Journal of vascular surgery
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Comparative Study
Systemic hypertension induced by aortic cross-clamping: detrimental effects of direct smooth muscle relaxation compared with ganglionic blockade.
Infrarenal aortic cross-clamping performed during vascular reconstructive procedures is often accompanied by systemic supraclamp hypertension. Much of the disease and death that attend aortic cross-clamping centers around hypertension. Many different strategies have been developed to attenuate intraoperative hypertension, and a host of pharmacologic agents are regularly used to lessen the heart-related, cerebral, and systemic effects of clamp-induced hypertension. This study was performed to evaluate two such strategies; the intravenous administration of either trimethaphan camsylate or nitroprusside. ⋯ The attenuation of clamp-induced hypertension by nitroprusside is associated with a dramatic increase in CO and cardiac work whereas the use of trimethaphan camsylate is not. The use of this ganglionic blocker may be more appropriate in this setting.
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Thirty-nine reoperations in 38 patients with recurrent symptoms of neurogenic thoracic outlet syndrome were performed by the supraclavicular approach. Scarring around the brachial plexus was the primary cause in 59% of procedure, whereas in 41% of reoperations residual osseous and soft tissue anomalies were identified in the supraclavicular area and were responsible for recurrence of symptoms. Anterior and middle scalenectomy and neurolysis of the brachial plexus were the procedures of choice. ⋯ Compared with the results of primary operations for neurogenic thoracic outlet syndrome, reoperations led to a longer hospital stay and inferior long-term results. Supraclavicular decompression allows maximal exposure of the brachial plexus and identification and correction of causative soft tissue and bony anomalies. For these reasons we recommend this as the approach of choice in both primary and secondary operations for neurogenic thoracic outlet syndrome.