J Cardiovasc Surg
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Surgery for thoracic outlet syndrome (TOS) is claimed to have a low risk of severe complications. To re-evaluate this, a questionnaire was sent out to the French vascular surgical community. There were 66 replies. ⋯ The results of the present study, as well as rare reports in the literature, demonstrate that these complications may occur even with experienced surgeons using either the supraclavicular or transaxillary approaches. We conclude that: (1) operation for TOS should be considered only when the diagnosis is certain and when operative decompression is the sole solution; (2) the choice of an adequate approach, good vision during operation, and meticulous technique are all mandatory for full security. Surgical guidelines are suggested.
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Four hours of complete normothermic ischemia in the rat hindlimb has been thought to produce extensive and irreversible damage and no possibility of salvage by reperfusion. This study tests the hypothesis that, in contrast to conventional wisdom, the cellular integrity is preserved after 4 hours of complete warm ischemia and control of the initial reperfusion can restore immediate contractility in these limbs. Ninety-two rat hindlimbs were isolated and 26 of the 92 did not undergo ischemia or reperfusion and served as controls. ⋯ In addition mitochondrial function was preserved well: mitochondrial oxidative phosphorylation capacity remained at 94% of control levels, ST3 at 93%, and ADP/O at 100% of control. Most importantly, controlled reperfusion restored immediate contractility in all limbs and was superior in all parameters investigated compared to uncontrolled reperfusion. These data support our inference that necrosis of skeletal muscle does not invariably occur after four hours of complete warm ischemia and suggest that muscle salvage by controlled reperfusion is possible after at least 4 hours of warm ischemia.