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Julie A Freischlag - One of the best experts on this subject based on the ideXlab platform.

  • Clinical Research Article McCleery Syndrome: Etiology and Outcome
    2016
    Co-Authors: Kendall C Likes, Danielle H Rochlin, Diana Call, Julie A Freischlag
    Abstract:

    Objectives: Patients presenting with swelling of the upper extremity without thrombosis have McCleery syndrome or inter-mittent compression of the subclavian vein. The purpose of this study was to determine outcomes in these patients who underwent First Rib Resection and scalenectomy (FRRS).Methods: Using a prospectively maintained database from 2003 to 2011, patients were retrospectively reviewed for presentation, diagnosis, treatment, and clinical outcomes. Results: Of the patients presenting with venous thoracic outlet syndrome, 19 (11%; 13 F/6 M; mean age 26 [10-44]) presented with intermittent arm swelling, of which 3 were identified as having chronic thrombus. A total of 20 FRRS operations were performed. Conclusions: First Rib Resection and scalenectomy is effective in relieving symptoms in patients with McCleery syndrome. These patients do not generally need a postoperative venogram unless they experience continuing symptoms. In patients with chronic thrombus, routine postoperative venography at 2 weeks is indicated. Patients can present with intermittent compression if an acute episode of deep vein thrombosis is not aggressively treated

  • limited venoplasty and anticoagulation affords excellent results after First Rib Resection and scalenectomy for subacute paget schroetter syndrome
    Journal of vascular surgery. Venous and lymphatic disorders, 2014
    Co-Authors: Christopher J Abularrage, Danielle H Rochlin, Ying Wei Lum, Shalini Selvarajah, Julie A Freischlag
    Abstract:

    Objective We have previously demonstrated excellent mid-term patency rates following routine venography after First Rib Resection and scalenectomy (FRRS) for subacute Paget-Schroetter syndrome. The goal of this study was to assess the long-term outcomes of this technique. Methods Retrospective analysis of a prospectively collected database was performed. Patients underwent routine venography 2 weeks post-FRRS. Warfarin was discontinued in those with patent veins. Patients with stenotic or occluded veins underwent attempted venoplasty with balloon diameters approximating the size of the anatomically normal vein. Patients with successful venoplasty or chronically occluded veins unable to be dilated were continued on warfarin up to 6 months. Follow-up duplex ultrasound dictated cessation of anticoagulation. Kaplan-Meier analysis was performed for primary, primary-assisted, and secondary patency. Results A total of 159 patients underwent FRRS and postoperative venography with a median follow-up of 13.8 months. One patient was lost to follow-up. The median time to FRRS after the initial onset of symptoms was 4.1 months. At the time of venography, there were 42 patent, 72 stenotic, and 44 occluded veins. Of the 44 occlusions, 25 underwent venoplasty, and 19 could not be crossed. In the entire group, restenosis occurred in seven patients and reocclusion in seven. At last follow-up, six patients remained occluded. Eighteen-month primary patency of venoplasty was 95.4% ± 2.6% in the stenotic group and 75.6% ± 8.7% in the occluded group. Eighteen-month primary-assisted patency of venoplasty was 98.3% ± 1.7% in the stenotic group and 96.0% ± 3.9% in the occluded group. Overall secondary patency at 3 years was 100% in the patent group, 98.4% ± 1.6% in the stenotic group, and 92.9% ± 3.9% in the occluded group. Conclusions Long-term venous patency rates after limited venoplasty and anticoagulation following FRRS are excellent. Furthermore, prolonged anticoagulation for occlusions that could not be crossed or in those who reocclude after venoplasty results in recanalization and delayed patency. These results argue against the need for stenting or open venous reconstruction and serve as a benchmark for the care of patients with subacute Paget-Schroetter syndrome.

