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At least 433 records · Page 24Linked to original sources
PubMed2006

The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-center study on 505 pregnant patients.

OBJECTIVES: We sought to evaluate the frequency and clinical characteristics of pruritic dermatoses in pregnancy and to assess a rationalized classification. METHODS: Data of 505 pregnant patients seen at two university-based dermatologic hospitals (1994-2004) were retrospectively studied. RESULTS: Diagnoses included eczema in pregnancy (49.7%), polymorphic eruption of pregnancy (PEP) (21.6%), pemphigoid gestationis (PG) (4.2%), intrahepatic cholestasis of pregnancy (ICP) (3%), prurigo of pregnancy (0.8%), pruritic folliculitis of pregnancy (0.2%), and miscellaneous dermatoses (20.6%). Eczema in pregnancy, prurigo of pregnancy, and pruritic folliculitis of pregnancy showed considerable overlap and were summarized as atopic eruption of pregnancy (AEP). While PEP, PG, and ICP presented in late pregnancy, AEP started significantly earlier. Primigravidae and multiple gestations were characteristic for PEP, abdominal involvement for PEP and PG, and a history of affected pregnancies for ICP. LIMITATIONS: This was a retrospective study. CONCLUSION: We propose classifying the dermatoses of pregnancy as PG, PEP, AEP, and ICP. Stereotypic immunofluorescence and laboratory findings are diagnostic of PG and ICP, whereas distinct clinical characteristics facilitate discrimination between PEP and AEP.

Adolescent↗
PubMed2006

Childhood acquired lipodystrophy: a retrospective study.

OBJECTIVE: We sought to describe the clinical characteristics and complications of children with acquired lipodystrophy (LD). METHODS: We conducted a retrospective chart review at a tertiary, academic children's hospital of children clinically given a diagnosis of acquired LD between January 1997 and December 2004. RESULTS: During the study period, 23 patients were identified. Their mean age at diagnosis was 9.74 +/- 3.98 years. Of patients, 61% were girls. The length of the follow-up was 4.8 +/- 3.5 years from the time of LD diagnosis. Of patients, 30% had evidence of localized disease (7 of 23), 26% (6 of 23) had localized partial disease, and 44% (10 of 23) had generalized LD. The most common underlying diagnosis was dermatomyositis (78%), alone or in association with other autoimmune diseases (juvenile rheumatoid arthritis 17%). Panniculitis with autoimmunity was noted in 17% of the patients. More than half of the patients had at least one complication attributable to LD such as acanthosis nigricans (22%), hyperpigmentation (22%), hepatomegaly (13%), hypertension (13%), protuberant abdomen (9%), and hyperlipidemia (4%). The only predictor for development of complications was the age of diagnosis of LD, with younger age being associated with increased risk (7 vs 12 years, P = .04). LIMITATIONS: Limitations were inherent to the retrospective design. CONCLUSIONS: Childhood acquired LD is seen more frequently in the context of autoimmunity. Affected children should be monitored for the development of complications, particularly if given a diagnosis of LD at a younger age.

Acanthosis Nigricans↗
PubMed2007

Topical imiquimod in the treatment of infantile hemangiomas: a retrospective study.

