vessels as they pass through the cervicothoracobrachial region, exiting the chest. There are three main types of TOS: neurogenic TOS, arterial TOS, and venous TOS. Neurogenic TOS accounts for approximately 95% of all cases, and it is usually caused by physical trauma (posttraumatic etiology), chronic repetitive motion (functional etiology), or bone or muscle anomalies (congenital etiology). We present two cases in which neurogenic TOS was elicited by vascular compression of the inferior portion of the brachial plexus...
January 2018: Journal of Brachial Plexus and Peripheral Nerve Injury
Meena M Archie, Johnathon C Rollo, Hugh A Gelabert
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...
February 22, 2018: Annals of Vascular Surgery
Stefano Bongiolatti, Daniela Massi, Vincenza Maio, Alessandro Gonfiotti, Domenico Viggiano, Luca Voltolini
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...
January 1, 2018: Asian Cardiovascular & Thoracic Annals
J Westley Ohman, Ahmmad A Abuirqeba, Senthil N Jayarajan, Joshua Balderman, Robert W Thompson
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 that underwent supraclavicular decompression for NTOS between January 1, 2014 and March 31, 2016...
February 5, 2018: Annals of Vascular Surgery
Joseph M White, Andrew J Soo Hoo, Scott R Golarz
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...
January 1, 2018: Military Medicine
Patrick Hangge, Lisa Rotellini-Coltvet, Amy R Deipolyi, Hassan Albadawi, Rahmi Oklu
Thoracic outlet syndrome (TOS) is a rare clinical entity with many etiologies. Venous thoracic outlet syndrome (VTOS), also called Paget-Schroetter syndrome (PSS), is a primary "effort" thrombosis. Here we will focus on the pathophysiology, anatomy, clinical presentation, treatments, and outcomes of VTOS. Treatment involves anticoagulation, catheter-directed thrombolysis, and surgical decompression. Early diagnosis and treatment can improve symptoms and quality of life.
December 2017: Cardiovascular Diagnosis and Therapy
Robert R Hagan, Joseph A Ricci, Kyle R Eberlin
Thoracic outlet syndrome (TOS) is a cause of upper extremity and shoulder dysfunction. TOS can present with a wide range of symptoms due to compression of the brachial plexus or its branches during their passage through the cervicothoracobrachial region or scalene triangle. There are three types of TOS: arterial, venous, and neurogenic. Neurogenic TOS (nTOS) is by far the most frequent type and represents more than 95% of all cases. Historically, surgical intervention for all types of TOS has evolved based on the treatment for a vascular etiology and has typically included a first rib resection...
February 2, 2018: Journal of Reconstructive Microsurgery
G Samoila, C P Twine, I M Williams
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...
February 2018: Annals of the Royal College of Surgeons of England
Garret Adam, Kevin Wang, Christopher J Demaree, Jenny S Jiang, Mathew Cheung, Carlos F Bechara, Peter H Lin
Thoracic outlet syndrome (TOS) is a neurovascular condition involving the upper extremity, which is known to occur in individuals who perform chronic repetitive upper extremity activities. We prospectively evaluate the incidence of TOS in high-performance musicians who played bowed string musicians. Sixty-four high-performance string instrument musicians from orchestras and professional musical bands were included in the study. Fifty-two healthy volunteers formed an age-matched control group. Bilateral upper extremity duplex scanning for subclavian vessel compression was performed in all subjects...
January 25, 2018: Diagnostics
Paige E Carpenetti, John M Grosel
Thoracic outlet syndrome can present with a wide variety of upper extremity neurovascular symptoms. Timely clinical recognition is essential for prompt treatment and maximal recovery. This article describes a case of thoracic outlet syndrome in a volleyball player with an underlying hypercoagulable state who presented with a subclavian vein thrombosis.
February 2018: JAAPA: Official Journal of the American Academy of Physician Assistants
Colin P Ryan, Nicolas J Mouawad, Patrick S Vaccaro, Michael R Go
Controversies in the treatment of venous thoracic outlet syndrome (VTOS) have been discussed for decades, but still persist. Calls for more objective reporting standards have pushed practice towards comprehensive venous evaluations and interventions after first rib resection (FRR) for all patients. In our practice, we have relied on patient-centered, patient-reported outcomes to guide adjunctive treatment and measure success. Thus, we sought to investigate the use of thrombolysis versus anticoagulation alone, timing of FRR following thrombolysis, post-FRR venous intervention, and FRR for McCleery syndrome (MCS) and their impact on patient symptoms and return to function...