  • bilateral First Rib Resection and scalenectomy is effective for treatment of thoracic outlet syndrome
    Journal of Vascular Surgery, 2014
    Co-Authors: Danielle H Rochlin, Kendall C Likes, Megan S Orlando, Carly Jacobs, Julie A Freischlag
    Abstract:

    Objective Because of the small numbers of thoracic outlet syndrome (TOS) patients treated with bilateral First Rib Resection and scalenectomy (FRRS), this patient subset has not been well studied. We examined a large cohort of TOS patients who underwent bilateral FRRS to evaluate patient characteristics and outcomes. Methods Patients treated with bilateral FRRS at Johns Hopkins Medical Institutions from 2003 to 2012 were identified by review of a prospectively maintained database. Statistical analysis compared patients with unilateral and bilateral FRRS and bilateral patients with different TOS indications. Results Fifty-three patients underwent bilateral FRRS with a mean follow-up of 11.4 months. Average time between operations was 17.0 months (range, 5.1-59.8 months). Compared with 408 unilateral FRRS patients, bilateral patients were younger (30 vs 35 years; P  = .012), with no significant difference in gender. Among patients with dual-sided FRRS, 25 (47%) had bilateral neurogenic symptoms, 2 (4%) had bilateral arterial symptoms, and 26 (49%) had venous symptoms with the First side due to intermittent compression in 5 (second side: four, intermittent compression; one, neurogenic) and effort thrombosis in 21 (second side: 9, effort thrombosis; 8, intermittent compression; 4, neurogenic). Ten patients had prophylactic FRRS to prevent contralateral venous or arterial thrombosis, and eight had cervical Ribs. Compared with neurogenic patients, venous patients were younger (25 vs 35 years; P Conclusions Bilateral FRRS is an effective method for treatment of TOS. Venous bilateral patients more often are younger, are competitive athletes, and require close postoperative monitoring for recurrent stenosis and thrombosis.

  • should thoracic outlet syndrome patients ever undergo bilateral First Rib Resection and scalenectomy
    Journal of Vascular Surgery, 2013
    Co-Authors: Danielle H Rochlin, Kendall C Likes, Carly Jacobs, Julie A Freischlag
    Abstract:

    Objectives: Due to the small numbers of thoracic outlet syndrome (TOS) patients treated with bilateral First Rib Resection and scalenectomy (FRRS), this patient subset has not been well studied. We examined a large cohort of TOS patients who underwent bilateral FRRS to evaluate patient characteristics and outcomes. Methods: Patients treated with bilateral FRRS at Johns Hopkins Medical Institutions from 2003-2012 were identified by review of a prospectively maintained database. Statistical analysis compared patients with unilateral and bilateral FRRS, and bilateral patients with different TOS indications. Results: 53 patients underwent bilateral FRRS with a mean follow-up of 11.4 months. Average time between operations was 17.0 (range, 5.1-59.8) months. Compared to 408 unilateral FRRS patients, bilateral patients were younger (30 vs 35 years; P < .008) with no significant difference in gender. Among patients with dual-sided FRRS, 25 (47%) had bilateral neurogenic (N) symptoms, two (4%) had bilateral arterial symptoms, and 26 (49%) had venous symptoms with the First side due to intermittent compression (IC) in five (second side 4 IC, 1 N) and effort thrombosis (ET) in 21 (second side 9 ET, 8 IC, 4 N). 12 patients had prophylactic FRRS to prevent contralateral venous or arterial thrombosis, and eight had cervical Ribs. Compared to neurogenic patients, venous patients were younger (25 vs 35 years; P < .002) with a trend towards more competitive athletes (7 venous vs 2 N). Symptomatic restenosis requiring dilation occurred after four FRRS for venous symptoms at a mean of 32 months, and rethrombosis occurred after four FRRS at a mean of 4 weeks (1 treated with warfarin, 3 with tPA), all on the primary side. Overall, 89% of FRRS led to resolved symptoms at last follow-up. Conclusions: Bilateral FRRS is an effective method for symptomatic and prophylactic treatment of TOS. Venous bilateral patients are more often younger, competitive athletes, and must be monitored closely postoperatively for recurrent stenosis and thrombosis.

  • quality of life scores in neurogenic thoracic outlet syndrome patients undergoing First Rib Resection and scalenectomy
    Journal of Vascular Surgery, 2013
    Co-Authors: Danielle H Rochlin, Marta M Gilson, Kendall C Likes, Emma Graf, Nancy Ford, Paul J Christo, Julie A Freischlag
    Abstract:

