Thoracic Outlet Syndrome in Children and Young Adults

Abstract

Extracranial Blood Flow Distribution During Carotid SurgeryAleksic M., Brunkwall J. Eur J Vasc Endovasc Surg 2009;38:552-5. Objective: The collateral function of the external carotid artery (ECA) for cerebral perfusion in cases of atherosclerotic occlusive disease of the internal carotid artery (ICA) is difficult to assess; for this reason, blood flow measurements were taken during carotid endarterectomy (CEA).Methods: Blood flow was measured before and after CEA using a transit-time flow meter at the carotid artery in 1000 patients who underwent CEA for high-degree (Ͼ70%) ICA stenosis. The data were collected prospectively and analysed retrospectively.Results: Median ICA blood flow increased significantly, up 46% from 160 ml min Ϫ1 (IQR: 100 -234 ml min Ϫ1 ) before CEA to 240 ml min Ϫ1 (IQR: 187-309 ml min 1 ) after CEA (P Ͻ 0.001). Median ECA blood flow dropped by 4%, from 152 ml min Ϫ1 (IQR: 108 -220 ml min Ϫ1 ) to 150 ml min Ϫ1 (IQR: 103-200 ml min Ϫ1 ) (P ϭ 0.001). Relative ICA blood flow volumes related to common carotid artery (CCA) flow increased from 58% before CEA to 73% after CEA, whereas relative ECA flow decreased from 54% to 44%.Conclusions: Increased blood flow in the ICA after CEA is accompanied by decreased ECA flow whereupon the absolute amount of this redistribution is relatively limited. A more profound evaluation of these haemodynamic conditions demands further study. Thoracic Outlet Syndrome in Children and Young AdultsMaru S., Dosluoglu H., Dryjski M., Cherr G., Curl G.R., Harris L.M. Eur J Vasc Endovasc Surg 2009;38:560-4.

Supraclavicular Scalenectomy for Thoracic Outlet Syndrome—Functional Outcomes Assessed Using the DASH Scoring System

“…Thoracic outlet syndrome has been principally described in young to middle-aged adults, a point reflected in this cohort with just 1 patient aged more than 60 years. Similarly, previous work has noted the predominance of this condition in women, in both the adult 13 and pediatric settings, 14 and this is mirrored in our cohort comprising 76% female patients. The large proportion of patients with vTOS is likely secondary to the tertiary vascular nature of the center under study; TOS is a condition managed by a range of specialties including vascular, orthopedic, and neurosurgery, and hence it is plausible that many of the patients who presented initially with nTOS were referred elsewhere.…”

Surgery for paediatric thoracic outlet syndrome

“…Almost all vascular symptomatology resolved with surgery, possibly reflecting the lack of truly severe vascular compromise in this series (most cases would be classified as neurogenic, with some instances of mild-to-moderate vascular involvement), although it may also reflect a greater resilience of vascular structures compared to neural structures. 13,16,17,[21][22][23] None of the factors examined for predictability of surgical outcome, including age at presentation, gender, and provocative postures, was found to be significant. Both EAST and Allen's manoeuvre had poor predictive value, though in eight patients post-operative EAST testing correlated with improvement or recurrence of symptoms.…”

“…[13][14][15][16][17][18][19][20][21][22][23]26 Despite residual symptoms in most of the operated limbs (67%), the majority of operations were deemed successful by both patients and observers. This may represent the significant improved mobility of these limbs post-operatively which was more important to the patients' quality of life.…”

“…12 The relative paucity of reports of paediatric TOS makes the condition in this age group particularly contentious. [13][14][15][16][17][18][19][20][21][22][23] The few studies of TOS in paediatric patients that have been reported in the literature are summarized in Table 1.…”

Pseudarthrosis of Cervical Rib: An Unusual Cause of Thoracic Outlet Syndrome

“…[5][6][7][8][9][10][11][12] Isolated cervical rib fracture is a rare occurrence, and we could find only 6 citations of this condition in the literature. [12][13][14][15][16][17] Of these, in 4 reports [13][14][15][16] there was no indication of them causing TOS.…”