Pub Date : 2024-06-01DOI: 10.1053/j.semvascsurg.2024.05.005
Chronic superficial venous disease, including superficial venous insufficiency, superficial venous thrombosis, and aneurysms, are prevalent conditions that affect millions of individuals worldwide. With chronic venous insufficiency specifically, the advent of office-based minimally invasive procedures in recent decades has significantly expanded access to outpatient treatment. However, as venous insufficiency is rarely life- or limb-threatening, the clinical diagnosis, diagnostic evaluation, and treatment indications should be considered carefully when recommending elective intervention. Appropriateness of care guidelines intend to aid providers and patients in the decision-making process, based on the available evidence in the scientific literature, to select the best care for the patient when treating their superficial venous disease.
{"title":"Appropriateness of care in superficial venous disease","authors":"","doi":"10.1053/j.semvascsurg.2024.05.005","DOIUrl":"10.1053/j.semvascsurg.2024.05.005","url":null,"abstract":"<div><p>Chronic superficial venous disease<span>, including superficial venous insufficiency<span><span>, superficial venous thrombosis, and aneurysms, are prevalent conditions that affect millions of individuals worldwide. With </span>chronic venous insufficiency<span> specifically, the advent of office-based minimally invasive procedures in recent decades has significantly expanded access to outpatient treatment. However, as venous insufficiency is rarely life- or limb-threatening, the clinical diagnosis, diagnostic evaluation, and treatment indications should be considered carefully when recommending elective intervention. Appropriateness of care guidelines intend to aid providers and patients in the decision-making process, based on the available evidence in the scientific literature, to select the best care for the patient when treating their superficial venous disease.</span></span></span></p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141502313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1053/j.semvascsurg.2024.04.007
The growing number of prevalent arteriovenous (AV) accesses has been associated with an increase in the incidence of procedures being performed to maintain patency. To reduce the rate of unnecessary procedures, the 2019 Kidney Disease Outcome Quality Initiative guidelines addended the AV access surveillance recommendations, which includes clinical monitoring and assessment of dialysis adequacy alone. Abnormal clinical findings would necessitate follow-up angiography with or without confirmatory duplex ultrasound. Due to poor patency, increased surveillance schedules have been proposed to identify stenosis early and potentially prevent acute thrombotic events and AV access failure. In this review, we outlined current AV access monitoring and maintenance procedure recommendations, as described by the Centers for Medicare and Medicaid Services and 2019 Kidney Disease Outcome Quality Initiative guidelines. In addition, we highlight the findings of recently published randomized controlled trials that have examined increased surveillance schedules.
{"title":"A review of the current recommendations and practices for hemodialysis access monitoring and maintenance procedures","authors":"","doi":"10.1053/j.semvascsurg.2024.04.007","DOIUrl":"10.1053/j.semvascsurg.2024.04.007","url":null,"abstract":"<div><p><span>The growing number of prevalent arteriovenous (AV) accesses has been associated with an increase in the incidence of procedures being performed to maintain patency. To reduce the rate of unnecessary procedures, the 2019 </span>Kidney Disease<span><span> Outcome Quality Initiative guidelines addended the AV access surveillance recommendations, which includes clinical monitoring and assessment of dialysis adequacy<span> alone. Abnormal clinical findings would necessitate follow-up angiography with or without confirmatory duplex ultrasound. Due to poor patency, increased surveillance schedules have been proposed to identify stenosis early and potentially prevent acute thrombotic events and AV access failure. In this review, we outlined current AV access monitoring and maintenance procedure recommendations, as described by the Centers for Medicare and Medicaid Services and 2019 Kidney Disease Outcome Quality Initiative guidelines. In addition, we highlight the findings of recently published </span></span>randomized controlled trials that have examined increased surveillance schedules.</span></p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141053114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1053/j.semvascsurg.2024.04.002
Concern regarding the exponential increase in optional utilization of inferior vena cava filters (IVCFs) in the early 2000s with a persistent low retrieval rate nationwide has resulted in increased scrutiny regarding clinical application of IVCFs. IVCFs are used in a variety of clinical scenarios, ranging from thromboembolic protection in patients with deep venous thrombosis and contraindication to anticoagulation to prophylactic deployment in multitrauma and critically ill patients. Evidence supporting IVCFs as mechanical thromboembolic protection in certain clinical scenarios has been established through evidenced-based guidelines. As an adjunct to evidence-based guidelines, appropriateness criteria to address specific clinical scenarios and facilitate clinical decision making when considering placement of an IVCF have been developed. In this review, current evidence-based and appropriateness guidelines are summarized.
