Two distinct terms are used to describe vascular thoracic outlet syndrome (TOS) depending on which structure is predominantly affected: venous TOS (due to subclavian vein compression) and arterial TOS (due to subclavian artery compression). Although the venous and arterial subtypes of TOS affect only 3% and <1% of all TOS patients respectively, the diagnostic and management approaches to venous and arterial TOS have undergone considerable evolution due to the recent emergence of minimally invasive endovascular techniques such as catheter-directed arterial and venous thrombolysis, and balloon angioplasty. In this review, we discuss the anatomical factors, etiology, pathogenesis and clinical presentation of vascular TOS patients. In addition, we use the most up to date observational evidence available to provide a contemporary approach to the diagnosis and management of venous TOS and arterial TOS patients.

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Patient reported health-related quality of life after infrarenal AAA repair is significantly impaired in the early postoperative period but returns to baseline by 6 months in patients treated with EVAR and OR. Patients having EVAR had significantly more rapid return to preoperative scores in selected domains of the SF-36. Even though EVAR is associated with shorter and less invasive perioperative hospital course and fewer postoperative complications, EVAR patients had lower quality of life scores 6 months after surgery than OR patients.

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This population-based cohort study compares long-term outcomes of elective endovascular aortic repair vs open surgical repair of abdominal aortic aneurysm among patients 40 years and older in Ontario, Canada.

I ndividuals with diabetes or peripheral artery disease share a common fear: leg amputation. Frequently synergistic, peripheral neuropathy and arterial insufficiency predispose patients to foot ulceration, tissue death and infection. 1,2 Diabetic foot ulcers are estimated to occur at a rate of 2%-4% per annum among individuals with diabetes in developed countries, 3 and the numbers are continuing to rise. 4 About one-third of diabetic foot ulcers fail to heal 5 and many patients with nonhealing ulcers progress to lower-extremity amputation, with 1 diabetes-related lowerextremity amputation occurring every 30 seconds worldwide. 3 When blood flow is sufficiently restricted to produce constant foot pain or gangrene, patients with peripheral artery disease have a 1-year mortality rate of 22% and a 1-year major amputation rate of 22%. 6 Together, peripheral artery disease and diabetes account for more than 80% of lower-extremity amputations in Canada. 7,8 Emerging data show that several diabetes-related complications, such as acute myocardial infarction, stroke, end-stage renal disease and hyperglycemia crisis, have declined over the last 20 years, 9 likely owing to improvements in pharmacotherapy and processes of care. Furthermore, hospital admissions for cardiovascular disease have declined by 54% between 1994 and 2014 in Ontario, Canada. 10 However, foot complications of diabetes and peripheral artery disease respond poorly to pharmacotherapy, and amputation-prevention efforts remain disjointed. 11 It is unclear whether declines have occurred in rates of lowerextremity amputations related to diabetes and peripheral artery

Supplemental Digital Content is available in the text.

Objective Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care. Methods We conducted a multicenter study of all diabetic foot ulcer patients admitted to general internal medicine wards at seven hospitals in the Greater Toronto Area, Canada from 2010 to 2015, using the GEMINI database. We compared the mean costs of care per patient for diabetic foot ulcer-related admissions, admissions for other diabetes-related complications, and admissions for the top five most costly general internal medicine conditions, using the Ontario Case Costing Initiative. Regression models were used to determine adjusted estimates of cost per patient. Propensity-score matched analyses were performed as sensitivity analyses. Results Our study cohort comprised of 557 diabetic foot ulcer patients; 2939 non-diabetic foot ulcer diabetes patients; and 23,656 patients with the top 5 most costly general internal medicine conditions. Diabetic foot ulcer admissions incurred the highest mean cost per patient ($22,754) when compared to admissions with non-diabetic foot ulcer diabetes ($8,350) and the top five most costly conditions ($10,169). Using adjusted linear regression, diabetic foot ulcer admissions demonstrated a 49.6% greater mean cost of care than non-diabetic foot ulcer-related diabetes admissions (95% CI 1.14–1.58), and a 25.6% greater mean cost than the top five most costly conditions (95% CI 1.17–1.34). Propensity-scored matched analyses confirmed these results. Conclusion Diabetic foot ulcer patients incur significantly higher costs of care when compared to admissions with non-diabetic foot ulcer-related diabetes patients, and the top five most costly general internal medicine conditions.