BACKGROUND: Active nonintervention remains the mainstay of therapy for most uncomplicated infantile hemangiomas (IH) because of their expected involution. Topical imiquimod, with its ability to induce the production of interferon, tumor necrosis factor-alpha, and the antiangiogenesis factor tissue inhibitor of matrix metalloproteinase, has been recently reported to be efficacious in the treatment of IH. OBJECTIVE: We sought to evaluate the efficacy of imiquimod 5% cream in the treatment of noncomplicated IH and possible side effects. METHODS: A retrospective chart review analysis was performed in 18 children (16 girls and 2 boys) with a median age of 18 weeks (range: 4-256 weeks). A total of 22 hemangiomas (14 located on head, 3 on genitalia, 2 on trunk, and 3 on extremities) were treated with imiquimod 5% cream. Imiquimod was applied 3 times weekly in 10 patients and 5 times weekly in 8 patients for a mean duration of 17 weeks (7-46 weeks). RESULTS: All superficial IH improved, and remission was achieved in 4 hemangiomas. There was little improvement in mixed IH with no or minimal change in all deep hemangiomas. One case with ulcerated hemangioma substantially improved with accelerated ulcer healing and hemangioma size reduction. No systemic complication was observed in any of our patients, with irritation and crusting being the most common reactive effects. LIMITATIONS: The small-sample, retrospective study limits the interpretation of results. CONCLUSION: Imiquimod 5% cream may be most effective in superficial IH. There was no significant correlation between response and early onset of treatment for any IH in our small sample study. Pharmacokinetic analysis and placebo-controlled study should follow to ascertain the safety and efficacy of imiquimod 5% cream in the pediatric age group.

Administration, Cutaneous↗
PubMed2006

High-potency steroid use in children with vitiligo: a retrospective study.

BACKGROUND: Data on efficacy and safety of treatments in children with vitiligo are limited. OBJECTIVE: We sought to describe the clinical outcomes and safety of children with vitiligo treated with high-potency topical corticosteroids. METHODS: Clinical improvement and laboratory data were retrospectively analyzed in 101 children (0-18 years) with vitiligo treated with moderate- to high-potency topical corticosteroids. RESULTS: Of patients, 64% (45 of 70) had repigmentation of the lesions, 24% (17 of 70) showed no change, and 11% (8 of 70) were worse than at the initial presentation. Local steroid side effects were noted in 26% of patients at 81.7 +/- 44 days of follow-up. Cortisol levels were abnormal in 29% of patients (21 of 73). Two children with low cortisol levels were given the diagnosis of steroid-induced adrenal suppression. Children with normal and abnormal cortisol levels were not significantly different by sex, age of onset, potency of the corticosteroid use, or family history. However, children with head and/or neck affected areas were 8.36 times more likely to have an abnormal cortisol level compared with children affected in other body areas (RR 95% confidence interval: 1.19, 58.60, P = .003, n = 72). Of patients, 8% (6 of 74) had an abnormal thyrotropin test result. LIMITATIONS: The retrospective design of this study presents inherent limitations. CONCLUSION: Moderate- to high-potency topical corticosteroids are efficacious in children with vitiligo, but may be associated with systemic absorption.

Adolescent↗
PubMed2006

Pityriasis lichenoides in childhood: a retrospective review of 124 patients.

BACKGROUND: Pityriasis lichenoides (PL) occurs in all age groups, although predominantly in younger individuals. OBJECTIVE: We sought to study the clinical features of PL in children followed up at our institution. METHODS: The records of 124 children who were given the diagnosis of PL at our institution between 1993 and 2003 were retrospectively reviewed. RESULTS: PL chronica (PLC) was recorded in 37% of the cases, PL et varioliformis acuta (PLEVA) in 57.3%, and clinical features of both disorders were seen simultaneously in the remaining. The median age of onset was 60 months (range: 6-180 months), although the median age of onset of PLEVA (median: 60 months) was significantly younger than that of PLC (median: 72 months) (P = .03). The age distribution showed peaks at 2 to 3 years (24.8%) and 5 to 7 years (32%). A history of infection or drug intake preceded the skin manifestations in 30% and 11.2% of patients with PLC and PLEVA, respectively. The disease began most commonly during winter (35%) or fall (30%). The median duration was 20 months (range: 3-132 months) in patients with PLC and 18 months (range: 4-108 months) in patients with PLEVA. Involvement was diffuse in 74.2% of the patients, peripheral in 20.2%, and central in the remainder. The disease was recurrent in 77% of the patients (n = 80). Of the patients, 59% had pruritus, whereas 32% reported no symptoms; the remainder had fever, arthralgia, or both. Erythromycin estolate or ethylsuccinate was administered to 79.7% of the affected children; 66.6% of these showed at least a partial response. LIMITATIONS: The analyzed data were collected retrospectively and biopsies were not performed in all patients. CONCLUSIONS: PL is not an uncommon disease in childhood, with age peaks in the preschool and early school-age years. It is usually recurrent, and shows a seasonal variation with onset most often in the fall or winter. In childhood PL, erythromycin is an effective initial treatment choice.