{"title":"Appropriateness guidelines for inferior vena cava filter utilization: A contemporary review","authors":"","doi":"10.1053/j.semvascsurg.2024.04.002","DOIUrl":"10.1053/j.semvascsurg.2024.04.002","url":null,"abstract":"<div><p><span>Concern regarding the exponential increase in optional utilization of inferior vena cava filters (IVCFs) in the early 2000s with a persistent low retrieval rate nationwide has resulted in increased scrutiny regarding clinical application of IVCFs. IVCFs are used in a variety of clinical scenarios, ranging from </span>thromboembolic<span><span> protection in patients with deep venous thrombosis and contraindication to </span>anticoagulation to prophylactic deployment in multitrauma and critically ill patients. Evidence supporting IVCFs as mechanical thromboembolic protection in certain clinical scenarios has been established through evidenced-based guidelines. As an adjunct to evidence-based guidelines, appropriateness criteria to address specific clinical scenarios and facilitate clinical decision making when considering placement of an IVCF have been developed. In this review, current evidence-based and appropriateness guidelines are summarized.</span></p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1053/j.semvascsurg.2023.04.019
Infective native arterial aneurysms and inflammatory aortic aneurysms are rare but morbid pathologies seen by vascular surgeons in the emergency setting. Presentation is not always clear, and a full workup must be obtained before adopting a management strategy. Treatment is multidisciplinary and is tailored to every case based on workup findings. Imaging with computed tomography, magnetic resonance, or with fluorodeoxyglucose-positron emission tomography aids in diagnosis and in monitoring response to treatment. Open surgery is traditionally performed for definitive management. Endovascular surgery may offer an alternative treatment in select cases with acceptable outcomes. Neither technique has been proven to be superior to the other. Physicians should consider patient's anatomy, comorbidities, life expectancy, and goals of care before selecting an approach. Long-term pharmacological treatment, with antibiotics in case of infective aneurysms and immunosuppressants in case of inflammatory aneurysms, is usually required and should be managed in collaboration with infectious disease specialists and rheumatologists.
{"title":"Infective native arterial aneurysms and inflammatory abdominal aortic aneurysms: An overview with a focus on emergency settings","authors":"","doi":"10.1053/j.semvascsurg.2023.04.019","DOIUrl":"10.1053/j.semvascsurg.2023.04.019","url":null,"abstract":"<div><p>Infective native arterial aneurysms and inflammatory aortic aneurysms<span> are rare but morbid pathologies seen by vascular surgeons in the emergency setting. Presentation is not always clear, and a full workup must be obtained before adopting a management strategy. Treatment is multidisciplinary and is tailored to every case based on workup findings. Imaging with computed tomography<span>, magnetic resonance, or with fluorodeoxyglucose-positron emission tomography aids in diagnosis and in monitoring response to treatment. Open surgery is traditionally performed for definitive management. Endovascular surgery may offer an alternative treatment in select cases with acceptable outcomes. Neither technique has been proven to be superior to the other. Physicians should consider patient's anatomy<span>, comorbidities, life expectancy, and goals of care before selecting an approach. Long-term pharmacological treatment, with antibiotics in case of infective aneurysms and immunosuppressants in case of inflammatory aneurysms, is usually required and should be managed in collaboration with infectious disease specialists and rheumatologists.</span></span></span></p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47421888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1053/j.semvascsurg.2024.04.004
Vascular surgeons have the ability to manage and intervene on numerous vascular diseases of both the arterial and venous systems. With the growing number of interventions available as endovascular technology evolves, it is important to determine when a procedure is safely indicated for a vascular surgery patient. Appropriate Use Criteria (AUC) offer synthesized clinical information and practice standards that can aid clinicians in making these management decisions. Professional societies, such as the Society for Vascular Surgery, bring experts in the field together to collaborate and create AUC for various vascular diseases and interventions. It is essential to publish these criteria in peer-reviewed journals, as well as make them available on public websites so the information is available to vascular surgeons and interventionalists from other specialties who also treat patients with vascular disease. Cardiology, interventional radiology, and interventional nephrology are some other specialties that perform procedures for vascular disease, and vascular interventions by nonsurgeon specialists continue to increase. The Society for Vascular Surgery has published AUC on intermittent claudication, carotid disease, and abdominal aneurysm management. These are intended to guide practice, but also have highlighted areas for improvement that would allow for more universal implementation of AUC in vascular patient care across medical specialties. Increased intersocietal participation and perhaps inclusion of government and other payer participation will allow professional society–sponsored AUC to evolve, resulting in coordinated, appropriate care for vascular surgery patients.
