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Tabatabaeishoorijeh A, Haddad P, Chauhan Y, Atkins MD, Rahimi M. Open repair of a proximal left subclavian artery mycotic aneurysm with median claviculectomy. J Vasc Surg Cases Innov Tech 2024; 10:101374. [PMID: 38130359 PMCID: PMC10731596 DOI: 10.1016/j.jvscit.2023.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Surgical repair of a subclavian artery mycotic aneurysm is dependent on aneurysm-specific characteristics and anatomic exposures could require sternotomy, thoracotomy, or supraclavicular incisions. Alternatively, a median claviculectomy can be used. We successfully performed a subclavian artery to axillary artery bypass with median claviculectomy in a 23-year-old man with multiple comorbidities. Postoperative Doppler ultrasound showed a patent left axillary artery with a palpable left radial artery, and the patient demonstrated full left shoulder range of motion without any significant deformities. This case suggests that a median claviculectomy can produce satisfactory outcomes in patients with subclavian artery mycotic aneurysms.
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Affiliation(s)
- Ahmad Tabatabaeishoorijeh
- School of Engineering Medicine, Texas A&M University, Houston, TX
- School of Medicine, Texas A&M University, Bryan, TX
- College of Engineering, Texas A&M University, Bryan, TX
| | - Paul Haddad
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Yusuf Chauhan
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Marvin D. Atkins
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Maham Rahimi
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
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Hoexum F, Hoebink M, Coveliers HME, Wisselink W, Jongkind V, Yeung KK. Management of Paget-Schroetter Syndrome: a Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2023; 66:866-875. [PMID: 37678659 DOI: 10.1016/j.ejvs.2023.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Currently, there is no consensus on the optimal management of Paget-Schroetter syndrome (PSS). The objective was to summarise the current evidence for management of PSS with explicit attention to the clinical outcomes of different management strategies. DATA SOURCES The Cochrane, PubMed, and Embase databases were searched for reports published between January 1990 and December 2021. REVIEW METHODS A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines. The primary endpoint was the proportion of symptom free patients at last follow up. Secondary outcomes were success of initial treatment, recurrence of thrombosis or persistent occlusion, and patency at last follow up. Meta-analyses of the primary endpoint were performed for non-comparative and comparative reports. The quality of evidence was assessed using the GRADE approach. RESULTS Sixty reports were included (2 653 patients), with overall moderate quality. The proportions of symptom free patients in non-comparative analysis were: anticoagulation (AC), 0.54; catheter directed thrombolysis (CDT) + AC, 0.71; AC + first rib resection (FRR), 0.80; and CDT + FRR, 0.96. Pooled analysis of comparative reports confirmed the superiority of CDT + FRR compared with AC (OR 13.89, 95% CI 1.08 - 179.04; p = .040, I2 87%, very low certainty of evidence), AC + FRR (OR 2.29, 95% CI 1.21 - 4.35; p = .010, I2 0%, very low certainty of evidence), and CDT + AC (OR 8.44, 95% CI 1.12 - 59.53; p = .030, I2 63%, very low certainty of evidence). Secondary endpoints were in favour of CDT + FRR. CONCLUSION Non-operative management of PSS with AC alone results in persistent symptoms in 46% of patients, while 96% of patients managed with CDT + FFR were symptom free at end of follow up. Superiority of CDT + FRR compared with AC, CDT + AC, and AC + FRR was confirmed by meta-analysis. The overall quality of included reports was moderate, and the level of certainty was very low.
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Affiliation(s)
- Frank Hoexum
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Max Hoebink
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | | | - Willem Wisselink
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Vincent Jongkind
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Kak Khee Yeung
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
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Takenoshita S, Asano N, Kasahara T, Hirozane T, Yamaguchi S, Mori T, Ohkita H, Nakayama R, Nakamura M, Matsumoto M. Secondary peripheral chondrosarcoma arising from solitary osteochondroma of the clavicle: A case report. J Orthop Sci 2023; 28:1592-1596. [PMID: 34924250 DOI: 10.1016/j.jos.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Shinichi Takenoshita
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Naofumi Asano
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan.
