A narrative review of the surgical management of Paget-Schroetter syndrome: case series and long-term follow-up

BACKGROUND AND OBJECTIVE: Paget-Schroetter syndrome (PSS) is an uncommon disorder which causes thrombosis of the subclavian vein (SV). This is due to compression of the SV by the surrounding anatomical structures. The optimal management of PSS remains subject to debate, with endovascular intervention and open surgical decompression being favoured current options. This review article evaluates both approaches to the management of PSS, while also presenting a case series with long-term follow-up of patients that underwent open surgical intervention for PSS. METHODS: The clinical outcomes of PSS patients undergoing different 4 surgical approaches to perform surgical decompression are included. A literature review, across publications from PubMed, Embase, and Web of Science, was conducted with specific criteria to facilitate evaluation of both open surgical and endovascular approaches to the management of PSS. KEY CONTENT AND FINDINGS: Evaluation of data from the included case series and available literature suggests that endovascular thrombolytic devices offer better clinical results, however, SV decompression is still required for successful resolution. CONCLUSIONS: An approach to PSS encompassing endovascular intervention followed by surgical anatomical decompression may provide optimal outcomes as both intrinsic lesions and extrinsic compression of the SV is treated. However, further prospective investigation into this field is warranted

Retroperitoneal Compared to Transperitoneal Approach for Open Abdominal Aortic Aneurysm Repair Is Associated with Reduced Systemic Inflammation and Postoperative Morbidity

Background  In the United Kingdom, the most common surgical approach for repair of open abdominal aortic aneurysms (AAAs) is transperitoneal (TP). However, retroperitoneal (RP) approach is favored in those with more complex vascular anatomy often requiring a cross-clamp on the aorta superior to the renal arteries. This study compared these approaches in patients matched on all major demographic, comorbid, anatomic, and physiological variables. Methods  Fifty-seven patients (TP: n  = 24; RP: n  = 33) unsuitable for endovascular aneurysm repair underwent preoperative cardiopulmonary exercise testing prior to open AAA repair. The surgical approach undertaken was dictated by individual surgeon preference. Postoperative mortality, complications, and length of hospital stay (LoS) were recorded. Patients were further stratified according to infrarenal (IR) or suprarenal/supraceliac (SR/SC) surgical clamping. Systemic inflammation (C-reactive protein) and renal function (serum creatinine and estimated glomerular filtration rate) were recorded. Results  Twenty-three (96%) of TP patients only required an IR clamp compared with 12 (36%) in the RP group. Postoperative systemic inflammation was lower in RP patients ( p  = 0.002 vs. TP) and fewer reported pulmonary/gastrointestinal complications whereas renal impairment was more marked in those receiving SR/SC clamps ( p  < 0.001 vs. IR clamp). RP patients were defined by lower LoS ( p  = 0.001), while mid-/long-term mortality was low/comparable with TP, resulting in considerable cost savings. Conclusion  Despite the demands of more complicated vascular anatomy, the clinical and economic benefits highlighted by these findings justify the more routine adoption of the RP approach for complex AAA repair

Theory as a driving force to understand reactions on nanoparticles: general discussion

International audienc

Production of polyetheretherketone in ionic liquid media

[EN] Polyetheretherketones were successfully synthesised in an ionic liquid, namely 1-butyl-3-methylimidazolium bis{(trifluoromethyl)sulfonyl}amide, by polycondensation reactions of hydroquinone with 4,4'-dihalobenzophenones in the presence of potassium carbonate at elevated temperatures (up to 320 degrees C). The materials thus produced were similar to polymers prepared in the solvent usually employed in commercial processes, i.e. diphenyl sulfone, as suggested by spectroscopic techniques and X-ray crystallography. By replacing volatile diphenyl sulfone with the effectively involatile ionic liquid, the separation efficiency was significantly improved but the molecular weights were lower.We acknowledge Dr S.R. Holding and T.S. Forsyth at Smithers Rapra Technology Limited for the gel permeation chromatographic analyses, and INVISTA Intermediates for funding.Gunaratne, HQN.; Langrick, CR.; Vaca Puga, A.; Seddon, KR.; Whiston, K. (2013). Production of polyetheretherketone in ionic liquid media. Green Chemistry. 15(5):1166-1172. doi:10.1039/C3GC36754AS1166117215