Search Our Scientific Publications & Authors

J Hand Surg Am 2021 May 4. Epub 2021 May 4.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

A 54-year-old woman with leukemia presented with coronavirus disease 2019 and a right upper-extremity indwelling peripherally inserted central catheter line for chemotherapy administration. On hospital admission day 9, she developed acute right upper-extremity edema and pain. Ultrasound demonstrated complete superficial and deep venous thrombosis up to the proximal subclavian vein. Read More

Dtsch Arztebl Int 2021 03;118(11):181-187

School of Human and Social Sciences, Department of Sports Medicine, University of Wuppertal.

Background: The occurrence of venous thromboembolisms (VTE) in association with sporting activity has been described but not yet systematically explored. The aim of this study was to determine the sites at which VTE occur in athletes, the accompanying features, and the special features of the symptoms and diagnosis, so that physicians can take the findings into consideration.

Methods: A search of the literature in the databases PubMed, Web of Science, and Cochrane in accordance with the PRISMA criteria, together with a search of Google Scholar up to 29 February 2020. Read More

Indian J Nephrol 2021 Jan-Feb;31(1):50-53. Epub 2021 Jan 27.

Department of Radiodiagnosis, All India Institute of Medical Sciences Bhopal, Madhya Pradesh, India.

A case of prefibrotic myelofibrosis with immune complex-mediated glomerulonephritis is presented. A 45-year-old female, with history of right subclavian and axillary vein thrombosis, presented with abdominal distension, facial puffiness, and pedal edema. Evaluation revealed deranged renal functions with nephrotic range proteinuria and acute kidney injury. Read More

Minerva Obstet Gynecol 2021 May 14. Epub 2021 May 14.

Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy -

The treatment of breast cancer diagnosed during pregnancy is a challenging situation for the patient, family and healthcare providers. Here we describe the case of a 35-year-old woman diagnosed with a triple-negative breast cancer relapse during pregnancy. She previously underwent neoadjuvant chemotherapy without any response, subsequent left skin sparing mastectomy plus axillary node dissection and radiation therapy to the chest wall and supraclavicular lymph nodes. Read More

J Vasc Access 2021 May 7:11297298211015041. Epub 2021 May 7.

Department of Cardiovascular Surgery, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.

Arterial injury during internal jugular vein cannulation can cause devastating complications such as stroke, hematoma, hemothorax, pseudoaneurysm, AV fistula, or even death. Acute upper limb ischemia caused by inadvertent arterial puncture during internal jugular vein cannulation has been rarely reported. The present report describes the case of a patient who experienced right upper limb ischemia caused by subclavian artery thrombosis developed during attempted placement of a tunneled hemodialysis catheter via the right internal jugular vein. Read More

Vascular 2021 Apr 9:1708538121997332. Epub 2021 Apr 9.

Cardiovascular Sciences, Department of Vascular Surgery, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.

Background: Venous thoracic outlet syndrome (vTOS) is caused by external compression of the subclavian vein at the costoclavicular junction. It can be subdivided in McCleery Syndrome and Paget-Schroetter Syndrome (PSS). To improve the venous outflow of the arm and to prevent recurrent thrombosis, first rib resection with venolysis of the subclavian vein can be performed. Read More

J Vasc Access 2021 Apr 8:11297298211008094. Epub 2021 Apr 8.

Department of Radiology, Boston Medical Center, Boston, MA, USA.

Purpose: To retrospectively review a single institution experience of ultrasound guided axillary vein port placement.

Methods: In this retrospective study, a patient list was generated after searching our internal database from 1/1/2012 to 10/1/2018. Patients who had undergone axillary vein port placement were included. Read More

Vascular 2021 Apr 4:17085381211002735. Epub 2021 Apr 4.

Department of Surgery, Yale School of Medicine, Connecticut, New Haven, CT, USA.

Objectives: We present a case in which a 44-year-old female smoker with a complex medical and surgical history presented with acute upper limb ischemia.