    Objective First Rib Resection and scalenectomy (FRRS) has been shown to improve short-term quality of life (QOL) in the treatment of neurogenic thoracic outlet syndrome (NTOS). Long-term benefits are not well studied but are believed to decrease over time. Our objective was to evaluate long-term NTOS outcomes using validated QOL instruments. Methods We identified 162 NTOS patients aged ≥18 years treated by FRRS from 2003 to 2010 after they had not responded to conservative management. The patients were mailed three surveys to assess QOL (Short-Form 12 [SF-12], Brief Pain Inventory [BPI], and Cervical Brachial Symptom Questionnaire [CBSQ]), with five total outcomes measures including the SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS), BPI severity, BPI interference, and CBSQ score. Demographic and clinical data were extracted from patient records. Each FRRS was categorized based on postoperative clinical assessment as successful, failed, or leading to recurrent symptoms. Results Survey yield was 53.7% (n = 87) with mean follow-up of 44.7 months (range, 12.4-91.9 months). There was no significant difference in QOL scores associated with long-term compared with short-term follow-up. Significantly poorer scores on all instruments were associated with comorbid chronic pain syndromes, opioid use, and unfavorable clinical assessment ( P P P P P P Conclusions The QOL after FRRS shows no significant difference with longer follow-up. Clinical assessment reflects patient-reported outcomes and can gauge postoperative improvement. Patient factors, particularly comorbidities and opioid use, are more predictive of long-term QOL than is preoperative scalene block and should also be considered when selecting patients for surgical intervention.

Hugh A Gelabert - One of the best experts on this subject based on the ideXlab platform.

  • high definition video assisted transaxillary First Rib Resection for thoracic outlet syndrome
    Journal of Vascular Surgery, 2013
    Co-Authors: Y.c. Chan, Hugh A Gelabert
    Abstract:

    Transaxillary First Rib Resection is a well-established effective surgical treatment for patients with symptomatic thoracic outlet syndrome, but surgical access may be limited and visualization is constrained. The use of high-definition video-assisted imaging overcomes these limitations. The use of high-definition video-assisted visualization of the anatomy enhances the surgeon's tactile feedback of the Rib from the small open wound and is effective in providing better surgical access and allows clear identification of vital structures for the operating surgical team. This technique enhances the appreciation of anatomic detail, situational awareness of the team, and allows for more efficient assistance to the surgeon. Improved visualization also facilitates effective education of nurses, residents, and students.

  • High-definition video-assisted transaxillary First Rib Resection for thoracic outlet syndrome
    'Elsevier BV', 2013
    Co-Authors: Y.c. Chan, Hugh A Gelabert
    Abstract:

    Transaxillary First Rib Resection is a well-established effective surgical treatment for patients with symptomatic thoracic outlet syndrome, but surgical access may be limited and visualization is constrained. The use of high-definition video-assisted imaging overcomes these limitations. The use of high-definition video-assisted visualization of the anatomy enhances the surgeon's tactile feedback of the Rib from the small open wound and is effective in providing better surgical access and allows clear identification of vital structures for the operating surgical team. This technique enhances the appreciation of anatomic detail, situational awareness of the team, and allows for more efficient assistance to the surgeon. Improved visualization also facilitates effective education of nurses, residents, and students.link_to_subscRibed_fulltex

  • Early postoperative hemorrhage after First Rib Resection for vascular thoracic outlet syndrome.
    Annals of vascular surgery, 2011
    Co-Authors: Hugh A Gelabert, Juan Carlos Jimenez, Gavin Davis, Brian G. Derubertis, Jessica B. O’connell, David A. Rigberg
    Abstract:

    Background Thrombosis and embolization are the most frequent complications associated with the vascular presentation of thoracic outlet syndrome (VTOS). Therefore, surgery for these conditions requires careful balancing of anticoagulation and hemostasis. Our goal is to identify the optimal postoperative anticoagulation management of these patients. Methods A prospective database of consecutive patients who have presented to our institution with the diagnosis of thoracic outlet syndrome was reviewed from 1996 through 2010 for instances of postoperative hemorrhage. All venous cases were managed with transaxillary First Rib Resection followed by postoperative venography and percutaneous angioplasty when required. All arterial cases First underwent thrombolysis, then decompression with transaxillary First and cervical Rib Resection with concomitant arterial repair when indicated. Results Over the study period, 423 patients diagnosed with thoracic outlet syndrome underwent 551 procedures. Of these, 108 presented with VTOS (12 arterial and 96 venous). Mean age of the patients in the cohort was 33.7 ± 11.5 years, with 53 women and 55 men. Postoperative hemorrhage occurred in four patients (4%): three venous cases and one arterial case. Three patients required tube thoracostomy (average blood return: 800 mL) and two required video-assisted thoracoscopic surgery for decortication. Age, gender, preoperative anticoagulation, interval from thrombolysis to surgery, operative duration, and operative blood loss had no effect on the risk of bleeding. No hemorrhage occurred in patients treated with postoperative coumadin alone (82 patients) or with no anticoagulant (24 patients). The four cases of hemorrhage occurred only in patients treated with postoperative low-molecular-weight heparin (LMWH; 14 patients; p Conclusion Postoperative hemorrhage was not a common complication of First Rib Resection for VTOS. In our experience, it occurred exclusively in patients receiving LMWH postoperatively. Postoperative LMWH should be used with caution in patients with VTOS.