| | - Tomoki Kasahara
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Toru Hirozane
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Sayaka Yamaguchi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Tomoaki Mori
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Hajime Ohkita
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Robert Nakayama
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
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Smolle MA, Niethard M, Schrader C, Bergovec M, Tunn PU, Friesenbichler J, Scheipl S, Leithner A. Clinical and functional outcome after partial or total claviculectomy without reconstruction for oncologic causes. J Shoulder Elbow Surg 2023; 32:1967-1971. [PMID: 37044301 DOI: 10.1016/j.jse.2023.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/19/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND To achieve clear margins in rare malignant clavicular neoplasms, claviculectomy may become necessary. This study aimed to review clinical, functional, and oncologic outcomes following partial or total claviculectomy without reconstruction. METHODS This study retrospectively included 15 patients from 2 tertiary sarcoma centers (mean age, 42.6 ± 20.3 years; 66.7% male patients). The median length of clinical and oncologic follow-up was 48.0 months (interquartile range [IQR], 24.0-83.5 months). Functional follow-up (Musculoskeletal Tumor Society score and QuickDASH score [short version of the Disabilities of the Arm, Shoulder and Hand questionnaire]) was available in 9 patients at a median of 36.0 months (IQR, 20.0-100.0 months). RESULTS Of the 15 patients, 7 underwent total claviculectomy; 5, partial lateral claviculectomy; and 3, partial medial claviculectomy. No postoperative complications emerged. The median Musculoskeletal Tumor Society and QuickDASH scores at latest follow-up amounted to 26.0 points (IQR, 24.0-29.0 points) and 18.0 points (IQR, 11.0-22.0 points), respectively. Notably, scores tended to be lower in patients who underwent total claviculectomy (n = 2) in comparison to partial claviculectomy (n = 7). CONCLUSION Satisfactory clinical and functional results can be achieved following partial or total claviculectomy without reconstruction, with a low complication rate and acceptable mid- to long-term function.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Maya Niethard
- Tumour Orthopaedics, HELIOS Klinikum Berlin-Buch, Berlin, Germany; Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Christian Schrader
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Per-Ulf Tunn
- Tumour Orthopaedics, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Susanne Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
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Bellamkonda KS, Perez Lozada JC, Chaar CIO. A rare presentation and management of thrombosis of an aberrant right subclavian artery related to thoracic outlet syndrome. Vascular 2021; 30:225-228. [PMID: 33813970 DOI: 10.1177/17085381211002735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We present a case in which a 44-year-old female smoker with a complex medical and surgical history presented with acute upper limb ischemia. METHODS The patient was diagnosed with thoracic outlet syndrome causing symptomatic thrombosis of an aberrant right subclavian artery associated with diverticulum of Kommerell. The patient had history of extensive surgeries and radiation in the right chest with fibrotic changes, so surgical dissection in the area was associated with significant risk of nerve injury. Therefore, revascularization of the arm was performed via carotid to brachial artery bypass with reversed saphenous vein and the thoracic outlet was decompressed with segmental clavicular resection. RESULTS Patient has been symptom free for 3 years with patent bypass. CONCLUSIONS This case demonstrates a unique presentation of distal thrombosis of a symptomatic aberrant right subclavian artery related to thoracic outlet syndrome. The combined claviculectomy-vein bypass is a safe and efficacious surgical approach that provides durable relief.
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Affiliation(s)
| | - Juan Carlos Perez Lozada
- Department of Radiology and Biomedical Imaging, Division of Vascular and Interventional Radiology, Yale School of Medicine, Connecticut, New Haven, CT, USA
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Auyang PL, Chauhan Y, Loh TM, Bennett ME, Peden EK. Medial claviculectomy for the treatment of recalcitrant central venous stenosis of hemodialysis patients. J Vasc Surg Venous Lymphat Disord 2019; 7:420-427. [DOI: 10.1016/j.jvsv.2018.10.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
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Thiyagarajah K, Ellingwood L, Endres K, Hegazi A, Radford J, Iansavitchene A, Lazo-Langner A. Post-thrombotic syndrome and recurrent thromboembolism in patients with upper extremity deep vein thrombosis: A systematic review and meta-analysis. Thromb Res 2019; 174:34-39. [DOI: 10.1016/j.thromres.2018.12.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/13/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
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Mills GJ, Warme WJ. Iatrogenic bipolar clavicular instability managed with clavicular lengthening and sternoclavicular and acromioclavicular stabilization: a case report. J Shoulder Elbow Surg 2018; 27:e308-e312. [PMID: 30111505 DOI: 10.1016/j.jse.2018.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/03/2018] [Accepted: 06/13/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Galen J Mills
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA.
