3 research outputs found
Surgical treatment of thoracic outlet syndrome: immediate and mid-term results
Introduction: We report the results from a consecutive series of patients treated by
scalenectomy or cervical rib resection for clearly symptomatic or paucisymptomatic
thoracic outlet syndrome (TOS) over a 6-year period.
Material and methods: From September 1999 to August 2005, 14 surgical
decompressions were performed in 12 patients with unremitting signs and
symptoms of nerve or vascular compression at the thoracic outlet. The symptoms
of TOS were due to involvement of the brachial plexus in 8 cases (57.1%). A sign
of vascular obstruction could be detected in 10 cases (71.4%): in 6 cases (42.8%)
the presentation was predominantly arterial (arm claudication, coldness, Raynaud’s
phenomenon and distal embolisation) and in 4 cases (28.5%) was related to vein
compression with congestion and swelling of the affected arm or vein thrombosis.
Two patients presented as emergencies with critical upper limb ischaemia or distal
vessel embolisation.
Results: The median follow-up period was 28.2 months (range 8-78 months).
Results were evaluated in terms of technical success, lack of complications
(temporary or permanent plexus injury, temporary or permanent phrenic palsy),
relief of symptoms. Outcome data were divided into immediate/perioperative
and mid-term results. Perioperative results: There was no operative mortality.
Technical success was achieved in all patients in excision of the fibrous band
with scalenectomy and in cervical rib excision. Mid-term results: In 4 patients
with venous symptoms complete relief was achieved in 75%. In all patients who
experienced arterial complications we registered complete relief. In patients with
neurological presentation we detected complete relief in 5 (62.5%), relief of some
symptoms in 2 (25%) and no improvement in 1 (12.5%).
Conclusions: Scalenectomy performed by a standard supraclavicular approach seems
to allow relief in the majority of patients with symptoms of neurological, arterial or
venous compression at the thoracic outlet. Nevertheless, we emphasize the importance
of an objective method of evaluation and the necessity of a prolonged follow-up.
Key words: thoracic outlet syndrome, scalenectomy, cervical rib resection
IL TRATTAMENTO ENDOVASCOLARE DELL’ANEURISMA DELL’AORTA ADDOMINALE: NOSTRA ESPERIENZA ENDOVASCULAR TREATMENT OF ABDOMINAL AORTIC ANEURISMS: OUR EXPERIENCE
Background. This report prospectively analyzes collected data of endovascular treatment
of abdominal aortic aneurysms in 114 patients selected to receive stent implantation based on
anatomic criteria and surgical risk. Methods. From December 2002 to May 2006, 114 patients with
abdominal aortic aneurism receive endovascular treatment. 108 were men (94,7%) and 6 female; age
range was 57-86 years with mean age of 73.3. The mean maximum diameter of the AAA was 5.71
cm (range 3.7- 13.0). Three different types of stents were used most of which were bifurcated in design
(97,3%). Endograft used were: Excluder, Talent; Zenith-Cook. Results. No perioperative mortality
was observed; 5 (4,3%) type I and 11 (9,6%) type II endoleak were detected; Iliac extension with
exclusion of the internal iliac artery was required in 27 cases. We observed 2 right branch, 2 iliac lesions,
2 ematoma and 1 distal vessels embolization surgically treated Mean follow-up period was
18,6 months. 17 patients died during follow-up. 11 endoleak were discovered during follow-up and in
3 cases thrombosis of a branch occurred. Mean aneurysm diameter, neck diameter, iliac or hypogastric
diameter or the clinical characteristics showed no statistical significant differences among the
three group (on the results). In each group influence of aneurysm and neck morphology and diameter
on type I or II endoleak was analyzed but no statistical significant differences were detected
among the three groups except for type-II endoleak in the Talent group that was registered in 100%
of no mural thrombus – aneurysms (p<0,05). Conclusions. Together with aneurysm sac growth andbranch vessels’ patency, structural failures continues to be a challenging problem. As long as no solution
will be find out for them endovascular aneurysm repair will remain an imperfect long-term
treatment and continued follow-up will be mandatory.
Key words: Aortic aneurysm, Aortic surgery, Endovascular treatment