Agustín Buero , Soledad Olivera Lopez , Gustavo A. Lyons , Leonardo G. Pankl , Pablo Young , Domingo J. Chimondeguy
{"title":"First Rib Resection Using Videothoracoscopy in Patients With Vascular Thoracic Outlet Syndrome","authors":"Agustín Buero , Soledad Olivera Lopez , Gustavo A. Lyons , Leonardo G. Pankl , Pablo Young , Domingo J. Chimondeguy","doi":"10.1016/j.ejvsvf.2024.06.004","DOIUrl":"10.1016/j.ejvsvf.2024.06.004","url":null,"abstract":"<div><h3>Objective</h3><p>Thoracic outlet syndrome (TOS) comprises a series of signs and symptoms produced by compression of neurovascular structures in any of the anatomical spaces of the thoracic outlet. First rib resection is a therapeutic alternative to decompress the structures of the thoracic outlet at the costoclavicular space. Traditional surgical approaches include transaxillary, supraclavicular, and infraclavicular access. The objective was to describe the surgical experience and follow up results of first rib resection using video assisted thoracoscopic surgery (VATS) in patients with vascular TOS.</p></div><div><h3>Methods</h3><p>Observational descriptive study based on a retrospective single centre analysis of a prospective database. Patients diagnosed with vascular TOS who underwent VATS first rib resection from January 2017 to December 2023 were included. The diagnosis for each subtype was based on the criteria defined in the standards of the American Society for Vascular Surgery in TOS. Among other things, the response to initial anticoagulation, peri-operative data, complications, symptom improvement, duration of post-operative anticoagulation, and symptom recurrence were investigated.</p></div><div><h3>Results</h3><p>Twenty nine patients diagnosed with vascular TOS who underwent VATS first rib resection, three of whom had bilateral procedures, were included. The total number of costal rib resections performed was 32 (31 venous TOS and one arterial TOS). The mean age was 29.1 ± 10.4 years and mean hospital stay was 2.7 ± 1.2 days. There were neither conversions to open surgery nor intra-operative complications, but there were two major post-operative complications (6.25%). No recurrences were detected during midterm follow up (median of 17.9 months, interquartile range 7.3, 45).</p></div><div><h3>Conclusion</h3><p>VATS first rib resection is a safe and feasible procedure. Unlike traditional approaches, this procedure allows physicians to make the resection under complete vision of the anatomical structures of the thoracic outlet reducing intra-operative complications and, if necessary, entire rib resection can be performed.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Pages 15-20"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000947/pdfft?md5=eebfda48f0d3dafb412e8c3c9f47dda3&pid=1-s2.0-S2666688X24000947-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141688849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alberto M. Settembrini , Leonardo Foresti , Paolo Verlato , Gianluca Buongiovanni , Daniele Bissacco , Chiara Lomazzi , Marco Maggioni , Santi Trimarchi
{"title":"Acute Lower Limb Ischaemia as a Presenting Sign of Atrial Myxoma: Case Report and Scoping Review of the Literature","authors":"Alberto M. Settembrini , Leonardo Foresti , Paolo Verlato , Gianluca Buongiovanni , Daniele Bissacco , Chiara Lomazzi , Marco Maggioni , Santi Trimarchi","doi":"10.1016/j.ejvsvf.2024.07.036","DOIUrl":"10.1016/j.ejvsvf.2024.07.036","url":null,"abstract":"<div><h3>Objective</h3><p>Cardiac myxomas (CMs) are the most common primary cardiac tumour in adults. They are a rare cause of peripheral embolisation and may present as acute lower limb ischaemia (ALI). A scoping review was undertaken and a case of ALI due to CM embolisation is presented in this paper.</p></div><div><h3>Methods</h3><p>MEDLINE, Scopus, and Embase were systematically searched for studies reporting data on ALI as a presentation of CM embolisation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed.</p></div><div><h3>Results</h3><p>A healthy 26 year old female presented to the emergency department with bilateral ALI. Urgent bilateral aorto-iliac embolectomy and distal embolectomy of the left femoropopliteal axis were performed. The retrieved embolic material exhibited a yellowish appearance and jelly like consistency, and histological analysis provided a diagnosis of a myxomatous embolus. Transoesophageal echocardiography confirmed the left atrial origin of a myxomatous tumour, but the residual mass was considered too small for further excision. At a two year clinical follow up, the patient was alive and well without recurrence. Between 1989 and 2023, 59 patients with ALI due to CM embolisation were identified in the literature. An in hospital mortality rate of 12.1% (<em>n</em> = 7) was reported, while the in hospital complication and re-intervention rates were 34.5% (<em>n</em> = 20) and 27.6% (<em>n</em> = 16), respectively. No post-discharge deaths, complications, or re-interventions were reported; fasciotomies were the most reported (<em>n</em> = 10). Post-discharge follow up was reported in 22 (37.3%) patients. Mean follow up was 18.0 ± 18.8 months (range 1–120), and 86.4% of patients (<em>n</em> = 19) were alive and well at last follow up.</p></div><div><h3>Conclusion</h3><p>This review and the associated case report underline that CM embolisation should be considered in healthy young patients presenting with cryptogenic ALI. Early transoesophageal echocardiography and histological analysis of the retrieved embolus are recommended to minimise misdiagnosis in these populations.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Pages 35-40"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24001321/pdfft?md5=5ce375cce41bfd9c07934e3a2584a9a0&pid=1-s2.0-S2666688X24001321-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Careers in Vascular and Endovascular Surgery in a Country Lacking an Integrated Vascular Residency Program","authors":"Tariq Alanezi ∗ , Hesham AlGhofili , Abdulmajeed Altoijry (Prof.) , Kaisor Iqbal , Sultan Alsheikh","doi":"10.1016/j.ejvsvf.2024.01.059","DOIUrl":"https://doi.org/10.1016/j.ejvsvf.2024.01.059","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Page S41"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000625/pdfft?md5=2ac662e8acac2fbb5b0bd1d1d22d9dbb&pid=1-s2.0-S2666688X24000625-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Mastrangelo ∗ , L. Semerano , G. Magistro , G. Palena , V. Sciannelli , R. Marinucci , P. Di Sebastiano , V. Palazzo
{"title":"The Road to the “Molecular Bypass”: First Results in Use of Autologous Mononuclear Cells in Critical Limb Ischaemia in “No Options” Patients","authors":"G. Mastrangelo ∗ , L. Semerano , G. Magistro , G. Palena , V. Sciannelli , R. Marinucci , P. Di Sebastiano , V. Palazzo","doi":"10.1016/j.ejvsvf.2024.07.018","DOIUrl":"10.1016/j.ejvsvf.2024.07.018","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Pages S12-S13"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}