| | - Winston J Warme
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
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Chen Y, Yu X, Huang W, Wang B. Is clavicular reconstruction imperative for total and subtotal claviculectomy? A systematic review. J Shoulder Elbow Surg 2018; 27:e141-e148. [PMID: 29305098 DOI: 10.1016/j.jse.2017.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effects of clavicular reconstruction on total and subtotal claviculectomy are controversial. The aim of this study is to disclose the impact of clavicular reconstruction on the efficacy of this rare surgical procedure. METHODS This is a systematic review of multiple medical databases for level I through IV evidence. RESULTS Eleven studies (level IV) with a mean follow-up duration of 53 months (range, 12-156 months) met the inclusion criteria. There were 70 subjects (70 shoulders) including 36 male patients (51%), and the average age at operation was 30 years (range, 2-77 years). The etiology included tumors in 34 subjects (49%) and other disorders in 36 (51%). Of the patients, 41 (59%) underwent total claviculectomy whereas 29 (41%) underwent subtotal clavicular excision. Clavicular reconstruction was performed in 14 subjects (20%), with bone allograft in 8, autograft in 1, and a bone cement prosthesis in 5. Objective measurement disclosed compromised strength and mobility in aclaviculate limbs; however, no studies investigating clavicular reconstruction used similar means of measurement. Functional assessment scales implied global limb function following the 2 procedures was similar (American Shoulder and Elbow Surgeons score, P = .13; Constant score, P = .38). Claviculectomy with and without reconstruction resulted in a similar incidence of complications (P = .45); however, isolated claviculectomy was related to fewer further surgical procedures (P <.001) and faster recovery (P <.001). The 2 procedures were associated with similar satisfaction rates (P > .99). CONCLUSIONS No evidence suggested clavicular reconstruction led to clinical outcomes superior to those of isolated claviculectomy. It is noteworthy that isolated excision of the clavicle was associated with a lower risk of further surgery and faster rehabilitation.
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Affiliation(s)
- Yu Chen
- Orthopedic Department, General Hospital of Jinan Military Command, Jinan City, China
| | - Xiuchun Yu
- Orthopedic Department, General Hospital of Jinan Military Command, Jinan City, China.
| | - Weimin Huang
- Orthopedic Department, General Hospital of Jinan Military Command, Jinan City, China
| | - Bing Wang
- Orthopedic Department, General Hospital of Jinan Military Command, Jinan City, China
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Keir G, Marshall MB. Management Strategy for Patients With Chronic Subclavian Vein Thrombosis. Ann Thorac Surg 2017; 103:672-5. [DOI: 10.1016/j.athoracsur.2016.09.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 08/21/2016] [Accepted: 09/07/2016] [Indexed: 11/20/2022]
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Abstract
Spontaneous thrombosis of the axillary and subclavian venous segments in young, healthy adults (effort thrombosis or Paget-Schroetter syndrome) is a rare but potentially disabling affliction. The diagnosis should be suspected in any young patient presenting with unilateral arm swelling. Typically, the dominant arm is affected, and frequent, repetitive arm use is a common component of the patients' history. Although the diagnosis can often be confirmed with a venous duplex evaluation, the central location of the venous abnormality occasionally mandates cross-sectional imaging or contrast venography to confirm the diagnosis. The underlying pathophysiology of this disorder is felt to be repetitive venous trauma owing to arm motion in the narrow anatomic space between the clavicle and first rib. The treatment of Paget-Schroetter syndrome is controversial and varies according to individual, institutional, and regional preferences. In general, the trend is toward more aggressive endovascular treatment. Prompt anticoagulation is generally accepted as the minimal treatment offered. Catheter-directed thrombolysis has also acquired a prominent role in reestablishing venous patency. The importance of relieving the anatomic compression of the subclavian vein by first rib resection remains controversial, with some experts advocating surgical intervention in all affected patients, whereas others perform this procedure selectively in cases of persistent venous stenosis or ongoing symptoms. Angioplasty with or without stenting is generally discouraged in the absence of anatomic decompression but may play an adjunctive role in patients undergoing first rib resection.
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Affiliation(s)
- Gregory J. Landry
- *Division of Vascular Surgery, Oregon Health & Science University, Portland, OR
| | - Timothy K. Liem
- *Division of Vascular Surgery, Oregon Health & Science University, Portland, OR
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Chen HC, Chang HS. The Sternocleidomastoid Flap for Oral Cavity Reconstruction: Extended Indications and Technical Modifications. J Oral Maxillofac Surg 2015; 73:2429-39. [DOI: 10.1016/j.joms.2015.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/16/2015] [Accepted: 07/29/2015] [Indexed: 11/25/2022]
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Lin B, He Y, Xu Y, Sha M. Outcome of bone defect reconstruction with clavicle bone cement prosthesis after tumor resection: a case series study. BMC Musculoskelet Disord 2014; 15:183. [PMID: 24885109 PMCID: PMC4046063 DOI: 10.1186/1471-2474-15-183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 05/21/2014] [Indexed: 11/24/2022] Open
Abstract
Background To investigate the short and medium term outcomes of bone defect reconstruction with bone cement prosthesis after clavicle malignancies resection. Methods A total of 5 clavicular malignancy patients experienced bone cement prosthesis reconstruction after subtotal claviculectomy were enrolled the study from January 2005 to May 2012. Musculoskeletal Tumor Society score (MSTS), Visual Analogue scale (VAS) and American Shoulder and Elbow Surgeons shoulder outcome score (ASES) were adopted for assessment. Results The mean follow-up period was 25.8 months. All patients were performed bone cement defect reconstruction after claviculectomy. In which, 3 cases showed disease-free and other 2 cases were alive with sickness. The average Musculoskeletal Tumor Society score was 85.40% ± 5.68%(77%-90%), Visual Analogue Scale was 1.40 ± 0.55 (1–2) and American Shoulder and Elbow Surgeons Shoulder Outcome Score was 92.40 ± 3.29(87–96). Conclusions Adoption of clavicle bone cement prosthesis for bone defect reconstruction after tumor resection can maintain the contour of shoulder and reduce the complications ascribe to the claviculectomy. It is an effective and feasible therapeutic procedure in clinical setting.