Adolescent↗
PubMed2006

En coup de sabre morphea and Parry-Romberg syndrome: a retrospective review of 54 patients.

BACKGROUND: The relationship between en coup de sabre morphea and Parry-Romberg syndrome is unclear, and not much is known regarding their demographic and clinical characteristics or the efficacy of the treatments that are used. OBJECTIVE: The purpose of this study was to describe demographic data, clinical features, and medications used in a large cohort of patients with en coup de sabre morphea and Parry-Romberg syndrome. METHODS: A retrospective review of patients diagnosed with en coup de sabre morphea or Parry-Romberg syndrome at the Mayo Clinic from 1984 to 2004 was conducted. Demographic data, examination findings, and treatments were noted. RESULTS: We identified 54 patients who met criteria for inclusion in the study. Twenty-six patients (48%) had en coup de sabre morphea, 13 (24%) had Parry-Romberg syndrome, and 15 (28%) had both. Disease was present bilaterally in 7.4% of patients. Thirteen percent of all patients in the study group had seizures. Of patients who received treatment, most were treated with antimalarial agents (57.1%) or methotrexate (28.6%). LIMITATIONS: The study design was that of a retrospective review at a tertiary care center with referral bias. There were also limitations present because of the inherent nature of the diseases studied. CONCLUSION: En coup de sabre morphea and Parry-Romberg syndrome frequently coexist and are likely both variants of morphea. Bilateral disease is more common than previously reported. The efficacy of antimalarials and methotrexate in the treatment of these diseases remains unclear.

Adolescent↗
PubMed2005

Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation group trial: a retrospective analysis.

OBJECTIVES: The purpose of this study was to investigate the relationship of serum digoxin concentration (SDC) and outcomes in women with heart failure (HF). BACKGROUND: Controversy continues concerning the clinical utility of digoxin in women with HF. METHODS: Our analysis was retrospective with data from the Digitalis Investigation Group (DIG) trial. The principal study analysis reviewed 4,944 patients with HF due to systolic dysfunction who survived for at least 4 weeks (all 3,366 patients randomized to placebo and the 1,578 of 3,372 patients randomized to digoxin who had serum concentration measured 6 to 30 h [inclusive] after the last dose of study drug at 4 weeks). RESULTS: Continuous multivariable analysis demonstrated a significant linear relationship between SDC and mortality in women (p = 0.008) and men (p = 0.002, p = 0.766 for gender interaction). Averaging hazard ratios (HRs) across serum concentrations from 0.5 to 0.9 ng/ml in women produced a HR for death of 0.8 (95% confidence interval [CI] 0.62 to 1.13, p = 0.245) and for death or hospital stay for worsening HF of 0.73 (95% CI 0.58 to 0.93, p = 0.011). In contrast, SDCs from 1.2 to 2.0 ng/ml were associated with a HR for death for women of 1.33 (95% CI 1.001 to 1.76, p = 0.049). CONCLUSIONS: Retrospective analysis of data from the DIG trial indicates a beneficial effect of digoxin on morbidity and no excess mortality in women at serum concentrations from 0.5 to 0.9 ng/ml, whereas serum concentrations > or =1.2 ng/ml seem harmful.

Age Factors↗
PubMed2006

Impact of blockade of histamine H2 receptors on chronic heart failure revealed by retrospective and prospective randomized studies.

