Autologus saphenous vein femoropopliteal bypass: analysis of 298 cases.

A retrospective review of 298 saphenous vein femoropopliteal bypasses performed for femoral artery occlusive disease over a 13 year period was carried out. The purpose of the study was to assess factors which influence long-term graft patency. Follow-up was 95.3 percent complete. Results were analyzed with the aid of IBM data processing equipment and standard statistical methods.

Surgical management of total carotid artery occlusion. An update.

Fourteen operations were performed in 13 patients with total carotid artery occlusion. All patients had symptoms ranging in duration from a few hours to several months. Flow wa reestablished in 10 of the 14 arteries operated on, a success rate of 74 percent. Complication included one operative death and one permanent neurologic deficit. An aggressive approach to the surgical management of patients with total carotid artery occlusion is recommended.

Supraclavicular resection of the first rib for thoracic outlet syndrome.

The experience with supraclavicular transcervical first rib resection (or cervical rib resection) and total scalenotomy reported herein shows this to be a safe and effective treatment for patients with the thoracic outlet syndrome. We recommend this method as a satisfactory anatomic approach for the correction of this condition. Its advantages are as follows: anatomic structures may be visualized fully by both the surgeon and the assistant; complex or recurrent thoracic outlet problems may be dealt with directly; additional procedures (such as vascular graft, neurolysis, neck exploration, sympathectomy and cervical rib resection) may be performed; the procedure can be done in 90 minutes or less; neither the patient nor the assistant is obliged to assume an awkward or strained position and consequently the likelihood of intraoperative iatrogenic injury is reduced; and neither the period of hospitalization nor the period of immobility is longer than with the other operative techniques currently used for this condition.

Anterior approach for resection of the first rib and total scalenotomy.

We have found the technique described herein to be advantageous to previously described techniques for resection of the first rib. The vital structures--the brachial plexus, subclavian artery and vein--are all readily visualized with the anterior approach and, therefore, subject to less risk of injury intraoperatively.

770 consecutive supraclavicular first rib resections for thoracic outlet syndrome.

During a 28-year period, 637 patients underwent 770 supraclavicular first rib resections and scalenectomies for thoracic outlet syndrome (TOS). The neurologic type of TOS was found in 705 cases (92%) and the remaining 65 cases (8%) had the vascular form of TOS. Of those extremities with brachial plexus irritation, the symptom complex consisted of paresthesia in 30 (4%), pain in 221 (31%), and pain with paresthesia in 454 (64%). In the cases of vascular TOS, 47 limbs (6%) had venous complications and 18 limbs (2%) had arterial sequelae. Following supraclavicular scalenectomy and rib resection, an excellent response was achieved in 59% (455 cases) and a good result was achieved in another 27% (206 cases). A fair outcome was present in 13% (95 cases) and a poor result was found in only 1% (13 cases). There was a single occurrence of lymphatic leakage and no brachial plexus injuries resulted. Postoperative causalgia requiring subsequent sympathectomy developed in two cases. No vascular or permanent phrenic nerve injuries occured and only 12 patients (2%) required operative intervention for recurrent TOS. First rib resection and scalenectomy can be performed by the supraclavicular route with an acceptable outcome, minimal morbidity, and long-lasting results.