Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thoracic outlet syndrome (TOS) associated with congenital clavicular pseudoarthrosis is rare in adults and often misdiagnosed. In this case report, we describe an adult female who was found to have thrombosis of the subclavian and axillary arteries with embolization documented by invasive angiography. This unusual vascular manifestation of TOS should remind physicians that anatomic derangements may predispose to upper extremity ischemia.
 ...
PMID:Congenital clavicular pseudoarthrosis associated with vascular thoracic outlet syndrome: case presentation and review of the literature. 749 4

Thoracic outlet syndrome is the causative factor in less than 5% of patients with upper extremity ischemia. Congenital bony abnormalities (cervical rib) are most often responsible for the arterial complications of this syndrome. This article presents the case report of a patient who presented with ischemia of an upper extremity caused by embolization from subclavian artery stenosis and an aneurysm secondary to cervical rib. The treatment plan included excision of the cervical rib, repair of the subclavian artery aneurysm and a bypass graft which achieved a satisfactory outcome.
 ...
PMID:Thoracic outlet syndrome with arm ischemia as a complication of cervical rib. 774 92

We present herein the cases of two patients with thoracic outlet syndrome (TOS) who required arterial reconstruction due to gangrene of the fingers and/or hand. In both patients, the cervical ribs had produced intimal injury of the subclavian arteries, and the successive distal arterial embolism brought about severe ischemia of the affected upper extremity. To treat the TOS, the cervical ribs were resected through a supraclavicular incision. In the first patient, arterial reconstruction was performed from the subclavian artery to the radial collateral artery, a branch of the deep brachial artery, which resulted in minimizing amputation of the gangrenous hand. In the second patient, resection and direct anastomosis of the injured subclavian artery were performed, and bypass surgery from a brachial artery to an interosseous artery was carried out, preserving finger function. Reversed saphenous vein grafts were utilized and Esmarch's bandage technique was applied as a substitute for a vascular clamp in both patients. Following these case reports, we discuss the technique of performing distal bypass in the upper extremities and comment on the usefulness of Esmarch's bandage technique for preserving upper extremity function.
 ...
PMID:Distal arterial reconstruction using Esmarch's bandage technique to salvage upper extremity function in thoracic outlet syndrome caused by cervical ribs: a report of two cases. 778 Feb 38

Symptomatic occlusive disease of the subclavian arteries, not associated with thoracic outlet syndrome, is an uncommon problem with a paucity of literature related to the appropriateness of bypass graft selection and long-term patency for revascularization. Between 1985 and 1993, 9 patients (3 men and 6 women) underwent 13 carotid brachial bypasses for chronic severe upper-extremity ischemia. Ages ranged from 47 to 75 years (mean 65). Three patients had documented collagen vascular disease, 1 had radiation arteritis, and 4 had bilateral disease requiring staged arterial reconstruction. Indications for operation included severe exercise-induced ischemia in two limbs (15%), rest pain in eight (62%), and gangrene or infection, or both, in three (23%). Two bypasses were performed for failed prior reconstructions. Inflow originated from the carotid artery (4 proximal and 9 bifurcation), and distal anastomoses were made to a disease-free section of brachial artery. Reinforced 6 mm thin-wall polytetrafluoroethylene (PTFE) grafts were used in all operations. No operative mortality or major upper-extremity amputation was associated with the procedure, although digital amputations were performed in four instances. Follow-up ranged from 4 to 83 months with a mean of 38 months. The 5-year primary patency rate, by life-table analysis, was 92%. Our results showed excellent long-term patency when prosthetic grafts were used for carotid brachial bypass, because of excellent runoff and the relatively short graft length required.
 ...
PMID:Carotid brachial bypass for treating proximal upper-extremity arterial occlusive disease. 805 29

The analysis of the stress manoeuver tests in patients with upper limb ischemia due to the thoracic outlet syndrome (TOS) was performed. Stress manoeuvre tests (Adson, hiperabduction, costo-clavicular, modified Adson test and AER test) were found useful in the diagnosis of TOS. However they do not allow to differentiate the mechanism of compression. It is important to observe the clinical symptoms of arm ischemia during the time of manoeuvre performance. The positive result of the one test only, especially AER or modified Adson test has little diagnostic value.
 ...
PMID:[Evaluation of the usefulness of stress tests in diagnosis of thoracic outlet syndrome with upper limb ischemia]. 852 10

Arterial injury is infrequent in the thoracic outlet syndrome but must be identified to prevent these younger patients from being dramatically disabled. This requires thorough interview and clinical examination, and then pursuit with a workup including complete bilateral arteriography with positional views. Helical computed tomography (CT) provides precise localization of arterial trauma with correlation to specific compressive elements. Unique features in athletes include a greater role of soft tissue hypertrophy and overuse in pathogenesis of arterial injury, more frequent compression of the axillary artery and its branches, and possible hand ischemia from direct trauma. In addition, these prospective or established professionals require optimum arm function to sustain their careers. Because of the desire to continue provocative arm use, decompression is performed early, and arm "claudication" is surgically treated. Operations are customized to achieve adequate decompression without compromising function. Surgical management consists of targeted resection of compressing structures, which is most often a cervical rib; arterial reconstruction to eliminate stenosis and the source of emboli; and improvement of distal perfusion with selection from an arsenal that includes catheter embolectomy, thrombolysis, and bypass grafting. Familiarization with the many unique diagnostic aspects and therapeutic options in arterial thoracic outlet syndrome produces excellent results in all but the most advanced cases.
 ...
PMID:Upper extremity ischemia in athletes. 967 Dec 39