Ernesto J Molina - One of the best experts on this subject based on the ideXlab platform.

  • reoperations after failed transaxillary First Rib Resection for subclavian vein thrombosis
    2013
    Co-Authors: Ernesto J Molina
    Abstract:

    With increasing frequency we are seeing patients who have undergone a late transaxillary approach to decompress the subclavian vein several weeks after the patient has been initially diagnosed and treated with thrombolytic agents and the thrombus has resolved. This policy is wrong. This tendency occurs despite the current recommendation to operate on these patients immediately at the time of the original event even if the vein has been reopened using either thrombolytics or percutaneous thrombectomy catheter [1, 2]. The longer the waiting period for a definitive surgery, the lesser the chance of reestablishing a long-term patency and flow in the subclavian vein (Fig. 22.1). After the radiologist clears the vein, many of these patients are operated using the transaxillary route to remove the First Rib on the thesis that simply by decompressing the thoracic inlet, the subclavian vein normal function will be reestablished. This is not the case. Because of the limitation of the transaxillary approach to reach the actual site of extrinsic compression of the vein caused by the subclavian tendon and the costoclavicular ligament, plus added incomplete removal of the anterior end of the Rib, (Fig. 22.2) these patients often re-thrombose or remain obstructed shortly after the thrombolytic stage is completed [3]. When these patients return with the same symptoms they are frequently subjected to prolonged periods of anticoagulation hoping to have the vein re-canalize. It never occurs. Patients may also then be subjected to balloon dilation of the obstructed segment, often accompanied by the placement of endovascular stents [4–8]. Most commonly this does not resolve the problem: the site of the extrinsic compression has not been relieved, and therefore the stent kinks and the vein reobstructs again (Fig. 23.1). Some of the patients that we have seen have undergone multiple balloon dilations and stent placements in the same area with no success (Fig. 23.2). The patients are often left with no hope of having a cure for this disabling condition. We highly recommended that if this is the situation, the patient must be reoperated using a different approach namely the anterior route [3]. This is the only way to access the site of extrinsic compression with which the vein is still affected, because the ligaments are still intact and the cartilaginous most anterior portion of the First Rib has not been removed. Often enough, the vein also needs to be repaired directly using a vein patch as descRibed in Chap. 12. Afterward, if needed a stent can also be implanted. Some of these examples are shown in Figs. 23.3a, b and 23.4a, b. Figure 23.5 depicts some of the initial intraoperative findings showing the still persistent mechanical obstruction of the subclavian vein at the inlet. The results of reoperating these patients have been rewarding. However, not every patient is a candidate for this operation, particularly if the elapsed time between the initial thrombosis to the time of the transaxillary operation Resection has been long. In a series of 16 patients seen with persistent obstruction of the subclavian vein after transaxillary Resection of the First Rib we were able to repair appropriately only 11 (Table 23.1). In five of them the vein was already extensively damaged and the fibrotic process had extended into the axillary vein with no adequate lumen was available to attempt any type of reconstruction. It is strongly suggested therefore that if the patient undergoes a transaxillary Resection of the First Rib for Paget–Schroetter syndrome he/she should have an immediate postoperative venogram obtained to assess the status of the vein. If thrombosis persists, these patients should be reoperated using the anterior subclavicular route as soon as possible.