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Affiliation(s)
| | | | | | - Mo Sha
- Department of Orthopedics, the 175th Hospital of PLA, Southeast Hospital of Xiamen University, Zhang Zhou, Fu Jian, China.
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Hassan S, Burgess E, Sangars B, Perricone V, Charalambous CP. Non-union of a clavicle fracture: lateral fragment excision for brachial artery embolism. Shoulder Elbow 2014; 6:105-7. [PMID: 27582923 PMCID: PMC4935075 DOI: 10.1177/1758573214522025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 01/10/2014] [Indexed: 11/16/2022]
Abstract
A 67-year-old motorcyslist was admitted to hospital following a high-speed road traffic collision and found to have a left midshaft clavicle fracture and multiple ipsilateral rib fractures. He was treated conservatively and went on to have non-union of the clavicle. The non-union was managed non-operatively. The patient then re-attended the hospital with an acute ischaemic left hand 3 years after the original injury date. An arterial duplex scan confirmed a embolus to the brachial artery. A brachial embolectomy was urgently performed. A computed tomography scan showed non-union of the clavicle fracture and an inflammatory mass compressing the left subclavian artery, which was the focus of the embolic event. The clavicle non-union was managed operatively with lateral half claviculectomy. Immediately after clavicle excision, the vascular team performed reconstruction of the brachial artery. At follow-up,there was normal shoulder and hand function at outpatient clinic. A duplex scan confirmed good triphasic waveforms throughout the arteries of the left upper limb.
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Affiliation(s)
- Syed Hassan
- Syed Hassan, Department of Orthopaedic Surgery, Blackpool Victoria Hospital, Blackpool, Lancashire FY3 8NR, UK. Tel.: +44 (0)1253 955983. E-mail:
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Tsekouras N, Comerota AJ. Current trends in the treatment of venous thoracic outlet syndrome: a comprehensive review. Interv Cardiol 2014. [DOI: 10.2217/ica.13.91] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rubright J, Kelleher P, Beardsley C, Paller D, Shackford S, Beynnon B, Shafritz A. Long-term clinical outcomes, motion, strength, and function after total claviculectomy. J Shoulder Elbow Surg 2014; 23:236-44. [PMID: 23942010 DOI: 10.1016/j.jse.2013.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/15/2013] [Accepted: 05/18/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total excision of the clavicle is rarely performed. No previous study has documented long-term outcomes with objective measurements of strength, motion, and patient-centered outcomes. We present the long-term consequences of total claviculectomy on shoulder girdle function, global upper extremity function, and overall general health. METHODS Five total claviculectomy patients were evaluated at 2 time points (2005 and 2010, mean 4.8 and 9.4 years postoperatively) by use of the DASH, SF-36, Simple Shoulder Test, ASES, UCLA, HSS, and Constant shoulder scores. Isokinetic strength, clinical range of motion, and kinematic analysis were performed on each limb pair. RESULTS All clinical scores allowing side-to-side comparison were poorer for the aclaviculate side, with significance reached for 2005 ASES scores and 2010 ASES, UCLA, HSS, and Constant scores. DASH scores and SF-36 scores were not significantly inferior to age- and sex-matched population norms. Deficits in strength were present in the aclaviculate limbs, with significance reached for adduction in 2005 and for forward flexion and external rotation in 2010. Kinematic and clinical range of motion analysis revealed scapular dyskinesis and significant deficits in external rotation in the aclaviculate limb. CONCLUSIONS We found that the clavicle contributes to the strength, coordinated scapulohumeral rhythm, and overall range of motion of the shoulder girdle. Patients compensate for loss of the clavicle with minimal functional deficit. With time, patients gradually lose some compensatory ability as evidenced by deteriorating limb-specific, patient-centered outcome measures, diminished strength in certain planes of shoulder motion, and scapular dyskinesis at long-term follow-up. Despite objective deficits, these patients continue to have normal self-perceptions of overall health and global upper extremity function.