January 23, 2018: Diagnostics
Gauranga Majumdar, Surendra Kumar Agarwal
No abstract text is available yet for this article.
January 2018: Annals of Cardiac Anaesthesia
Hosseinali Abdolrazaghi, Azade Riyahi, Morteza Taghavi, Pezhman Farshidmehr, Abolfazl Mohammadbeigi
We report a rare case of multiple hereditary exostosis where patient presented with bilateral base of neck exostoses with concurrent compression of brachial plexus and subclavian artery and vein. The patient was a young 26-year-old woman with chief complaints of pain in the left upper extremity, paresthesia in the left ring and little finger, and weakness in hand movement and grip. On referral, history, physical examination, radiological imaging, and electrodiagnostic tests evaluated the patient. Due to severe pain and disability in performing routine activities, surgical intervention was necessary...
January 2018: Annals of Cardiac Anaesthesia
Jaber Mustafa, Ilan Asher, Zev Sthoeger
Upper extremity deep vein thrombosis (UEDVT) is defined as thrombosis of the deep venous system (subclavian, axillary, brachial, ulnar, and radial veins), which drains the upper extremities. It can be caused by thoracic outlet anatomic obstruction, such as Paget-Schroetter syndrome, (primary) or by central intravenous catheters (secondary). UEDVT may be asymptomatic or present with acute severe pain and arm swelling. Clinical suspicion should be confirmed by diagnostic imaging procedures such as duplex ultrasound, computed tomography scan, or magnetic resonance imaging...
January 2018: Israel Medical Association Journal: IMAJ
Jesse Peek, Cornelis G Vos, Çağdas Ünlü, Michiel A Schreve, Rob H W van de Mortel, Jean-Paul P M de Vries
First rib resection for thoracic outlet syndrome (TOS) is clinically successful and safe in most patients. However, long-term functional outcomes are still insufficiently known. Long-term functional outcome was assessed using a validated questionnaire. A multicenter retrospective cohort study including all patients who underwent operations for TOS from January 2005 until December 2016. Clinical records were reviewed and the long-term functional outcome was assessed by the 11-item version of the Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire...
January 12, 2018: Diagnostics
Jesus M Matos, Lorena Gonzalez, Elias Kfoury, Angela Echeverria, Carlos F Bechara, Peter H Lin
Objectives Thoracic outlet syndrome, a condition commonly reported in adults, occurs infrequently in the pediatric population. The objective of this study was to assess the outcome of surgical interventions of thoracic outlet syndrome in pediatric patients. Methods Clinical records of all pediatric patients with thoracic outlet syndrome who underwent operative repair from 2002 to 2015 in a tertiary pediatric hospital were reviewed. Pertinent clinical variables and treatment outcomes were analyzed. Results Sixty-eight patients underwent a total of 72 thoracic outlet syndrome operations (mean age 15...
January 1, 2018: Vascular
Henrik Nuutinen, Teemu Riekkinen, Voitto Aittola, Kimmo Mäkinen, Jussi M Kärkkäinen
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...
December 27, 2017: Annals of Thoracic Surgery
Jari Arokoski, Jaro Karppinen, Karl-August Lindgren, Heidi Vastamäki, Martti Vastamäki, Leena Ristolainen, Katri Laimi
It is important to remember the possibility of nonspecific thoracic outlet syndrome (TOS) when treating patients with neck and upper extremity symptoms. There are no specific diagnostic criteria for the syndrome. Diagnosis is based on symptoms, clinical examination and the ruling out of other causes. The first-line option of clinical care is conservative treatment, which in most cases is sufficient for the patient to regain normal functioning. However, some of the most difficult TOS patients need surgical treatment, especially when persistent symptoms have already begun in adolescence, and if compression of neural or vascular structures is thought to result from anatomical structures...
2017: Duodecim; Lääketieteellinen Aikakauskirja
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