  • reoperations after failed transaxillary First Rib Resection to treat paget schroetter syndrome patients
    The Annals of Thoracic Surgery, 2011
    Co-Authors: Ernesto J Molina
    Abstract:

    Background. A series of 15 patients previously treated for Paget-Schroetter syndrome with a transaxillary First Rib Resection (TARR) were seen with recurrent thrombosis. Methods. Ten were reoperated using an anterior subclavicular approach. The time of reoperation ranged from 5 months to 7 years (mean, 23.4 months). All patients had been subjected to multiple balloon plasties and 4 of them in addition had up to 3 stents implanted, which also failed. Reevaluation was done with venography. Ten patients were considered to be still salvageable and were reoperated, but 5 were inoperable due to progressive obliteration of the venous channel as early as 2 weeks after TARR. Results. All 10 patients had successful reestablishment of the subclavian vein patency and caliber and have remained patent without anticoagulants. Conclusions. The patients who re-thrombose or remain obstructed after TARR should be reoperated instead of resourcing to implanting stents or multiple balloon plasties that invariably fail, and patients should not be kept on anticoagulation indefinitely hoping to maintain the vein open.

  • operative technique of First Rib Resection via subclavicular approach
    Vascular Surgery, 1993
    Co-Authors: Ernesto J Molina
    Abstract:

    A subclavicular approach to the First Rib for Resection in cases of subclavian vein thrombosis or chronic obstruction is descRibed. The steps of the surgical procedure are descRibed. The technique is ideally suited for emergency care of Paget-Schroetter syndrome patients.

Danielle H Rochlin - One of the best experts on this subject based on the ideXlab platform.

  • Clinical Research Article McCleery Syndrome: Etiology and Outcome
    2016
    Co-Authors: Kendall C Likes, Danielle H Rochlin, Diana Call, Julie A Freischlag
    Abstract:

    Objectives: Patients presenting with swelling of the upper extremity without thrombosis have McCleery syndrome or inter-mittent compression of the subclavian vein. The purpose of this study was to determine outcomes in these patients who underwent First Rib Resection and scalenectomy (FRRS).Methods: Using a prospectively maintained database from 2003 to 2011, patients were retrospectively reviewed for presentation, diagnosis, treatment, and clinical outcomes. Results: Of the patients presenting with venous thoracic outlet syndrome, 19 (11%; 13 F/6 M; mean age 26 [10-44]) presented with intermittent arm swelling, of which 3 were identified as having chronic thrombus. A total of 20 FRRS operations were performed. Conclusions: First Rib Resection and scalenectomy is effective in relieving symptoms in patients with McCleery syndrome. These patients do not generally need a postoperative venogram unless they experience continuing symptoms. In patients with chronic thrombus, routine postoperative venography at 2 weeks is indicated. Patients can present with intermittent compression if an acute episode of deep vein thrombosis is not aggressively treated

  • bilateral First Rib Resection and scalenectomy is effective for treatment of thoracic outlet syndrome
    Journal of Vascular Surgery, 2014
    Co-Authors: Danielle H Rochlin, Kendall C Likes, Megan S Orlando, Carly Jacobs, Julie A Freischlag
    Abstract:

    Objective Because of the small numbers of thoracic outlet syndrome (TOS) patients treated with bilateral First Rib Resection and scalenectomy (FRRS), this patient subset has not been well studied. We examined a large cohort of TOS patients who underwent bilateral FRRS to evaluate patient characteristics and outcomes. Methods Patients treated with bilateral FRRS at Johns Hopkins Medical Institutions from 2003 to 2012 were identified by review of a prospectively maintained database. Statistical analysis compared patients with unilateral and bilateral FRRS and bilateral patients with different TOS indications. Results Fifty-three patients underwent bilateral FRRS with a mean follow-up of 11.4 months. Average time between operations was 17.0 months (range, 5.1-59.8 months). Compared with 408 unilateral FRRS patients, bilateral patients were younger (30 vs 35 years; P  = .012), with no significant difference in gender. Among patients with dual-sided FRRS, 25 (47%) had bilateral neurogenic symptoms, 2 (4%) had bilateral arterial symptoms, and 26 (49%) had venous symptoms with the First side due to intermittent compression in 5 (second side: four, intermittent compression; one, neurogenic) and effort thrombosis in 21 (second side: 9, effort thrombosis; 8, intermittent compression; 4, neurogenic). Ten patients had prophylactic FRRS to prevent contralateral venous or arterial thrombosis, and eight had cervical Ribs. Compared with neurogenic patients, venous patients were younger (25 vs 35 years; P Conclusions Bilateral FRRS is an effective method for treatment of TOS. Venous bilateral patients more often are younger, are competitive athletes, and require close postoperative monitoring for recurrent stenosis and thrombosis.

