Isolated Dorsoradial Capsular Tear of the Thumb Metacarpophalangeal Joint: Missed Diagnosis and the Management of Delayed Presentation
Isolated dorsoradial capsule injuries of the thumb metacarpophalangeal joint are different from those associated with collateral ligament disruption. Early suspicion of this rare injury is important because, if overlooked, ulnarward subluxation of extensor pollicis longus tendon can develop. Functionally, active thumb extension becomes impaired, and over the long term, a thumb Boutonniere's deformity becomes established. Joint hypermobility/instability may predispose to this injury. The 2 cases presented illustrate this through anatomic differences. At the time of acute injury, 3 presenting clinical features should raise suspicion of dorsoradial capsular rupture: a history of isolated hyperflexion injury to the thumb, stable collateral ligaments on examination, and x-ray evidence of palmar subluxation of the proximal phalanx on the metacarpal. Ulnarward subluxation of the extensor pollicis longus is a delayed sign. Diagnostic imaging, beyond x-ray studies, may not be helpful in defining the injury. Early exploration and repair of this injury give the best long-term outcome. Postrepair, metacarpophalangeal joint range of motion may not be fully restored, but stability and a preinjury level of hand function can usually be reestablished.
Peripheral artery aneurysms (PAAs) include popliteal, femoral, carotid, subclavian, upper limb, and visceral aneurysms, the incidence of which is much lower than that of abdominal aortic aneurysms. The treatment approach most recommended for PAAs is complete resection of the aneurysm sac followed by arterial reconstruction or endovascular repair with a stent graft. Here, we present a new technique, “sleeve shaping,” in the surgical treatment of two complex cases of extracranial carotid and subclavian artery aneurysms.
The objective of this study was to analyze information from a single clinical center evaluating early results of one-stage endovascular repair for aortic disease and coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) for coronary artery disease.
This study was carried out at Biocor Instituto, Anesthesiology, Nova Lima, MG, Brazil.
This study developed a fast virtual stenting algorithm to simulate stent-induced aortic remodeling to assist in real-time thoracic endovascular aortic repair (TEVAR) planning and thus to predict complications like distal stent-induced new entry (SINE).
Surgical repair of aortic arch aneurysms is still an invasive procedure requiring arch replacement during deep hypothermic circulatory arrest. Endovascular aortic arch repair is less invasive compared with the open surgical aortic arch repair in treating aortic arch disease; this correlates with low morbidity and mortality rates, even in high-risk patients. Aortic arch diseases, such as aneurysms and dissections, often involve the origin of the supra-aortic branches. Surgical aortic arch debranching is therefore indicated before covering of these branches.
As the preferred method for treatment of type B dissection, thoracic endovascular aortic repair (TEVAR) has been recognized by clinicians for its efficacy compared with open surgery. However, some serious complications still occur after TEVAR, such as progression of anterograde tear of the dissection, formation of new intimal rupture, rupture of the dissection aneurysm, and retrograde type A dissection (RTAD). Although the incidence rate of these complications is not high, the consequence is serious and should cause the clinician's attention.
Rerouting of the supra-aortic vessels and zone 0 stent grafting have been developed as a less invasive option for aortic arch repair. However, aortic arch aneurysm sometimes involves dilated ascending aorta that cannot provide an appropriate proximal landing zone. We have introduced the ascending aortic banding technique, which reduces aortic diameter to provide sufficient proximal landing zone. The aim of this study was to assess the early and midterm outcomes and anatomic change after the zone 0 stent grafting with ascending aortic banding.
Open repair of type III thoracoabdominal aneurysms (TAAs) remains a surgical challenge in view of massive dissection and secondary visceral, renal, and limb ischemia during surgery. A novel approach with two-bifurcated graft technique (to reduce visceral, renal, and limb ischemic complications) is reported.
The bovine aortic arch (BAA) is a common finding in candidates for thoracic endovascular aortic repair, being a marker of thoracic aortic disease. Our aim was to assess whether this peculiar anatomic variant presents a consistent biomechanical pattern of proximal landing zones (PLZs) for thoracic endovascular aortic repair.
The objective of this study was to evaluate the outcome of the t-Branch (Cook Medical, Bloomington, Ind) stent graft for treatment of thoracoabdominal and pararenal aortic aneurysms in patients who had previous infrarenal aortic repair.