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Affiliation(s)
- James Rubright
- University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, Burlington, VT, USA
| | - Peter Kelleher
- University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, Burlington, VT, USA
| | - Christina Beardsley
- University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, Burlington, VT, USA
| | - David Paller
- The Warren Alpert Medical School of Brown University, Department of Orthopaedics, Providence, RI, USA
| | - Steven Shackford
- University of Vermont College of Medicine, Department of Surgery, Burlington, VT, USA
| | - Bruce Beynnon
- University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, Burlington, VT, USA
| | - Adam Shafritz
- University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, Burlington, VT, USA.
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Coughlin LM, Koenig KN, Clark PM. Claviculectomy with thrombectomy for management of paget-schroetter syndrome in a patient with chronic clavicular malunion. Ann Vasc Surg 2013; 27:498.e1-4. [PMID: 23562149 DOI: 10.1016/j.avsg.2012.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/28/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Abstract
Paget-Schroetter syndrome, or primary upper extremity deep vein thrombosis, is a relatively rare condition for which various treatment protocols have been proposed. No randomized controlled trials exist to guide management, and treatment must be tailored to the individual. This report describes a case of a 39-year-old man with chronic clavicular malunion from multiple clavicular fractures who presented with Paget-Schroetter syndrome. The thrombus occluded the right axillary, brachial, and subclavian veins. Attempted thrombolytic therapy was unsuccessful, and decompressive surgery was used to avoid postphlebitic complications and regain functionality of the upper extremity. Rather than first rib resection, claviculectomy with thrombectomy and subclavian vein repair was performed.
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Affiliation(s)
- Lisa M Coughlin
- Department of Surgery, University of Toledo Medical Center, Toledo, OH 43614, USA.
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Affiliation(s)
- Anthony S Ward
- Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, UK
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Vázquez Berges I, Marzo Álvarez A, Rivera Rodríguez M, Feijoo Cano C, Marco Luque M. Tratamiento de la trombosis venosa de esfuerzo en el miembro superior. Angiología 2011. [DOI: 10.1016/j.angio.2011.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Illig KA, Doyle AJ. A comprehensive review of Paget-Schroetter syndrome. J Vasc Surg 2010; 51:1538-47. [DOI: 10.1016/j.jvs.2009.12.022] [Citation(s) in RCA: 275] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/02/2009] [Accepted: 12/06/2009] [Indexed: 11/22/2022]
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23
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Stone DH, Scali ST, Bjerk AA, Rzucidlo E, Chang CK, Goodney PP, Nolan BW, Walsh DB. Aggressive treatment of idiopathic axillo-subclavian vein thrombosis provides excellent long-term function. J Vasc Surg 2010; 52:127-31. [PMID: 20385467 DOI: 10.1016/j.jvs.2010.01.091] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 01/28/2010] [Accepted: 01/28/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE While much attention has been devoted toward treatment paradigms for idiopathic axillo-subclavian vein thrombosis (ASVT), little has focused on long-term durability of aggressive treatment and its associated functional outcomes. The purpose of this study was to review our own surgical therapeutic algorithm and its associated durability and functional outcomes. METHODS All patients treated with combined endovascular and open surgery at Dartmouth-Hitchcock Medical Center for ASVT from 1988 to 2008 were identified. Patient demographics, comorbidities, and operative techniques were recorded. Patency, freedom from reintervention, and functional outcomes were documented. Follow-up via telephone and clinic visit allowed quantitative comparison of functional status, pre- and postoperatively. RESULTS Thirty-six patients were treated for ASVT throughout the study interval. Seven patients (19.4%) were lost to follow-up. Most patients were male (66%; N = 24); mean age was 32 years. Catheter-directed thrombolysis was utilized in the majority of patients (83.3%; N = 30) with an average time from symptom onset to lysis of 12 days. Surgical decompression was undertaken in all patients via transaxillary (52%; N = 19), supraclavicular (31%; N = 11), or infraclavicular approaches (17%; N = 6). Eleven stents were placed in 11 patients (30.5%) for residual stenotic disease. Mean follow-up was 65 months, with 1- and 5-year overall patency at 100% and 94%, respectively. Freedom from reintervention was 100% and 74.4% at 1 and 5 years, respectively. Seven patients (19.4%) required postoperative reintervention with four receiving additional lytic therapy, two requiring a stent, and one venoplasty. At presentation, 65.5% (N = 19) of patients were unable to work or perform routine activities. After treatment, 86% (N = 25) returned to their employment and have experienced sustained symptomatic and functional improvement. CONCLUSIONS Patients with symptomatic idiopathic axillo-subclavian vein thrombosis can expect durable patency with sustained freedom from reintervention following aggressive combined endovascular and surgical treatment. Good functional outcomes can be expected in patients with relief of symptoms and return to work.