  • limited venoplasty and anticoagulation affords excellent results after First Rib Resection and scalenectomy for subacute paget schroetter syndrome
    Journal of vascular surgery. Venous and lymphatic disorders, 2014
    Co-Authors: Christopher J Abularrage, Danielle H Rochlin, Ying Wei Lum, Shalini Selvarajah, Julie A Freischlag
    Abstract:

    Objective We have previously demonstrated excellent mid-term patency rates following routine venography after First Rib Resection and scalenectomy (FRRS) for subacute Paget-Schroetter syndrome. The goal of this study was to assess the long-term outcomes of this technique. Methods Retrospective analysis of a prospectively collected database was performed. Patients underwent routine venography 2 weeks post-FRRS. Warfarin was discontinued in those with patent veins. Patients with stenotic or occluded veins underwent attempted venoplasty with balloon diameters approximating the size of the anatomically normal vein. Patients with successful venoplasty or chronically occluded veins unable to be dilated were continued on warfarin up to 6 months. Follow-up duplex ultrasound dictated cessation of anticoagulation. Kaplan-Meier analysis was performed for primary, primary-assisted, and secondary patency. Results A total of 159 patients underwent FRRS and postoperative venography with a median follow-up of 13.8 months. One patient was lost to follow-up. The median time to FRRS after the initial onset of symptoms was 4.1 months. At the time of venography, there were 42 patent, 72 stenotic, and 44 occluded veins. Of the 44 occlusions, 25 underwent venoplasty, and 19 could not be crossed. In the entire group, restenosis occurred in seven patients and reocclusion in seven. At last follow-up, six patients remained occluded. Eighteen-month primary patency of venoplasty was 95.4% ± 2.6% in the stenotic group and 75.6% ± 8.7% in the occluded group. Eighteen-month primary-assisted patency of venoplasty was 98.3% ± 1.7% in the stenotic group and 96.0% ± 3.9% in the occluded group. Overall secondary patency at 3 years was 100% in the patent group, 98.4% ± 1.6% in the stenotic group, and 92.9% ± 3.9% in the occluded group. Conclusions Long-term venous patency rates after limited venoplasty and anticoagulation following FRRS are excellent. Furthermore, prolonged anticoagulation for occlusions that could not be crossed or in those who reocclude after venoplasty results in recanalization and delayed patency. These results argue against the need for stenting or open venous reconstruction and serve as a benchmark for the care of patients with subacute Paget-Schroetter syndrome.

  • should thoracic outlet syndrome patients ever undergo bilateral First Rib Resection and scalenectomy
    Journal of Vascular Surgery, 2013
    Co-Authors: Danielle H Rochlin, Kendall C Likes, Carly Jacobs, Julie A Freischlag
    Abstract:

    Objectives: Due to the small numbers of thoracic outlet syndrome (TOS) patients treated with bilateral First Rib Resection and scalenectomy (FRRS), this patient subset has not been well studied. We examined a large cohort of TOS patients who underwent bilateral FRRS to evaluate patient characteristics and outcomes. Methods: Patients treated with bilateral FRRS at Johns Hopkins Medical Institutions from 2003-2012 were identified by review of a prospectively maintained database. Statistical analysis compared patients with unilateral and bilateral FRRS, and bilateral patients with different TOS indications. Results: 53 patients underwent bilateral FRRS with a mean follow-up of 11.4 months. Average time between operations was 17.0 (range, 5.1-59.8) months. Compared to 408 unilateral FRRS patients, bilateral patients were younger (30 vs 35 years; P < .008) with no significant difference in gender. Among patients with dual-sided FRRS, 25 (47%) had bilateral neurogenic (N) symptoms, two (4%) had bilateral arterial symptoms, and 26 (49%) had venous symptoms with the First side due to intermittent compression (IC) in five (second side 4 IC, 1 N) and effort thrombosis (ET) in 21 (second side 9 ET, 8 IC, 4 N). 12 patients had prophylactic FRRS to prevent contralateral venous or arterial thrombosis, and eight had cervical Ribs. Compared to neurogenic patients, venous patients were younger (25 vs 35 years; P < .002) with a trend towards more competitive athletes (7 venous vs 2 N). Symptomatic restenosis requiring dilation occurred after four FRRS for venous symptoms at a mean of 32 months, and rethrombosis occurred after four FRRS at a mean of 4 weeks (1 treated with warfarin, 3 with tPA), all on the primary side. Overall, 89% of FRRS led to resolved symptoms at last follow-up. Conclusions: Bilateral FRRS is an effective method for symptomatic and prophylactic treatment of TOS. Venous bilateral patients are more often younger, competitive athletes, and must be monitored closely postoperatively for recurrent stenosis and thrombosis.