Methods: The patient was diagnosed with thoracic outlet syndrome causing symptomatic thrombosis of an aberrant right subclavian artery associated with diverticulum of Kommerell. The patient had history of extensive surgeries and radiation in the right chest with fibrotic changes, so surgical dissection in the area was associated with significant risk of nerve injury. Read More

Turk Gogus Kalp Damar Cerrahisi Derg 2021 Jan 13;29(1):13-19. Epub 2021 Jan 13.

Department of Cardiovascular Surgery, Ordu University Training and Research Hospital, Ordu, Turkey.

Background: This study aims to analyze the safety and efficacy of permanent hemodialysis catheter insertion via the brachial vein in unsuitable patients for catheter insertion from other vascular access sites.

Methods: A total of 21 patients (6 males, 18 females; mean age: 54.4±11. Read More

Vasc Endovascular Surg 2021 Mar 24:15385744211002803. Epub 2021 Mar 24.

Inova Fairfax Hospital, Falls Church, VA, USA.

Purpose: Traditional treatment of axillary-subclavian venous thrombosis is resource intensive due to the need for advanced nursing care and increased utilization of intensive care units for thrombolysis procedures. We recently encountered this in the management of 2 patients with effort-induced upper extremity venous thrombosis following COVID-19 infection and offer a treatment paradigm for consideration.

Case Reports: A 30-year-old presented with 2 weeks of left upper extremity symptoms following COVID-19 infection. Read More

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:23247096211003263

Ashland Bellefonte Cancer Center, Ashland, KY, USA.

Paget-Schroetter syndrome or effort thrombosis is a relatively rare primary spontaneous thrombosis of upper extremity deep veins secondary to entrapment of axillary subclavian veins from an abnormality of the thoracic outlet. It is commonly seen in young adults who lift heavy weights or strenuous use of the upper extremities during athletic activities. Repetitive microtrauma to the subclavian vein secondary to narrow costoclavicular space and strenuous activities leads to intimal layer inflammation, hypertrophy, fibrosis, and coagulation cascade activation. Read More

J Craniofac Surg 2021 Mar-Apr 01;32(2):e176-e177

Department of Thoracic Surgery, Health Science University Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey.

Abstract: Paget-Schroetter syndrome is a rare clinical condition characterized by subclavian vein thrombosis following repetitive upper extremity effort. In this case, we presented a 35-year-old female patient who underwent septorhinoplasty in our clinic. A swelling of the left part of the neck extending to the clavicle was detected 4 hours after the operation. Read More

JBJS Case Connect 2021 03 10;11(1). Epub 2021 Mar 10.

Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California.

Case: We report the case of a 29-year-old man with a displaced mid-diaphyseal clavicle fracture that healed in anatomic position without fracture callus after surgical treatment but developed symptoms of late venous thoracic outlet syndrome (TOS) 19 months postoperatively. He was diagnosed with proximal subclavian vein thrombosis and was treated with urgent thrombolysis and staged first rib resection with resolution of symptoms.

Conclusions: Late venous TOS is a potential complication of clavicle fracture, even in the setting of anatomic reduction and primary bone healing. Read More

Plast Reconstr Surg Glob Open 2021 Feb 17;9(2):e3400. Epub 2021 Feb 17.

Department of Plastic and Reconstructive Surgery, University Hospitals Birmingham Foundation Trust, Birmingham, United Kingdom.

The anterioabdominal wall is the most common site for low molecular weight heparin administration for anticoagulation, either for prophylactic or for therapeutic indications. Occasionally, this could be associated with damage of the abdominal pannus microvasculature, which could possibly jeopardize the reliability of free abdominal flaps as deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle, especially with therapeutic anticoagulation therapy. These flaps are reliant on a highly intricate complex vascular anatomy and perforasomes for their adequate perfusion and survival. Read More

Int J Surg Case Rep 2021 Mar 25;80:105710. Epub 2021 Feb 25.

Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119 Kassel, Germany.

Introduction And Importance: Thoracic outlet syndrome (TOS) includes disorders caused by compression of the neurovascular structures in the upper thoracic outlet (Roos and Owens, 1996 [1]; Bürger, 2014; Curuk, 2020 [3]). Depending on the compressed structure, it is categorized into neurological, arterial and venous TOS. SAPHO syndrome (synovitis-acne-pustulosis-hyperostosis-osteitis syndrome) is a rare chronic inflammatory disease of unknown etiology. Read More

BMJ Case Rep 2021 Feb 26;14(2). Epub 2021 Feb 26.