血管外科医生有能力处理和干预动脉和静脉系统的多种血管疾病。随着血管内技术的不断发展,介入治疗的方法也越来越多,因此,确定一种手术何时安全地适用于血管外科患者非常重要。适当使用标准(Appropriate Use Criteria,AUC)提供了综合临床信息和实践标准,可帮助临床医生做出这些管理决策。血管外科学会等专业协会将该领域的专家聚集在一起,共同合作制定各种血管疾病和干预措施的适当使用标准。必须在同行评审期刊上发表这些标准,并将其公布在公共网站上,以便血管外科医生和治疗血管疾病患者的其他专科介入医生可以获得相关信息。心脏病学、介入放射学和介入肾脏病学等其他一些专科也会对血管疾病进行手术治疗,而非外科医生专科医师进行的血管介入手术也在不断增加。血管外科学会发布了关于间歇性跛行、颈动脉疾病和腹部动脉瘤治疗的 AUC。这些指南旨在指导实践,但也强调了需要改进的地方,以便在各医学专科的血管患者护理中更普遍地实施 AUC。加强学会间的参与,或许还可以让政府和其他支付方参与进来,这将使专业学会发起的 AUC 不断发展,从而为血管外科患者提供协调、适当的治疗。
{"title":"Appropriate Use Criteria Committees: The professional society role in the development and implementation of Appropriate Use Criteria","authors":"","doi":"10.1053/j.semvascsurg.2024.04.004","DOIUrl":"10.1053/j.semvascsurg.2024.04.004","url":null,"abstract":"<div><p><span><span>Vascular surgeons have the ability to manage and intervene on numerous vascular diseases of both the arterial and venous systems. With the growing number of interventions available as endovascular technology evolves, it is important to determine when a procedure is safely indicated for a </span>vascular surgery<span><span> patient. Appropriate Use Criteria (AUC) offer synthesized clinical information and practice standards that can aid clinicians in making these management decisions. Professional societies, such as the Society for Vascular Surgery, bring experts in the field together to collaborate and create AUC for various vascular diseases and interventions. It is essential to publish these criteria in peer-reviewed journals, as well as make them available on public websites so the information is available to vascular surgeons and interventionalists from other specialties who also treat patients with vascular disease. Cardiology, </span>interventional radiology, and interventional </span></span>nephrology<span><span> are some other specialties that perform procedures for vascular disease, and vascular interventions by nonsurgeon specialists continue to increase. The Society for Vascular Surgery has published AUC on intermittent claudication, </span>carotid disease, and abdominal aneurysm management. These are intended to guide practice, but also have highlighted areas for improvement that would allow for more universal implementation of AUC in vascular patient care across medical specialties. Increased intersocietal participation and perhaps inclusion of government and other payer participation will allow professional society–sponsored AUC to evolve, resulting in coordinated, appropriate care for vascular surgery patients.</span></p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141051332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1053/j.semvascsurg.2024.05.004
{"title":"First do no harm (and do what's right)","authors":"","doi":"10.1053/j.semvascsurg.2024.05.004","DOIUrl":"10.1053/j.semvascsurg.2024.05.004","url":null,"abstract":"","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0895796724000310/pdfft?md5=7d4dc9a8662ff831df73baf2640fb8df&pid=1-s2.0-S0895796724000310-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1053/j.semvascsurg.2024.03.002
Carotid artery stenosis is one of the most common diagnoses treated by vascular specialists in the United States. The optimal management of carotid stenosis remains controversial, however, with notable variation surrounding diagnostic imaging modalities, longitudinal surveillance, medical therapies, and procedural interventions. Data from high-quality randomized controlled trials and observational studies form the foundation for current management paradigms and societal guidelines that inform clinical practice. Presently, a diagnosis of carotid disease is most often established with duplex ultrasound and supplemental cross-sectional imaging using computed tomography or magnetic resonance angiography as needed to provide additional anatomic information. All patients with documented occlusive disease should receive goal-directed medical therapy with antiplatelet agents and a lipid-reduction strategy, most commonly with a statin. Those with severe carotid stenosis and an acceptable life expectancy may be considered for carotid artery revascularization. The proceduralist should optimally consider a shared decision-making approach in which the tradeoffs of revascularization can be carefully considered with the patient to optimize informed therapeutic decision making. In current practice, three distinct procedure options exist to treat carotid artery stenosis, including carotid endarterectomy, transfemoral carotid artery stenting, and transcarotid artery revascularization. It should be noted that each procedure, although often used interchangeably in most clinical settings, carry technical nuances and outcome disparities. In this review, each of these topics are explored and various approaches are outlined surrounding the appropriate use of treatments for patients with asymptomatic carotid artery stenosis.