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de León RA, Chang DC, Hassoun HT, Black JH, Roseborough GS, Perler BA, Rotellini-Coltvet L, Call D, Busse C, Freischlag JA. Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome. Surgery 2009; 145:500-7. [PMID: 19375608 DOI: 10.1016/j.surg.2008.09.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 09/24/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND We sought to determine the outcomes in patients presenting with venous thoracic outlet syndrome. METHODS Prospectively collected data from 67 patients between October 2003 and December 2007. The average age was 31 years (range, 16-54); the 37 males and 30 females presented on average 9.2 months (range, 1 month-6 years) after acute thrombosis. Four treatment algorithms were utilized. RESULTS In group 1, 3 patients presented with acute occlusion and received tissue plasminogen activator (tPA) and immediate first rib resection with scalenectomy (FRRS). One vein rethrombosed and was treated by intravenous tPA postoperatively. In group 2, 39 patients presented with stenotic subclavian veins an average of 22 weeks after their initial thrombosis, all of whom underwent FRRS followed by a venogram 2 weeks postoperatively: 25 had a tight stenosis and underwent venoplasty with anticoagulation; 13 had patent, nonstenotic subclavian veins, and 1 patient required tPA and venoplasty owing to rethrombosis. Two patients had their subclavian vein thrombose after venoplasty and were treated with anticoagulation, tPA, and venoplasty. In group 3, 11 patients presented with intermittent venous obstruction without thrombosis and underwent FRRS; 3 underwent venograms because of concerns of residual stenosis, 2 of whom required venoplasty postoperatively. Finally, in group 4, 14 patients presented with occluded subclavian veins and underwent FRRS with long-term anticoagulation. Eleven have recanalized at an average of 6 months (range, 2-12). CONCLUSION Overall, 64 of 67 patients have patent subclavian veins after a median follow-up of 10 months, and all patients are asymptomatic for a success rate of 96%. Tailored treatment algorithms including FRRS, postoperative venograms with or without intervention, and the use of long-term anticoagulation seems to be required in this complicated group of young patients to achieve optimal results.
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Affiliation(s)
- Ricardo A de León
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Tubbs RS, Louis RG, Wartmann CT, Cormier JL, Pearson BE, Loukas M, Shoja MM, Oakes WJ. Use of the clavicle in anterior cervical discectomy/corpectomy fusion procedures: cadaveric feasibility study. Childs Nerv Syst 2008; 24:337-41. [PMID: 17639418 DOI: 10.1007/s00381-007-0433-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Graft sources for cervical fusion procedures include synthetic materials, donor grafts, and autologous bones such as the iliac crest. Considering the data that autologous bone grafts seem to generate the best results for fusion, the next logical step is to seek alternative donor sites so as to attempt to reduce the morbidity associated with these procedures. To our knowledge, autologous clavicle has not been explored as a potential source for cervical fusion. Therefore, the following study was performed to verify the utility of this bone for these procedures. MATERIALS AND METHODS Seven adult cadavers were used for this study. In the supine position, a standard surgical approach and dissection to the anterior cervical spine were performed. Specimens underwent a standard discectomy or corpectomy with placement of harvested ipsilateral clavicle previously dissected. An anterior cervical plating system was next placed over these sites using standard techniques. Measurements of the harvested clavicle were made. RESULTS The results of our morphometric analysis were as follows: An average of 5 cm of bone was easily removed from the middle one third of the clavicle. No gross injury was found to vicinal neurovascular structures. The middle one third of the clavicle offered sufficient bone for the one to two segments fused in our study with remaining bone for at least two additional segments. The mean diameter of this part of the clavicle was 1.2 cm. CONCLUSIONS Based on our cadaveric study, such a bony substitute as autologous clavicle might be a reasonable alternative to the iliac crest for use in anterior cervical fusion procedures.