Department of Acute Medicine, Princess Alexandra Hospital, Harlow, UK.

Medicina (B Aires) 2021 ;81(1):31-36

Servicio de Clínica Médica, Hospital Británico, Buenos Aires, Argentina.

Thoracic outlet syndrome (TOS) refers to a number of signs and symptoms that arise from compression of the neurovascular bundle at the costoclavicular junction. Paget-Schroetter syndrome is defined as the primary, spontaneous or effort thrombosis of the subclavian vein. The supraclavicular and trans-axillary approaches are currently the most commonly used for first rib resection. Read More

J Dent Anesth Pain Med 2021 Feb 29;21(1):81-85. Epub 2021 Jan 29.

Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea.

Central venous catheter (CVC) insertion is commonly used in the operating room and intensive care unit to monitor central venous pressure and secure an intravenous route to deliver medications and nutritional support that cannot be safely infused into peripheral veins. However, CVC insertion may be associated with serious complications such as arterial puncture, hematoma, pneumothorax, hemothorax, catheter infections, and thrombosis. Several methods have been recommended to prevent these complications. Read More

Case Rep Orthop 2021 26;2021:8865592. Epub 2021 Jan 26.

Division of Orthopaedics and Trauma Surgery, University Hospital of Basel, Spitalstrasse 21, 4056 Basel, Switzerland.

Isolated insertional ruptures of the pectoralis minor tendon at the coracoid process are a rare condition. Hitherto, very few cases have been reported in the literature. A precise diagnosis is often difficult to obtain and commonly requires advanced imaging to confirm the suspicion and rule out concomitant injuries. Read More

Dtsch Arztebl Int 2021 03 19;118(Forthcoming). Epub 2021 Mar 19.

Background: The occurrence of venous thromboembolisms (VTE) in association with sporting activity has been described but not yet systematically explored. The aim of this study was to determine the sites at which VTE occur in athletes, the accompanying features, and the special features of the symptoms and diagnosis, so that physicians can take the findings into consideration.

Methods: A search of the literature in the databases PubMed, Web of Science, and Cochrane in accordance with the PRISMA criteria, together with a search of Google Scholar up to 29 February 2020. Read More

Ann Transl Med 2021 Jan;9(1):78

Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Patients presenting with periodic swelling of the upper extremity without thrombosis are diagnosed with McCleery syndrome. There have been sporadic cases reported over the past decades. Due to the rarity of this disease, no standard consensus on diagnosis and treatment of McCleery syndrome was established. Read More

J Vasc Surg Venous Lymphat Disord 2021 05 2;9(3):801-810.e5. Epub 2021 Feb 2.

Department of Vascular Surgery, Athens University Medical School, Athens, Greece.

Objective: There is currently no general agreement on the optimal treatment of Paget-Schroetter syndrome. Most centers have advocated an interventional approach that is based on the results of small institutional series. The purpose of our meta-analysis was to focus on the safety and efficacy of thrombolysis or anticoagulation with decompression therapy. Read More

Cureus 2020 Dec 31;12(12):e12392. Epub 2020 Dec 31.

Cardiology, Mohammed I University/Mohammed VI University Hospital, Oujda, MAR.

Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure that occurs during the final month of pregnancy through about five months after delivery, without any other known cause, and it increases the risk of thromboembolic events by many folds. A 38-year-old female with a history of peripartum dilated cardiomyopathy was admitted to our hospital, one month after a cesarean section, for severe breathlessness. Examination revealed signs of global heart failure and right deep vein thrombosis. Read More

J Vasc Surg Venous Lymphat Disord 2021 Jan 8. Epub 2021 Jan 8.