OBJECTIVES: The goal of this work was to determine whether the blockade of histamine H2 receptors is beneficial for the pathophysiology of chronic heart failure (CHF). BACKGROUND: Because CHF is one of the major life-threatening diseases, we need to find a novel effective therapy. Intriguingly, our previous study, which predicts the involvement of histamine in CHF, suggests that we should test this hypothesis in patients with CHF. METHODS: We selected 159 patients who received famotidine among symptomatic CHF patients for the retrospective study. We blindly selected age- and gender-matched CHF patients receiving drugs for gastritis other than histamine H2 receptor blockers as a control group. For the prospective study, 50 symptomatic CHF patients were randomly divided into 2 groups. One group received famotidine of 30 mg/day for 6 months, and the other group received teprenone. RESULTS: In the retrospective study, famotidine of 20 to 40 mg decreased both left ventricular end-diastolic and end-systolic lengths (LVDd and LVDs, respectively) and the plasma B-type natriuretic peptide (BNP) levels (182 +/- 21 vs. 259 +/- 25 pg/ml, p < 0.05) with unaltered fractional shortening (FS). In a randomized, open-label study, compared with teprenone, famotidine of 30 mg prospectively decreased both New York Heart Association functional class (p < 0.05) and plasma BNP levels (183 +/- 26 pg/ml vs. 285 +/- 41 pg/ml, p < 0.05); this corresponded to decreasing both LVDd (57 +/- 2 mm vs. 64 +/- 2 mm, p < 0.05) and LVDs (47 +/- 2 mm vs. 55 +/- 2 mm, p < 0.05) with unaltered FS (15 +/- 1% vs. 17 +/- 1%). The frequency of readmission because of worsening of CHF was lower in the famotidine group (4% and 24%, p < 0.05). On the other hand, teprenone had no effects on CHF. CONCLUSIONS: Famotidine improved both cardiac symptoms and ventricular remodeling associated with CHF. Histamine H2 receptor blockers may have therapeutic benefits for CHF.

Aged↗
PubMed2004

Child and adolescent clinical features as forerunners of adult-onset major depressive disorder: retrospective evidence from an epidemiological sample.

BACKGROUND: Adult-onset cases of DSM-III-R major depressive disorder (MDD) often have had a history of mood disturbances and allied clinical features during childhood or adolescence. This study seeks to illuminate these early-life disturbances, as recalled and reported by adult-onset MDD cases (i.e. those whose first episode of MDD occurred after age 18) and non-cases. METHODS: Our research group has re-assessed survivors in the Baltimore Epidemiologic Catchment Area (ECA) community sample roughly 13.5 years after first diagnostic assessments in 1981. Of the 1920 participants, 150 were found to have a history of adult-onset MDD; 1755 were sub-threshold with respect to DSM criteria or reported few or no depression-related problems. Survival analysis was used to plot and study the cumulative occurrence of each clinical feature of depression from age 6 through 18 years for cases of adult-onset MDD versus non-cases. RESULTS: The earliest and most frequently occurring forerunners of adult-onset MDD were persistent depressed mood, anhedonia, feelings of worthlessness, and thoughts of death or suicide, with persistent anhedonia and worthlessness having a special prognostic value. One-third of adult-onset cases of MDD reported at least one clinical feature before age 19 versus only 7.3% of non-cases. LIMITATIONS: The study's estimates are based on retrospective recall, although a life chart methodology sought to reduce recall inaccuracies. CONCLUSIONS: The ECA follow-up sample data, though based on retrospection, provide new details about early forerunners of adult-onset depression from a sample of survivors. When they appear in children or adolescents, persistent anhedonia and persistent feelings of worthlessness merit special attention. These two clinical features, in particular, may help predict later risk of adult-onset major depression.

Adolescent↗
PubMed2004

Electroconvulsive therapy in adolescent and adult psychiatric inpatients--a retrospective chart design.