{"title":"Appropriateness of care: Asymptomatic carotid stenosis including transcarotid artery revascularization","authors":"","doi":"10.1053/j.semvascsurg.2024.03.002","DOIUrl":"10.1053/j.semvascsurg.2024.03.002","url":null,"abstract":"<div><p><span>Carotid artery stenosis is one of the most common diagnoses treated by vascular specialists in the United States. The optimal management of carotid stenosis remains controversial, however, with notable variation surrounding diagnostic imaging modalities, longitudinal surveillance, medical therapies, and procedural interventions. Data from high-quality </span>randomized controlled trials<span><span><span> and observational studies form the foundation for current management paradigms and societal guidelines that inform clinical practice. Presently, a diagnosis of carotid disease<span> is most often established with duplex ultrasound and supplemental cross-sectional imaging using computed tomography<span><span> or magnetic resonance angiography as needed to provide additional anatomic information. All patients with documented occlusive disease should receive goal-directed medical therapy with </span>antiplatelet agents and a lipid-reduction strategy, most commonly with a statin. Those with severe carotid stenosis and an acceptable life expectancy may be considered for </span></span></span>carotid artery<span> revascularization. The proceduralist should optimally consider a shared decision-making approach in which the tradeoffs of revascularization can be carefully considered with the patient to optimize informed therapeutic decision making. In current practice, three distinct procedure options exist to treat carotid artery stenosis, including </span></span>carotid endarterectomy<span>, transfemoral carotid artery stenting, and transcarotid artery revascularization. It should be noted that each procedure, although often used interchangeably in most clinical settings, carry technical nuances and outcome disparities. In this review, each of these topics are explored and various approaches are outlined surrounding the appropriate use of treatments for patients with asymptomatic carotid artery stenosis.</span></span></p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140928486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1053/j.semvascsurg.2024.05.002
Fenestrated and branched endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms is increasingly replacing open repair as the primary modality of treatment. Mid- and long-term results are encouraging and support its use in the correct settings. Nevertheless, appropriateness of indication for treatment, patient selection, and surgeon and hospital performance has not been clearly evaluated and reviewed. The objective of this review article was to identify areas in which appropriateness of care is relevant and can be optimized when considering treatment of patients with fenestrated and branched endovascular repair for complex abdominal and thoracoabdominal aortic aneurysms.
{"title":"Appropriateness of care in complex fenestrated-branched aortic endografting","authors":"","doi":"10.1053/j.semvascsurg.2024.05.002","DOIUrl":"10.1053/j.semvascsurg.2024.05.002","url":null,"abstract":"<div><p>Fenestrated and branched endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms is increasingly replacing open repair as the primary modality of treatment. Mid- and long-term results are encouraging and support its use in the correct settings. Nevertheless, appropriateness of indication for treatment, patient selection, and surgeon and hospital performance has not been clearly evaluated and reviewed. The objective of this review article was to identify areas in which appropriateness of care is relevant and can be optimized when considering treatment of patients with fenestrated and branched endovascular repair for complex abdominal and thoracoabdominal aortic aneurysms.</p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141142697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1053/j.semvascsurg.2024.02.001
Vamsi K. Potluri, Ruojia D. Li, Paul Crisostomo, Carlos F. Bechara
Arterial thoracic outlet syndrome (TOS) is a condition in which anatomic abnormalities in the thoracic outlet cause compression of the subclavian or, less commonly, axillary artery. Patients are usually younger and typically have an anatomic abnormality causing the compression. The condition usually goes undiagnosed until patients present with signs of acute or chronic hand or arm ischemia. Workup of this condition includes a thorough history and physical examination; chest x-ray to identify potential anatomic abnormalities; and arterial imaging, such as computed tomographic angiography or duplex to identify arterial abnormalities. Patients will usually require operative intervention, given their symptomatic presentation. Intervention should always include decompression of the thoracic outlet with at least a first-rib resection and any other structures causing external compression. If the artery is identified to have intimal damage, mural thrombus, or is aneurysmal, then arterial reconstruction is warranted. Stenting should be avoided due to external compression. In patients with symptoms of embolization, a combination of embolectomy, lytic catheter placement, and/or therapeutic anticoagulation should be done. Typically, patients have excellent outcomes, with resolution of symptoms and high patency of the bypass graft, although patients with distal embolization may require finger amputation.
