An isolated double-crush-syndrome in posttraumatic thoracic outlet syndrome - A case report.

Thoracic outlet Syndrome (TOS) includes all disorders caused by compression of all neurovascular Structures in the upper thoracic outlet (Ross and Owners, 1966, Bürger and Arterien, 2014, Sanders and Annest, 2017). The Double-Crush-Syndrome (DBS) defines multilevel lesions along a neurovascular trunk caused by mechanical compression in different areas. Pectoralis-minor-syndrome (PMS) is also classified in the disorders of he upper thoracic outlet and was also known as hyperabductionsyndrome or subcoracoidal-syndrome. Between 2015-2019 our department treatet 488 patients suffering from neurological, vascular or combined TOS. Surgical treatment, depending on clinical and specific diagnostics was performed in 175 cases via transaxillary approach, including cervical rib resection, first rib resection, neurolysis of plexus brachialis, thoracal sympathectomy or vascular reconstruction. In all this year just a single patient with double crush syndrome was present. CASE PRESENTATION AND METHODS: We report a case of a 28-years old female patient, reported in line with the SCARE criteria [13], suffering from neurvascular compression in the upper thoracic outlet after surgically treated clavicula fracture. She developed typical symptomes of a Thoracic Outlet Syndrome. CONCLUSION: Double-Crush-Syndrome in patients with Thoracic Outlet Syndrome are very rare, case reports seldomly exist. The diagnosis requires a specific clinical testing and x-ray radiography. Furthermore dynamic tests like ultrasound and angiography and neurophysiological testing requires a high degree of experience, so the compressed area can be detected. Treatment includes an attempt of best medical and physical therapy, in case of failure a surgical treatment is necessary.

Ectopic vascularization of the right kidney by a contralateral origin of the main renal artery from the left common iliac artery: report of a case.

In daily practice, an atypical renal blood supply is a rare finding. An ectopic origin of the right main renal artery from the contralateral common iliac artery was observed when angiography was performed to diagnose irregularities in perfusion of the lower extremities and to determine the necessity for vascular surgical intervention in a 66-year-old man. Conservative treatment was successful in this patient, who suffered from intermittent claudication because of an obstruction of the superficial femoral arteries. The diagnostic approach with angiography is considered to be essential for revealing such anomalies. Conventional vascular surgical reconstruction would have threatened the perfusion of the right kidney in this case.

Ergotamine-induced acute vascular insufficiency of the lower limb--a case report.

Ergotamine-containing drugs are widely used in the treatment of acute migraine attacks. Spastic vasoconstriction is one of the possible side effects usually affecting the lower extremities and sometimes leading to gangrene. A 28-year-old woman was hospitalized for severe acute arterial insufficiency of the limbs. The initial surgical approach was not successful since the diagnosis was missed. Overuse of ergotamine derivative was acknowledged by the patient, who had a long history of migraine headaches. Therefore, the patient was treated conservatively with intravenous heparin and prostaglandin infusion and sympatheticolysis via epidural catheter. The vascular complications, angiographic findings, and different modalities of treatment of ergotamine-induced peripheral vascular insufficiency of the lower limb are reviewed.

Selective embolization of a renal artery aneurysm.

The treatment modalities for renal artery aneurysm have changed. The aim in the presented case was to evaluate the endovascular therapy in a 52-year-old woman (with hematuria as the only symptom) with a saccular aneurysm at the first bifurcation of the right main renal artery, which was diagnosed with contrast-enhanced computerized tomography and angiography. We approached the aneurysm with minimally invasive supraselective embolization. There were no postoperative complications, as confirmed with control angiography, during the intervention and after an interval of 4 weeks. In conclusion, selective coil embolization as first-line therapy to treat saccular renal artery aneurysm is feasible. In this case, minimally invasive procedure provided maximum functioning kidney tissue.

Aneurysm of the vertebral artery near the atlas arch.

In this case report, we describe an nontraumatic extracranial aneurysm of the vertebral artery at the V3 segment. Its etiology and pathogenesis could not be clarified completely. The walnut-sized aneurysm was treated surgically by proximal ligation. There were no postoperative complications.

Heparin-induced vascular occlusion in vasculosurgical patients. An evaluation of the disease in 13 cases.

OBJECTIVE: To describe the diagnosis and treatment of adverse reaction to heparin (heparin-induced thrombocytopenia [HIT]) administered prophylactically for thrombosis and embolism. EXPERIMENTAL DESIGN: case series. SETTING: vascular surgical division in a University hospital. PATIENTS: thirteen patients treated for HIT type II between October 1994 and June 1997. Measures/Interventions: diagnosis of heparin-induced complications is based on exact medical history and regular measurement of platelet counts. Confirmation can be obtained with the aggregation test, serotonin-release test, heparininduced platelet release (HIPA) test, and platelet factor 4/heparin ELISA. Vasculosurgical reconstruction is usually required to eliminate vessel occlusion. RESULTS: In our series, HIT was confirmed by HIPA test (11 patients) and aggregation test (2 patients). All patients had positive cross reaction with low-molecular-weight heparin, and six had cross reaction with heparinoid danaproid sodium (Orgaran). Occlusions occurred between day 2 and 22 after the start or resumption of heparin administration (mean, 11 days). Anticoagulation treatment with hirudin or danaproid sodium was given to 5 patients, in conjunction with vasculosurgical reconstruction. Three of those patients died and the other two required amputation. CONCLUSIONS: Heparin-induced vascular occlusion is a rare but severe adverse effect of heparin treatment. When HIT is suspected, heparin administration must be stopped, with substitution of dextran and acetylsalicylic acid. Laboratory tests must be used for confirmation or exclusion. However, the diagnosis can be obscured by a normal platelet count due to pre-existing polycythemia and by false-negative test results. Surgery is usually warranted, depending on the degree and localization of ischemia.

Ruptured cervical aneurysm of the carotid artery--case report of a rare disease.

Rupture of a cervical carotid artery aneurysm is a rare but life-threatening event. The diagnostic evaluation and therapeutic management of a 55-year-old woman with such a lesion are described. In this case, the aneurysmal rupture was complicated by localized Staphylococcus aureus infection confirmed by bacteriologic culture of excised tissue, septicemia, and prevertebral and intraspinal abscess. Definitive diagnosis was a ruptured mycotic aneurysm of the extracranial carotid artery. The origin of the infection was probably the patient's previously infected vascular prosthesis for hemodialysis.