We report a thoracic outlet syndrome revealed by neurological complications. Angiography of the subclavian artery depicted an isolated positional occlusion of the descending scapular artery. This side branch of the subclavian artery is anatomically located close to and supplies the brachial plexus. Surgical treatment led to improvement of most symptoms and post-operative control angiography was normal. Not previously described, this sign illustrates the objective compression of the brachial plexus. Ischemia is perhaps intricated with compression, a well-known pathophysiological mechanism of neurological complications in this syndrome. This artery feeding the brachial plexus is usually ligated during surgical neurolysis but must be preserved in order to improve recovery of neurological function and prevent surgical failures.
 ...
PMID:[Positional occlusion of the descending scapular artery in transverse thoraco-brachial syndrome with neurologic symptoms]. 1005 40

Vascular pathology in the upper extremity of a throwing athlete comprises a spectrum of serious disorders apt to threaten the patient's career and the viability of the involved parts. Such pathology includes digital vessel thrombosis, proximal thrombosis with distal embolization, vessel aneurysm, and vessel compression, such as in thoracic outlet syndrome and quadrilateral space syndrome. This article provides a description of vascular disorders prone to result from sports activities and a review of published data relevant to throwing athletes. Recognition of vascular compromise as a cause for dead arm syndrome or painful digital dysfunction among athletes is essential to prevent the grave consequences of progressive ischemia.
 ...
PMID:Vascular pathology in the throwing athlete. 1095 20

This paper documents the various causes of upper limb ischemia in a series of 64 Egyptian patients presenting to a tertiary referral center over a 4-year period and offers a diagnostic dissertation and review of the pertinent literature. Atraumatic upper limb ischemia is an uncommon entity. It has a broad etiology with diverse management pathways. Nineteen patients presented with severe and immediate limb-threatening ischemia. These patients underwent immediate surgical exploration: an embolus was diagnosed in 15 and thrombosis in 4. Twenty-eight patients presented with ischemia of lesser severity, allowing preoperative angiography. Of these 28 patients, 6 had an embolus, 14 had thrombosis, 4 had thoracic outlet syndrome, the remainder had miscellaneous causes. Fifteen patients had upper limb ischemia secondary to arteritis, and 2 patients with dissection of the ascending thoracic aorta presented with upper limb ischemia. Forty-seven patients underwent a surgical procedure, with a morbidity rate of 21% and mortality rate of 19%. Patients presenting with upper limb ischemia tend to have significant co-existing disease. Management of upper limb ischemia requires preoperative and/or peroperative angiography with careful application of vascular surgical expertise.
 ...
PMID:Atraumatic acute upper limb ischemia: a series of 64 patients in a Middle East tertiary vascular center and literature review. 1145 44

The surgical treatment of 30 cases of vascular thoracic outlet syndrome (TOS) in 25 patients is presented. Patients included 17 women and 8 men with average age of 26.1 years. The causes of compression were cervical rib ( n = 16), soft tissue anomalies ( n = 12), and scar tissue after clavicle fracture ( n = 2). Ten subclavian artery aneurysms containing intraluminal thrombus as well as one subclavian artery occlusion were found. All such cases had multiple distal arterial embolization. Presenting features of cases with arterial TOS included: hand ischemia ( n = 11), transient ischemic attack (TIA) ( n = 1), and claudication or vasomotor phenomena during the arm hyperabduction ( n = 11). Two patients with venous TOS developed hand edema during arm hyperabduction, and five other patients had axillary-subclavian venous thrombosis. In all cases decompressive procedures using a combined supraclavicular and infraclavicular approach were performed. Decompression was achieved by cervical rib excision ( n = 12), combined cervical and first rib excision ( n = 4), and first rib excision ( n = 14). In all cases division of all soft tissue elements was also accomplished. Associated vascular procedures included resection and replacement of 10 subclavian artery aneurysms, one subclavian-axillary and one axillary-brachial bypass, as well as nine brachial embolectomies. All five cases with axillary-subclavian vein thrombosis before decompression were treated with anticoagulant therapy. The mean follow-up period was 3 years and 2 months (range 1 to 6 years). Two pleural entry injuries and two transient brachial plexus injuries were noted. All reconstructed arteries were patent during the follow-up period. Complete resolution of symptoms with a return to full activity was noticed in all cases with arterial TOS and in two cases with venous TOS without axillary-subclavian vein thrombosis. In cases with axillary-subclavian vein thrombosis relief of symptoms was mild, and there were limitations on daily activity. Vascular TOS is seen less frequently than the neurogenic form; however, in most cases it requires surgical treatment. We prefer a combined supraclavicular and infraclavicular approach because it offers complete exposure of the subclavian artery, cervical and first ribs, and all soft tissue anomalies.
 ...
PMID:Vascular thoracic outlet syndrome. 1271 20


<< Previous 1 2 3 4 Next >>