Long Term Functional Results of the Surgical Management of Neurogenic Thoracic Outlet Syndrome (NTOS)

Abstract

Male Gender BSA (m 2 ) BMI Cannula Size (Fr) Mortality (%) Limb ischemia 36 Ϯ 18 7/7 2.09 Ϯ 0.29 29.5 Ϯ 10.0 16.9 Ϯ 1.1 4/7 (57) No limb ischemia 58 Ϯ 14 20/26 2.13 Ϯ 0.27 30.8 Ϯ 5.4 18.0 Ϯ 1.7 23/26 (88) Prophylactic-Y 44 Ϯ 16 7/10 2.06 Ϯ 0.23 29.4 Ϯ 9.0 17.7 Ϯ 1.8 7/10 (70) P-value* 0.001 0.30 0.57 0.65 0.09 0.09 BMI, Body mass index; BSA, body surface area. *Between "limb ischemia" and "no limb ischemia" groups. Does the Addition of Routine IVC/Iliac Vein and Infrapopliteal Duplex Scan Confer any Benefit? Alhabouni S, Hingorani A, Ascher E, et al Objectives:The routine evaluation for lower extremity deep vein thromboses (DVT) usually involves the femoral and popliteal veins with no regard to the more proximal (Iliac and inferior vena cava [IVC]) veins or the more distal (infra-popliteal) veins. In this study, we attempted to evaluate the benefits of routine scanning of these segments.Methods: We reviewed 1624 consecutive lower extremity venous duplex studies performed for 1513 of our in-house patients between January 2008 and July 2008. All studies included routine evaluation of the IVC/iliac and infra-popliteal vein segments. All studies were also evaluated for any evidence of pulmonary embolism (PE).Results: The IVC/iliac vein segments were completely evaluated in 1270 duplex studies with evidence of IVC/iliac vein DVTs in 37 (2.9%). In 354 studies, the evaluation was incomplete due to improper visualization of the IVC mostly due to bowel gas. Despite that, evidence of iliac vein DVT was noted in 18 (5.1%) of these studies. In total, the addition of routine iliac vein/IVC duplex scan resulted in the detection of 55 (3.38%) DVTs with evidence of PE in five (incidence of 9.1%). In five of those 55 duplex studies, the IVC/iliac vein DVT was the only DVT detected, with evidence of PE in one (incidence of 20%). The rest of the study population had evidence of DVT in 244 studies (15.55%) with evidence of PE in 32 (incidence of 13.1%) of them (P ϭ .59). Infra-popliteal segment: 145 infra-popliteal DVTs were detected, of which 50 (34.5%) were isolated to the infrapopliteal segments with evidence of PE in three (incidence of 6%). The rest of the study population showed evidence of DVT in 98 with evidence of PE in 14 (incidence of 14.3%) (P ϭ .135).Conclusions: Although routine scanning of the IVC/Iliac veins resulted in detection rate of 3.38%, the detection of an isolated DVT in those veins was very low (0.3%). However, isolated DVT of the iliac veins had a PE rate of 20%. As for the routine scanning for infra-popliteal DVTs, 50 additional DVTs were detected with a PE rate of 6%, with no statistical difference from the rate of PE from more proximal segments (P ϭ .135).Hence infra-popliteal DVTs should be regarded as risky as more proximal DVTs and should therefore be treated similarly.BMI, Body mass index; DM, diabetes mellitus; HTN, hypertension. Multilevel Versus Isolated Tibial Interventions for Critical Limb IschemiaFernandez N, Marone L, Rhee R, Leers S, Makaroun MS, Chaer R Objectives: Endovascular interventio...