Department of Vascular Surgery, Catharina Hospital, Eindhoven; Care and Public Health Research Institute School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht. Electronic address:

Objective: Venous thoracic outlet syndrome (VTOS) is considered chronic when symptoms and venous stenosis or occlusion are present for >3 months after the initial primary upper extremity deep vein thrombosis event. Many of patients with chronic VTOS receive conservative treatment. However, a subset of these patients will have persistent post-thrombotic syndrome symptoms because of underlying causative anatomy. Read More

Ann Vasc Surg 2021 May 26;73:185-196. Epub 2020 Dec 26.

DFW Vascular Group, Dallas, TX; Surgery, Methodist Dallas Medical Center, Dallas, TX; TCU School of Medicine, Ft. Worth, TX. Electronic address:

Background: Subclavian vein and brachiocephalic vein occlusions are challenging problems in dialysis patients with ipsilateral upper extremity (UE) vascular access or in need of one. HeRO grafts (Hemodialysis Reliable Outflow, Merit Medical Systems, Inc, South Jordan, UT) have been used to manage such occlusions but patients with chronic hypotension treated with HeRO graft may have threatened patency. We describe an alternative technique using a supraclavicular stent graft to reconstruct the venous outflow, evaluate outcomes of this procedure, and discuss its role in complex hemodialysis patients. Read More

World J Nucl Med 2020 Jul-Sep;19(3):271-272. Epub 2019 Nov 7.

Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Brussels, Belgium.

A 53-year-old female underwent a lung ventilation/perfusion scintigraphy (V/Q scan) in the workup of extensive thrombosis of the left subclavian and internal jugular veins. The perfusion lung scan visualized an atypical uptake in the thoracic vertebrae. A chest Computed Tomography (CT) scan demonstrated unusual tortuous and opacified thoracic superficial veins, collaterals of the lateral thoracic vein. Read More

J Vasc Access 2020 Dec 21:1129729820983183. Epub 2020 Dec 21.

Department of Interventional Radiology, "G. Genimatas" General Hospital of Athens, Athens, Attike, Greece.

Obstruction or occlusion of the central veins (Central venous disease, CVD) represents a major complication in hemodialysis patients (HD) limiting central venous access available for a central venous catheter placement. Endovascular treatment with percutaneous transluminal angioplasty (PTA) is the first therapeutic option to restore patency and gain access. This case presents our initial experience of a HD patient with CVD treated with a combination therapy of a balloon PTA to the left brachiocephalic trunk, through the right hepatic vein and standard catheter placement technique to the previously occluded junction of the left internal jugular vein to the left subclavian vein. Read More

J Vasc Surg Venous Lymphat Disord 2020 Dec 17. Epub 2020 Dec 17.

Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif.

Objective: Spontaneous subclavian vein (SCV) thrombosis (Paget-Schroetter syndrome [PSS]) has been attributed to venous compression at the thoracic outlet and traditionally diagnosed using venography. Intravascular ultrasonography (IVUS) allows for a multidimensional view of vascular structures and might be more accurate in revealing venous compression. The goal of the present study was to compare venography and IVUS in patients presenting with PSS to assess the relative accuracy of each modality. Read More

Ann Vasc Surg 2021 Apr 3;72:147-158. Epub 2021 Feb 3.

Division of Vascular & Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA. Electronic address:

Background: Thoracic outlet syndrome (TOS) surgery is relatively rare and controversial, given the challenges in diagnosis as well as wide variation in symptomatic and functional recovery. Our aims were to measure trends in utilization of TOS surgery, complications, and mortality rates in a nationally representative cohort and compare higher versus lower volume centers.

Methods: The National Inpatient Sample was queried using International Classification of Diseases, Ninth Revision, codes for rib resection and scalenectomy paired with axillo-subclavian aneurysm (arterial [aTOS]), subclavian deep vein thrombosis (venous [vTOS]), or brachial plexus lesions (neurogenic [nTOS]). Read More

BMJ Case Rep 2020 Dec 17;13(12). Epub 2020 Dec 17.

Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

A 25-year-old Indian man presented with low-grade fever followed by gradually increasing swelling of neck and face. Physical examination showed bilateral neck swelling, facial swelling and dilated veins in the upper chest. Superior vena cava (SVC) obstruction due to an underlying malignancy was suspected. Read More