  • quality of life scores in neurogenic thoracic outlet syndrome patients undergoing First Rib Resection and scalenectomy
    Journal of Vascular Surgery, 2013
    Co-Authors: Danielle H Rochlin, Marta M Gilson, Kendall C Likes, Emma Graf, Nancy Ford, Paul J Christo, Julie A Freischlag
    Abstract:

    Objective First Rib Resection and scalenectomy (FRRS) has been shown to improve short-term quality of life (QOL) in the treatment of neurogenic thoracic outlet syndrome (NTOS). Long-term benefits are not well studied but are believed to decrease over time. Our objective was to evaluate long-term NTOS outcomes using validated QOL instruments. Methods We identified 162 NTOS patients aged ≥18 years treated by FRRS from 2003 to 2010 after they had not responded to conservative management. The patients were mailed three surveys to assess QOL (Short-Form 12 [SF-12], Brief Pain Inventory [BPI], and Cervical Brachial Symptom Questionnaire [CBSQ]), with five total outcomes measures including the SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS), BPI severity, BPI interference, and CBSQ score. Demographic and clinical data were extracted from patient records. Each FRRS was categorized based on postoperative clinical assessment as successful, failed, or leading to recurrent symptoms. Results Survey yield was 53.7% (n = 87) with mean follow-up of 44.7 months (range, 12.4-91.9 months). There was no significant difference in QOL scores associated with long-term compared with short-term follow-up. Significantly poorer scores on all instruments were associated with comorbid chronic pain syndromes, opioid use, and unfavorable clinical assessment ( P P P P P P Conclusions The QOL after FRRS shows no significant difference with longer follow-up. Clinical assessment reflects patient-reported outcomes and can gauge postoperative improvement. Patient factors, particularly comorbidities and opioid use, are more predictive of long-term QOL than is preoperative scalene block and should also be considered when selecting patients for surgical intervention.

Y.c. Chan - One of the best experts on this subject based on the ideXlab platform.

  • high definition video assisted transaxillary First Rib Resection for thoracic outlet syndrome
    Journal of Vascular Surgery, 2013
    Co-Authors: Y.c. Chan, Hugh A Gelabert
    Abstract:

    Transaxillary First Rib Resection is a well-established effective surgical treatment for patients with symptomatic thoracic outlet syndrome, but surgical access may be limited and visualization is constrained. The use of high-definition video-assisted imaging overcomes these limitations. The use of high-definition video-assisted visualization of the anatomy enhances the surgeon's tactile feedback of the Rib from the small open wound and is effective in providing better surgical access and allows clear identification of vital structures for the operating surgical team. This technique enhances the appreciation of anatomic detail, situational awareness of the team, and allows for more efficient assistance to the surgeon. Improved visualization also facilitates effective education of nurses, residents, and students.

  • High-definition video-assisted transaxillary First Rib Resection for thoracic outlet syndrome
    'Elsevier BV', 2013
    Co-Authors: Y.c. Chan, Hugh A Gelabert
    Abstract:

    Transaxillary First Rib Resection is a well-established effective surgical treatment for patients with symptomatic thoracic outlet syndrome, but surgical access may be limited and visualization is constrained. The use of high-definition video-assisted imaging overcomes these limitations. The use of high-definition video-assisted visualization of the anatomy enhances the surgeon's tactile feedback of the Rib from the small open wound and is effective in providing better surgical access and allows clear identification of vital structures for the operating surgical team. This technique enhances the appreciation of anatomic detail, situational awareness of the team, and allows for more efficient assistance to the surgeon. Improved visualization also facilitates effective education of nurses, residents, and students.link_to_subscRibed_fulltex