BACKGROUND: The knowledge available on electroconvulsive therapy (ECT) in adolescents is largely anecdotal, or based on findings from adults. The aim of the present study is to compare the use of ECT in adolescent and adult inpatients. METHODS: We retrospectively analyzed the files of all 36 adolescent (between the ages of 13 and 19) and 57 randomly selected adult inpatients (above the age of 20) treated with ECT in a university-affiliated mental heath center in Israel between 1991 and 1997. RESULTS: Sixty one percent of the adolescents improved by the end of treatment, and 53% were not hospitalized in the subsequent year. The respective percentages among adults were 83% and 49%. Whereas most adults were treated with ECT because of schizophrenic disorders, almost half of the adolescents received ECT for affective disorders. Significantly more adolescents were treated with ECT because of acute life-endangering conditions (catatonia or severe suicidal risk). No significant adverse effects were found in both groups. LIMITATIONS: Our study is based on a retrospective chart review. The adolescent and adult groups are different in psychiatric morbidity, diagnosis and outcome, have not been assessed in a blind manner, and we have not used standardized psychometric batteries for the evaluation of ECT-related memory disturbances. CONCLUSIONS: ECT may be an effective, well-tolerated and safe procedure in both adult and adolescent inpatients.

Adolescent↗
PubMed2005

Gender differences in electroconvulsive therapy: a retrospective chart review.

BACKGROUND: There is a growing interest in gender differences of different psychiatric disorders, especially major depression. We sought a possible gender difference related to electroconvulsive therapy (ECT). METHODS: This retrospective study compared 20 male and 23 female depressed adult patients treated by ECT. We compared their findings on gender differences to those of 12 female and 4 male bipolar patients and 11 male and 19 female schizophrenic patients, all treated in the same ECT setting. RESULTS: Depressed female patients underwent significantly fewer antidepressant drug trials than males before being referred to ECT (t41=2.09, P<0.05). A similar gender difference was found in the treatment of patients suffering from schizophrenia: female patients underwent fewer pharmacological antipsychotic trials than males before being referred to ECT (t28=3.11, P<0.01). ECT was significantly more effective in female patients than in male patients suffering from schizophrenia (U=38, P<0.05). LIMITATIONS: This is a retrospective pilot study whose results are based on subjective evaluations. CONCLUSION: The findings of this study may support a gender difference both in referral and in the outcome of ECT. CLINICAL RELEVANCE: there might be a need to consider lowering the number of pre-ECT drug trials for depressed males and to consider ECT as a viable therapeutic option for schizophrenic females.

Major Depressive Disorder↗
PubMed2005

Suicide in depressive disorders: a retrospective case-control study of 127 suicides.

BACKGROUND: Depressive disorders are associated with a significant risk of suicide. Inpatient status and recent discharge from hospital have been identified as times of high risk of suicide within the course of illness. METHOD: A matched retrospective case control study of 127 patients with depression requiring inpatient care who died by suicide as inpatients or in the 12 months following discharge from hospital. Single and multivariable conditional logistic regression identified independent risk and protective factors for suicide. RESULTS: A history of deliberate self harm is a significant risk factor for suicide in patients with depression (OR 6.96; 95% CI 3.41-14.19), as is living alone (OR 2.11; 95% CI 1.15-3.87) and paid employment (OR 2.80; 95% CI 1.48-5.32). Admission to hospital during social crisis is associated with a reduction in suicide risk (OR 0.43; 95% CI 0.24-0.75). LIMITATIONS: This is a retrospective case-control study, using clinical data not originally collected for research purposes. CONCLUSIONS: General population risk factors for suicide are less predictive of suicide in patients with depression requiring inpatient treatment. Clinicians need to be aware of factors which increase or reduce the risk of suicide in this group.

Adult↗
PubMed2005

Demographic and clinical features of schizoaffective (schizobipolar) disorder--a 5-year retrospective study. Support for a bipolar spectrum disorder.