胸廓出口动脉综合征(TOS)是一种胸廓出口解剖异常导致锁骨下动脉或(较少见的)腋动脉受压的疾病。患者通常较年轻,通常有导致压迫的解剖异常。在患者出现急性或慢性手部或手臂缺血症状之前,这种疾病通常不会被诊断出来。这种疾病的检查包括全面的病史和体格检查;胸部 X 光检查,以确定潜在的解剖异常;以及动脉成像,如计算机断层扫描血管造影或双相成像,以确定动脉异常。鉴于患者的症状表现,他们通常需要手术干预。介入治疗应始终包括胸廓出口减压,至少进行第一肋切除术,并切除造成外部压迫的任何其他结构。如果发现动脉有内膜损伤、壁栓或动脉瘤,则需要进行动脉重建。应避免因外部压迫而进行支架植入术。对于有栓塞症状的患者,应综合采用栓子切除术、溶解导管置入术和/或治疗性抗凝术。尽管远端栓塞患者可能需要截指,但患者的治疗效果通常很好,症状得到缓解,旁路移植的通畅性也很高。
{"title":"A review of arterial thoracic outlet syndrome","authors":"Vamsi K. Potluri, Ruojia D. Li, Paul Crisostomo, Carlos F. Bechara","doi":"10.1053/j.semvascsurg.2024.02.001","DOIUrl":"10.1053/j.semvascsurg.2024.02.001","url":null,"abstract":"<div><p>Arterial thoracic outlet syndrome (TOS) is a condition in which anatomic abnormalities in the thoracic outlet cause compression of the subclavian or, less commonly, axillary artery. Patients are usually younger and typically have an anatomic abnormality causing the compression. The condition usually goes undiagnosed until patients present with signs of acute or chronic hand or arm ischemia. Workup of this condition includes a thorough history and physical examination; chest x-ray to identify potential anatomic abnormalities; and arterial imaging, such as computed tomographic angiography or duplex to identify arterial abnormalities. Patients will usually require operative intervention, given their symptomatic presentation. Intervention should always include decompression of the thoracic outlet with at least a first-rib resection and any other structures causing external compression. If the artery is identified to have intimal damage, mural thrombus, or is aneurysmal, then arterial reconstruction is warranted. Stenting should be avoided due to external compression. In patients with symptoms of embolization, a combination of embolectomy, lytic catheter placement, and/or therapeutic anticoagulation should be done. Typically, patients have excellent outcomes, with resolution of symptoms and high patency of the bypass graft, although patients with distal embolization may require finger amputation.</p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0895796724000097/pdfft?md5=d724161cf1aaa38c9fde345efe2e703a&pid=1-s2.0-S0895796724000097-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139814305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1053/j.semvascsurg.2024.01.003
Sarah A. Loh, Britt H. Tonnessen
Venous thoracic outlet syndrome (vTOS) is an esoteric condition that presents in young, healthy adults. Treatment includes catheter-directed thrombolysis, followed by first-rib resection for decompression of the thoracic outlet. Various techniques for first-rib resection have been described with successful outcomes. The infraclavicular approach is well-suited to treat the most medial structures that are anatomically relevant for vTOS. A narrative review was conducted to specifically examine the literature on infraclavicular exposure for vTOS. The technique for this operation is described, as well as the advantages and disadvantages of this approach. The infraclavicular approach is a reasonable choice for definitive treatment of uncomplicated vTOS.
{"title":"The infraclavicular approach for venous thoracic outlet syndrome","authors":"Sarah A. Loh, Britt H. Tonnessen","doi":"10.1053/j.semvascsurg.2024.01.003","DOIUrl":"10.1053/j.semvascsurg.2024.01.003","url":null,"abstract":"<div><p>Venous thoracic outlet syndrome (vTOS) is an esoteric condition that presents in young, healthy adults. Treatment includes catheter-directed thrombolysis, followed by first-rib resection for decompression of the thoracic outlet. Various techniques for first-rib resection have been described with successful outcomes. The infraclavicular approach is well-suited to treat the most medial structures that are anatomically relevant for vTOS. A narrative review was conducted to specifically examine the literature on infraclavicular exposure for vTOS. The technique for this operation is described, as well as the advantages and disadvantages of this approach. The infraclavicular approach is a reasonable choice for definitive treatment of uncomplicated vTOS.</p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139578658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}