Treatment of End-Stage Emphysema
Surgical management of end-stage emphysema has been and continues to be both interesting and ever changing. The modern-day surgical treatment began in the early 1990s using laser techniques to try to cause some volume reduction. This was followed by more effective stapled resection of the emphysematous areas and better understanding of proper patient selection. More recently, we have seen the introduction of endobronchial valves and other novel treatments trying to achieve results less invasively. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Stephen R. Hazelrigg, Traves D. Crabtree Tags: Preface Source Type: research
Far from Benign: Thoracic Management of Emphysema
We are excited to bring you this focused issue for the Thoracic Surgery Clinics on “Surgical Management of Benign Lung Disease.” As per the Preface title by guest editors Hazelrigg and Crabtree, this is more specifically a treatise on End-Stage Emphysema. The contributing authors focused on interventional approaches to improving the quality of life of patients with emphysema, a costly and deadly disease impacting over 3 million Americans. This emphysema issue is about reduction and not replacement, that refers to lung transplant, which we will read about in next year’s issue to be guest edited by Drs Kukreja and Vena...
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Virginia R. Litle Tags: Foreword Source Type: research
Surgical Management of Benign Lung Disease
THORACIC SURGERY CLINICS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Stephen R. Hazelrigg, Traves D. Crabtree Source Type: research
Copyright
ELSEVIER (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research
Contributors
VIRGINIA R. LITLE, MD (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research
Contents
Virginia R. Litle (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research
Forthcoming Issues
Lung Cancer 2021, Part I (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research
Surgical Technique
Thoracic outlet syndrome is a condition of compression involving the brachial plexus and subclavian vessels. Although there are multiple surgical approaches to address thoracic outlet decompression, supraclavicular first rib resection with scalenectomy and brachial plexus neurolysis allow for complete exposure of the first rib, brachial plexus, and vasculature. This technique is described in detail. This approach is safe and can produce excellent outcomes in all variants of thoracic outlet syndrome. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 19, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Brett L. Broussard, Dean M. Donahue Source Type: research
Reoperation for Persistent or Recurrent Neurogenic Thoracic Outlet Syndrome
Identifying the exact cause for persistent and recurrent neurogenic thoracic outlet syndrome (NTOS) is challenging even with high-resolution imaging of the thoracic outlet. Improvement can be achieved with redo first rib resection, although the posterior first rib remnant is one of several potential points of brachial plexus compression. In approaching reoperative surgery for NTOS, the aim is to provide complete thoracic outlet decompression as guided by the patient ’s history, physical examination, and adjunctive imaging. This may involve resection of the posterior first rib remnant, scar tissue encasing the brachial pl...
Source: Thoracic Surgery Clinics - November 19, 2020 Category: Cardiovascular & Thoracic Surgery Authors: William W. Phillips, Dean M. Donahue Source Type: research
Evaluation and Management of Venous Thoracic Outlet Syndrome
Venous thoracic outlet syndrome (TOS) is uncommon but occurs in young, healthy patients, typically presenting as subclavian vein (SCV) effort thrombosis. Venous TOS arises through chronic repetitive compression injury of the SCV in the costoclavicular space with progressive venous scarring, focal stenosis, and eventual thrombosis. Diagnosis is evident on clinical presentation with sudden spontaneous upper extremity swelling and cyanotic discoloration. Initial treatment includes anticoagulation, venography, and pharmacomechanical thrombolysis. Surgical management using paraclavicular decompression can result in relief from ...
Source: Thoracic Surgery Clinics - November 19, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Jason R. Cook, Robert W. Thompson Source Type: research
How Common Is Thoracic Outlet Syndrome?
The incidence of neurogenic thoracic outlet syndrome is completely unknown, and has been wildly overestimated in the past. Based on a prospectively maintained database at our academic Thoracic Outlet Center, we estimate the yearly incidence of neurogenic and venous thoracic outlet syndrome to be approximately 3 and 1 per 100,000 population, respectively. The ratio of neurogenic to venous thoracic outlet syndrome seems to be approximately 80:20 based on presentation, and 75:25 based on operative correction. These data will help to understand the impact of these disorders, and perhaps help to guide resource management. (Sour...
Source: Thoracic Surgery Clinics - November 19, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Karl A. Illig, Eduardo Rodriguez-Zoppi Source Type: research
Imaging Assessment of Thoracic Outlet Syndrome
Imaging studies play a significant role in assessment of thoracic outlet syndrome. In this article, we discuss the etiology and definition of thoracic outlet syndrome and review the spectrum of imaging findings seen in patients with thoracic outlet syndrome. We then discuss an optimized technique for computed tomography and MRI of patients with thoracic outlet syndrome, based on the experience at our institution and present some representative examples. Based on our experience, a combination of computed tomography angiography and MRI (with postural maneuvers) effectively demonstrate thoracic outlet syndrome abnormalities. ...
Source: Thoracic Surgery Clinics - November 19, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Omid Khalilzadeh, McKinley Glover, Martin Torriani, Rajiv Gupta Source Type: research
Physical Therapy Management of Neurogenic Thoracic Outlet Syndrome
Neurogenic thoracic outlet syndrome is a complex and challenging condition to manage. There is a lack of high-quality evidence to guide clinical decision making and therefore a need to individualize treatment. Examination includes identifying postural, anatomic, and biomechanical factors that contribute to compromise of the neurovascular structures. Patients can experience good outcomes with conservative management with pain science-informed physical therapy combined with biomechanical approaches addressing contributing impairments. Retraining movement patterns while maintaining patency allows for a greater tolerance to fu...
Source: Thoracic Surgery Clinics - November 19, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Eileen Collins, Michael Orpin Source Type: research
Surgical Technique
Minimally invasive surgical approaches to the treatment of thoracic outlet syndrome (TOS) will become increasingly common as more surgeons gain experience in thoracoscopic and robotic technique. Robotic surgery may be more technically advantageous because of improved visualization and maneuverability of wristed instruments. Longer-term outcome data are necessary to definitively establish the equivalency or superiority of minimally invasive TOS compared with open surgery in the treatment of TOS. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 19, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Christina L. Costantino, Lana Y. Schumacher Source Type: research
Evaluation of Patients with Neurogenic Thoracic Outlet Syndrome
Neurogenic thoracic outlet syndrome (NTOS) results from the compression or irritation of the brachial plexus within the thoracic outlet. The associated symptoms result in significant disability and negative effects on patient health-related quality of life. The diagnosis of NTOS, despite being the most common type of TOS, remains challenging for surgeons, in part due to the nonspecific symptoms and lack of definitive diagnostic testing. In this article, we present the essential components of the evaluation of patients with NTOS including a thorough history and physical examination, stress maneuvers, diagnostic and therapeu...
Source: Thoracic Surgery Clinics - November 19, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Nikhil Panda, Dean M. Donahue Source Type: research