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Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Melby SJ, Vedantham S, Narra VR, Paletta GA, Khoo-Summers L, Driskill M, Thompson RW. Comprehensive surgical management of the competitive athlete with effort thrombosis of the subclavian vein (Paget-Schroetter syndrome). J Vasc Surg 2008; 47:809-820; discussion 821. [PMID: 18280096 DOI: 10.1016/j.jvs.2007.10.057] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 10/10/2007] [Accepted: 10/21/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The results of treatment for subclavian vein effort thrombosis were assessed in a series of competitive athletes. METHODS A retrospective review was conducted of high-performance athletes who underwent multidisciplinary management for venous thoracic outlet syndrome in a specialized referral center. The overall time required to return to athletic activity was assessed with respect to the timing and methods of diagnosis, initial treatment, operative management, and postoperative care. RESULTS Between January 1997 and January 2007, 32 competitive athletes (29 male and 3 female) were treated for venous thoracic outlet syndrome, of which 31% were in high school, 47% were in college, and 22% were professional. The median age was 20.3 years (range, 16-26 years). Venous duplex ultrasound examination in 21 patients had a diagnostic sensitivity of 71%, and the mean interval between symptoms and definitive venographic diagnosis was 20.2 +/- 5.6 days (range, 1-120 days). Catheter-directed subclavian vein thrombolysis was performed in 26 (81%), with balloon angioplasty in 12 and stent placement in one. Paraclavicular thoracic outlet decompression was performed with circumferential external venolysis alone (56%) or direct axillary-subclavian vein reconstruction (44%), using saphenous vein panel graft bypass (n = 8), reversed saphenous vein graft bypass (n = 3), and saphenous vein patch angioplasty (n = 3). In 19 patients (59%), simultaneous creation of a temporary (12 weeks) adjunctive radiocephalic arteriovenous fistula was done. The mean hospital stay was 5.2 +/- 0.4 days (range, 2-11 days). Seven patients required secondary procedures. Anticoagulation was maintained for 12 weeks. All 32 patients resumed unrestricted use of the upper extremity, with a median interval of 3.5 months between operation and the return to participation in competitive athletics (range, 2-10 months). The overall duration of management from symptoms to full athletic activity was significantly correlated with the time interval from venographic diagnosis to operation (r = 0.820, P < .001) and was longer in patients with persistent symptoms (P < .05) or rethrombosis before referral (P < .01). CONCLUSIONS Successful outcomes were achieved for the management of effort thrombosis in a series of 32 competitive athletes using a multidisciplinary approach based on (1) early diagnostic venography, thrombolysis, and tertiary referral; (2) paraclavicular thoracic outlet decompression with external venolysis and frequent use of subclavian vein reconstruction; and (3) temporary postoperative anticoagulation, with or without an adjunctive arteriovenous fistula. Optimal outcomes for venous thoracic outlet syndrome depend on early recognition by treating physicians and prompt referral for comprehensive surgical management.
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Affiliation(s)
- Spencer J Melby
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
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Doyle A, Wolford HY, Davies MG, Adams JT, Singh MJ, Saad W, Waldman DL, DeWeese JA, Illig KA. Management of Effort Thrombosis of the Subclavian Vein: Today's Treatment. Ann Vasc Surg 2007; 21:723-9. [DOI: 10.1016/j.avsg.2007.07.017] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 06/15/2007] [Accepted: 07/15/2007] [Indexed: 11/29/2022]
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Krishnan SG, Schiffern SC, Pennington SD, Rimlawi M, Burkhead WZ. Functional outcomes after total claviculectomy as a salvage procedure. A series of six cases. J Bone Joint Surg Am 2007; 89:1215-9. [PMID: 17545423 DOI: 10.2106/jbjs.e.01436] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total claviculectomy has been used for the treatment of tumor, infection, nonunion, and vascular compromise. Given its limited indications, few reports on the outcome after claviculectomy exist. The purpose of the present study was to evaluate the function of the shoulder, with use of a modern scoring system, after total claviculectomy. METHODS A retrospective review of the records of six patients who had undergone unilateral claviculectomy was performed after an average duration of follow-up of 5.7 years. The indication for surgery had been an infection at the site of a clavicular nonunion for three patients, nonunion with subclavian vein compression for two, and pain after a failed medial clavicular excision for one. The preoperative and postoperative evaluations included testing of the range of motion, strength, and stability as well as determination of the American Shoulder and Elbow Surgeons score on the basis of a functional questionnaire. RESULTS Range of motion was improved slightly or unchanged following claviculectomy. The mean American Shoulder and Elbow Surgeons score improved from 18 (range, 5 to 35) preoperatively to 88 (range, 75 to 95) postoperatively. The mean pain level (with 0 indicating no pain and 10 indicating the worst pain) decreased from 9.5 preoperatively to 1.5 postoperatively. Postoperatively, strength testing showed improvement from grade 4- (of 5) to 5 in all planes tested except extension (in which it remained at grade 4). Patient satisfaction was high, with a mean of 9.0 on a 10-point scale. There were five complications, including one subclavian vein laceration requiring vascular repair, two deep infections, and two superficial infections. CONCLUSIONS Despite a high complication rate, the functional outcomes following claviculectomy were good in this group of six patients. Total claviculectomy may be a useful salvage procedure for clinical situations in which the restoration of normal clavicular osseous anatomy is impossible. Patients can expect acceptable pain relief and few or no deficits in activities of daily living. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Sumant G Krishnan
- Shoulder Service, The Carrell Clinic, 9301 North Central Express-way, Suite 400, Dallas, TX 75231, USA.