BACKGROUND: Schizobipolar disorder is considered related to both schizophrenia and bipolar disorder. We aimed to describe with retrospective methodology the demographic, clinical, and treatment features in a group of schizobipolar disorder patients who have been treated for at least a 5-year period and compare them with bipolar I and schizophrenic patients who were treated during the same period. METHOD: We compared the demographic and clinical data of 61 schizobipolar, 57 bipolar I, and 55 schizophrenic outpatients who were diagnosed and treated for at least 5 years in the outpatient clinic in the Federal University of Rio de Janeiro. RESULTS: The schizobipolar disorder patients had a profile similar to the bipolar I patients but are significantly different from schizophrenic patients in educational level, marital status, occupation, drug and alcohol abuse episodes, presence of depressive, mixed and maniac episodes, family history of bipolar I and mood disorders, and use of medications. Only the age of onset, suicide attempts, and family history of suicide are not significantly different among the groups. The schizophrenic patients used antipsychotics for more days and the schizobipolar and bipolar I used more antidepressants and mood stabilizers. 37 (60.6%) schizobipolar patients had their diagnosis changed to bipolar disorder by their physician in different periods during the period studied. LIMITATIONS: It is a retrospective data description based on a naturalistic treatment. The family history was collected from the patient and whenever possible from one first-degree relative. CONCLUSION: Schizobipolar disorder patients have demographic, clinical and therapeutic features similar to bipolar I patients and data support its definite inclusion in the bipolar spectrum group.

Adult↗
PubMed2005

Guidelines were developed for data collection from medical records for use in retrospective analyses.

OBJECTIVE: To construct a set of guidelines for data collection from medical records. STUDY DESIGN AND SETTING: Retrospective analysis of clinical data is often performed by physician-scientists. In such research, the source of clinical data is the patient's medical record; however, medical records are intended for patient care and the data are not systematically recorded for research purposes. We drew on recommendations in the literature and our own experience with a retrospective cohort study that uses a DNA bank to construct guidelines for data collection from medical records. RESULTS: The guidelines incorporate a number of strategies for accurate data collection, which are discussed and illustrated by application. CONCLUSION: With guidelines for data collection, the quality of research data is enhanced. A well-designed case record form and a handbook for standardized data collection are essential for training the data collectors and for ensuring fastidious searching of the record; however, certain kinds of information are not always well documented in patient records. Consequently, it is essential to perform a pilot study to assess the study design and to use additional questionnaires. Correct interpretation of clinical outcomes documented in the medical records often necessitates an independent adjudication committee to prevent bias in outcome definition.

Bias↗
PubMed2004

Odontogenic tumours, a collaborative retrospective study of 75 cases covering more than 25 years from Estonia.

INTRODUCTION: The aim of the present collaborative study was to analyse retrospectively the character of odontogenic tumours in Estonia, involving the entire Estonian population (1.4 million), and to compare their prevalence with the figures presented in similar reports from other countries. MATERIAL AND METHODS: All material for the retrospective study was retrieved from the files of the Departments of Maxillofacial Surgery in Tartu and Tallinn, Estonia, where all in/out-patients are treated from the whole country. The final diagnosis in each case of odontogenic tumour was based on the 1992 WHO histological criteria. RESULTS: A total of 75 odontogenic tumours was found, 74 (98.6%) of which were benign, and 1 (1.3%) was malignant. The frequency of odontogenic tumours in this study was the lowest ever reported. The most common tumours were odontoma (34.3%), followed by ameloblastoma with different subtypes (25.3%), ameloblastic fibroma (16%), odontogenic myxoma (12%) and benign cementoblastoma (8%). CONCLUSION: Odontogenic tumours are relatively rare in Estonia compared with the data from other countries.

Adolescent↗
PubMed2026

Clinical accuracy and short-term outcomes of intraoral photogrammetry for complete-arch implant rehabilitation: A retrospective multicentre study on 35 patients.

