Sharon Kiang

Regrown first rib in patients with recurrent thoracic outlet syndrome.

BACKGROUND Recurrent symptoms of thoracic outlet syndrome (TOS) after first rib resection have varying etiologies. Regrowth of a first rib is a rare event. Recurrent symptoms in the presence of a regrown rib strongly suggest a causal relationship. We report our experience with recurrent symptoms of TOS and regrown first ribs. METHODS We identified patients with recurrent TOS symptoms and regrown first ribs presented between 1995 and 2012. Details regarding their presentation, evaluation, and treatment were gathered. RESULTS Eight patients (6 women and 2 men) presenting with recurrent TOS symptoms and regrown first ribs underwent 10 decompression surgeries. Prior surgeries included supraclavicular first rib resection (5), transaxillary first rib resection (5), scalenectomy (5), cervical rib resection (1). The average period between initial surgery and reoperation was 4.7 years. Average age at current presentation was 40.8 years (range 29-52). All patients (8) represented with neurogenic symptoms and 1 patient with concomitant venous TOS symptoms. Presenting symptoms included pain (8), numbness and tingling (7), weakness (6), headache (2), and venous congestion (3). Initial treatment included physical therapy in all. Preoperative assessment included chest X-rays (8), magnetic resonance imaging (7), electrodiagnostic studies (8), venography (2), and anterior scalene muscle block (2). Surgical approach included transaxillary resection of the regrown first rib (10), neurolysis of brachial plexus (10), scalenectomy (5), and lysis of subclavian vein (1). After an average follow-up of 10.8 months, resolution of symptoms included 4 complete and 4 partial. CONCLUSIONS Regrowth of the first rib is a rare event. There is a concordance between a regrown rib and TOS symptoms. Patients presenting with recurrent TOS symptoms and a regrown first rib have a high probability of improvement with resection of the regrown rib.

Ischemic colitis after translumbar n-butyl cyanoacrylate injection for treatment of endoleak

A 76-year-old man with history of endovascular repair of an infrarenal abdominal aortic aneurysm and right hypogastric artery embolization was found to have a persistent type II endoleak 2 years after his initial repair. Sac expansion by 1.6 cm during the following year prompted intervention by direct sac injection. Further sac expansion by 1 cm during 3 months elevated concern for occult proximal perigraft flow (type IA endoleak). We subsequently performed Aptus EndoAnchor (Aptus Endosystems, Sunnyvale, Calif) placement, with completion angiography demonstrating improved graft apposition. Interval imaging, however, demonstrated further sac expansion, and computed tomography (CT)-guided translumbar direct sac injection was performed (A). A total of 1 g of n-butyl cyanoacrylate was used. Completion CT showed glue cast filling of the endoleak sac with extension into the inferior mesenteric artery and secondary branches (B/Cover). After the procedure, the patient developed abdominal distention with focal peritonitis and was taken to the operating room for exploratory laparotomy. He was found to have a completely ischemic sigmoid colon requiring resection. Follow-up CT angiography demonstrated resolution of endoleak and decrease in the sac size by 0.6 cm (C). The patient’s consent has been obtained for the publication of this case report.

IP213. Endovascular Reconstruction for TransAtlantic Inter-Society Consensus II D Aortoiliac Occlusive Disease Achieves Equivalent Long-Term Outcomes Compared With Surgical Bypass

Fig 1. Peripheral artery disease (PAD) or diabetes-related lower extremity amputations (minor or major) in Ontario, Canada. Inter-Society Consensus II D Aortoiliac Occlusive Disease Achieves Equivalent Long-Term Outcomes ComparedWith Surgical Bypass Joshua Gabel, Roger Tomihama, Ahmed Abou-Zamzam Jr, Theodore Teruya, Christian Bianchi, Sharon Kiang. Loma Linda University Medical Center, Loma Linda, Calif