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Vartanian SM, Colaco S, Orloff LE, Theodore PR. Oklahoma Prosthesis: Resection of Tumor of Clavicle and Chest Wall Reconstructed With a Custom Composite Graft. Ann Thorac Surg 2006; 82:332-4. [PMID: 16798248 DOI: 10.1016/j.athoracsur.2005.09.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 09/09/2005] [Accepted: 09/14/2005] [Indexed: 11/20/2022]
Abstract
Tumors involving the clavicle by primary or metastatic growth may require clavicular resection often with rib resection. The resulting cosmetic and functional impairment of clavicular resection may be significant with a sloped appearing shoulder girdle and chronically impaired movement of the upper extremity. We report a 48-year-old woman presenting with a bulky metastatic renal cell mass of her left clavicle extending to the chest wall. We report en-bloc clavilculectomy and chest wall resection with a novel method of reconstruction using a single methyl methacrylate and prolene composite prosthesis in a configuration resembling the state of Oklahoma.
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Affiliation(s)
- Shant M Vartanian
- Division of Cardiothoracic Surgery, University of California, San Francisco, California 94143-1674, USA
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Lozano P, Dóaz M, Riera R, Gomez FT. Venous thoracic outlet syndrome secondary to congenital pseudoarthrosis of the clavicle. Presentation in the fourth decade of life. Eur J Vasc Endovasc Surg 2003; 25:592-3. [PMID: 12787706 DOI: 10.1053/ejvs.2002.1864] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- P Lozano
- Angiology and Vascular Surgery Department, Hospital Son Dureta, Palma de Mallorca, Spain
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Sullivan VV, Wolk SW, Whitehouse WM. Simultaneous bilateral upper extremity venous thrombosis in a factor V Leiden heterozygote: a case report and review. Vasc Surg 2001; 35:361-8. [PMID: 11565040 DOI: 10.1177/153857440103500506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary upper extremity deep venous thrombosis (DVT), or effort thrombosis, typically occurs in young, healthy individuals with a history of repetitive upper extremity movement while secondary upper extremity DVT is associated with a number of predisposing factors. The role of factors such as hypercoagulability in the development of effort thrombosis is less well described. This report describes a previously healthy 21-year-old man who presented with simultaneous bilateral upper extremity DVT after hours of pushing and lifting a heavy wheelbarrow. Treatment included thrombolytic therapy followed by delayed venolysis and vein patch angioplasty. Hypercoagulable screening revealed factor V Leiden heterozygous characteristics.
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Affiliation(s)
- V V Sullivan
- Department of Surgery, St. Joseph Mercy Hospital, Michigan Heart and Vascular Institute, 5325 Elliott Drive, Ann Arbor, MI 48106, USA
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Schmacht DC, Back MR, Novotney ML, Johnson BL, Bandyk DF. Primary axillary-subclavian venous thrombosis: is aggressive surgical intervention justified? Vasc Surg 2001; 35:353-9. [PMID: 11565039 DOI: 10.1177/153857440103500505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multimodal (thrombolysis, surgical decompression, venous reconstruction, oral anticoagulation) treatment of primary axillary-subclavian venous thrombosis was reviewed to assess the impact of venous patency on functional outcome. Since 1996, 7 patients (6 men, 1 woman) of ages 16-53 years (mean 33 years) presented with symptomatic acute axillosubclavian venous thrombosis as a result of a recent athletic or strenuous arm activity. Five patients had undergone previous (>2 weeks) catheter-directed thrombolysis and venous angioplasty. Diagnostic contrast venography followed by repeat catheter-directed thrombolysis demonstrated abnormal (residual stenosis [n=6] or occlusion [n=1]) axillosubclavian venous segments in all patients. Surgical intervention was performed at a mean interval of 7 days (range 1-19 days) after thrombolysis and consisted of thoracic outlet decompression with scalenectomy and 1st rib resection via a paraclavicular (n=4) or supraclavicular (n=3) approach. Medial claviculectomy or cervical rib resection was performed in 2 patients. Concomitant venous surgery was performed in all patients to restore normal venous patency by circumferential venolysis (n=7) and balloon catheter thrombectomy (n=3), or vein-patch angioplasty (n=2), or endovenectomy (n=5), or internal jugular transposition (n=2). Postoperative venous duplex testing beyond 1 month identified recurrent thrombosis in 4 patients despite therapeutic oral anticoagulation. Subsequent venous recanalization was documented in 3 patients. Poor functional outcome was associated with an occluded venous repair and extensive venous thrombosis on initial presentation. A patent or recanalized venous repair present in 6 of 7 patients was associated with good functional outcome and may justify multimodal intervention in patients with primary axillosubclavian effort thrombosis presenting with recurrent thrombosis and significant residual disease after thrombolysis.
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Affiliation(s)
- D C Schmacht
- Division of Vascular Surgery, University of South Florida College of Medicine, Harbourside Medical Tower #650, 4 Columbia Dr., Tampa, FL 33606, USA
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