OBJECTIVES: To evaluate the clinical accuracy and short-term outcomes of complete-arch implant-supported fixed dental prostheses (ISFDPs) fabricated using an intraoral photogrammetry (IPG) based digital workflow in completely edentulous patients. METHODS: This multicenter retrospective clinical study included 35 patients rehabilitated with 52 complete-arch ISFDPs (10 FP1, 18 FP2 and 24 FP3 restorations) supported by 221 implants. All definitive prostheses were designed and fabricated using a fully digital workflow initiated by IPG acquisition with the Aoralscan Elite IPG&#xae; (SHINING 3D). The primary outcome was clinical accuracy, assessed at definitive prosthesis delivery through evaluation of passive fit using the Sheffield test and radiographic verification. Secondary outcomes included biologic and prosthetic complications, as well as implant and prosthesis survival rates during the follow-up. RESULTS: Passive fit was achieved in all definitive restorations (100%). Radiographic evaluation confirmed accurate marginal adaptation at the implant-prosthesis interface in all cases. No statistically significant differences in clinical accuracy were observed according to treated arch, number of supporting implants, or prosthetic design (P > .05). During a mean follow-up period of 12.1 &#xb1; 3.5 months, biologic and prosthetic complications were limited and generally minor. Implant survival was 99.5%, and prosthesis survival was 100%. CONCLUSIONS: Within the limitations of this retrospective clinical study, the IPG based workflow demonstrated high clinical accuracy and predictable short-term outcomes for complete-arch implant rehabilitation, consistently enabling passive fit and favorable prosthetic performance. CLINICAL RELEVANCE: IPG may represent a clinically reliable and predictable approach for complete-arch digital implant impression acquisition. The high rates of passive fit, together with the low incidence of biologic and prosthetic complications observed in this multicenter clinical study, support the use of IPG based workflows for the fabrication of complete-arch ISFDPs.

Humans↗
PubMed2005

Feasibility of endovascular repair in penetrating axillosubclavian injuries: a retrospective review.

BACKGROUND: Penetrating injuries to the axillary and subclavian vessels are a source of significant morbidity and mortality. Although the endovascular repair of such injuries has been increasingly described, an algorithm for endovascular versus conventional surgical repair has yet to be clearly defined. On the basis of institutional endovascular experience treating vascular injuries in other anatomic locations, we defined an algorithm for the management of axillosubclavian vascular injuries. Subsequently, a near decade long experience with the management of axillosubclavian vascular injuries was retrospectively analyzed, so as to more accurately assess the true feasibility of endovascular treatment in these patients. METHODS: We defined a management algorithm that included (1) indications, (2) relative contraindications, and (3) strict contraindications for the endovascular repair of axillosubclavian vascular injuries. Anatomic indications for endovascular repair were restricted to relatively limited axillosubclavian injuries (pseudoaneurysms, arteriovenous fistulas, first-order branch vessel injuries, intimal flaps, and focal lacerations). Relative contraindications for endovascular repair included injury to the axillary artery's third portion, substantial venous injury (eg, transection), refractory hypotension, and upper extremity compartment syndrome with neurovascular compression. Strict contraindications to endovascular repair included long segmental injuries, injuries without sufficient proximal or distal vascular fixation points, and subtotal/total arterial transection. Within the context of these definitions, we retrospectively reviewed 46 noniatrogenic subclavian and axillary vascular injuries in 45 patients identified by a prospectively maintained computer registry during a 9-year period. Presentations were reviewed concurrently by two endovascular surgeons, and potential candidates for endovascular management were defined. RESULTS: Among 46 total case presentations and among the 40 patients who maintained vital signs on presentation, 17 were potentially treatable with endovascular therapy. Among the cohort of 40 presentations, the most common contraindications to endovascular therapy were hemodynamic instability (n = 10), vessel transection (n = 7), and no proximal vascular fixation site (n = 3). CONCLUSIONS: Despite growing enthusiasm for endovascular repair of injuries to the axillary and subclavian vessels, realistic clinical presentation and anatomic locations restrict the broad application of this technique at present. In our experience, less than but approaching 50% of all injuries encountered could be addressed with an endovascular approach. This percentage will increase during the upcoming decades if the endovascular technologies available in hybrid endovascular operating rooms uniformly improve.

Adolescent↗