Vascular thoracic outlet syndrome: Registry of 30-years of patient's outcomes at King Saud University Medical City, Riyadh, Saudi Arabia.

OBJECTIVES: To outline our experience with both arterial vascular thoracic outlet syndrome (ATOS) and venous TOS (VTOS). METHODS: This was a retrospective review carried out at King Saud University Medical City, Riyadh, Saudi Arabia, from 1992-2022. All patients were diagnosed based on clinical presentation, imaging, and underwent surgical decompression solely via the supraclavicular approach. The median follow-up period was 18 months (range: 4-36 months). RESULTS: A total of 90 limbs were diagnosed with vascular TOS in 69 patients. Females accounted for 69.6% of the patients and approximately 86.7% had ATOS. All patients were symptomatic and underwent plain thoracic inlet and cervical spine radiography, along with duplex scans in both rest and provocative positions. Total cervical rib resection was carried out in 60% of cases, while 2% had partial resection. First rib resection was carried out in 13.3% of cases and combined cervical and first rib resections were carried out in 23.3%. Vascular procedures were needed for arterial repair in 20% of cases, while venous repair were carried out in 2.2%. No recurrence or post-operative mortality had been reported. Post-operative complications were observed in 18.9% of cases. CONCLUSION: Careful patient selection and diagnosis using advanced, but less invasive radiological imaging coupled with adequate surgical treatment can improve the patient's outcome.

Vascular injuries of the upper extremity

OBJECTIVE: This study analyzes the causes of injuries, presentations, surgical approaches, outcome and complications of vascular trauma of the upper limbs, in spite of limited hospital resources. METHODS: A 5-year retrospective analysis. From 01/01/2001 to 31/12/2005, 165 patients were operated for vascular injuries at King Fahd Hospital, Medina, Saudi Arabia. Of all peripheral vascular trauma patients (115), upper limb trauma was present in 58. Diagnosis was made by physical examination and hand-held Doppler alone or in combination with Doppler scan/angiography. Primary vascular repair was performed whenever possible; otherwise, the interposition vein graft was used. Fasciotomy was considered when required. Patients with unsalvageable lower extremity injury requiring primary amputation were excluded from the study. RESULTS: Fifty patients were male (86 percent) and eight were female (14 percent), aged between 2.5-55 years (mean 23 years). Mean duration of presentation was 8 h after the injury. The most common etiological factor was road traffic accidents, accounting for 50.5 percent in the blunt trauma group and 33 percent among all penetrating and stab wound injuries. Incidence of concomitant orthopedic injuries was very high in our study (51 percent). The brachial artery was the most affected (51 percent). Interposition vein grafts were used in 53 percent of the cases. Limb salvage rate was 100 percent. CONCLUSION: Patients who suffer vascular injuries of the upper extremities should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.

OBJETIVO: Este estudo analisa as causas de lesões, apresentação, abordagens cirúrgicas, desfechos e complicações do trauma vascular de membros superiores, apesar de recursos hospitalares limitados. MÉTODOS: Análise retrospectiva de 5 anos. De 01/01/2001 a 31/12/2005, 165 pacientes foram operados devido a lesões vasculares no King Fahd Hospital, Medina, Arábia Saudita. De todos os pacientes com trauma vascular periférico (115), trauma de membros superiores esteve presente em 58. O diagnóstico foi realizado por exame físico e Doppler manual isoladamente ou associado com ultra-som Doppler/angiografia. A restauração vascular primária foi realizada sempre que possível; do contrário, utilizou-se a interposição de veia. A fasciotomia foi considerada quando necessário. Pacientes com lesão de membro inferior não resgatável necessitando de amputação foram excluídos do estudo. RESULTADOS: Cinqüenta pacientes eram homens (86 por cento) e oito eram mulheres (14 por cento), com idade entre 2,5 e 55 anos (média de 23 anos). A duração média de apresentação foi 8 h pós-lesão. O fator etiológico mais comum foi acidente em estradas, sendo responsável por 50,5 por cento no grupo de trauma contuso e 33 por cento entre as lesões penetrantes e por arma branca. A incidência de lesões ortopédicas concomitantes foi muito alta em nosso estudo (51 por cento). A artéria braquial foi a mais afetada (51 por cento). A interposição de veias foi utilizada em 53 por cento dos casos. A taxa de preservação de membros foi de 100 por cento. CONCLUSÃO: Pacientes que sofrem lesões vasculares de membros superiores devem ser transferidos para centros de cirurgia vascular o mais rápido possível. O tratamento imediato do trauma vascular periférico aumentará a sobrevida dos pacientes e a preservação dos membros. Devem-se estabelecer prioridades no tratamento de lesões associadas e evitar o atraso quando alterações isquêmicas estiverem presentes.

Vascular anomalies - diagnosis and therapy.

OBJECTIVE: Vascular anomalies were once thought to be impossible to properly diagnose and treat. Hence, we aimed to evaluate the different diagnostic and therapeutic modalities in the management of vascular anomalies. METHODS: We carried out a retrospective review of our experience to evaluate different diagnostic and therapeutic modalities in the management of 25 patients with vascular anomalies over a 2-year-period at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia and follow-up period ranging from 2 months to 2 years. RESULTS: Vascular anomalies were more common in male patients (N=19). Age range was 7 to 46 years. Vascular anomalies were categorized as hemangioma (N=2) or malformation (N=23). The vascular malformation were further subdivided into slow flow (N=5) and fast flow (N=18). Duplex (N=12) and radiographic studies; angiography (N=21), venography (N=7), computerized tomography (N=10) and magnetic resonnance angiography (N=8) were used to confirm diagnosis. The treatment of hemangiomas were surgical resection (N=1) and conservative treatment (N=1). Embolization was the main modality of treatment in vascular malformation (N=16), with surgical resection in 4 patients, sclerotherapy in one and conservative in the other 2. All cases had successful outcome with no complications. CONCLUSION: Control of large vascular malformations with acceptable results can be achieved nowadays. Intra-arterial embolization is the mainstay of treatment and long term follow-up with serial physical examination, duplex and arteriography is required.