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Thoracic Outlet Syndrome: A Comprehensive Review
Simpson, Tamara; Safir, Scott; Radulovic, Miroslav; Hines, George
Thoracic outlet syndrome (TOS) comprises a range of conditions characterized by compression of the brachial plexus, subclavian artery, or subclavian vein as these structures traverse the thoracic outlet. Although TOS was first documented in 1860 by Willshire, it remains a diagnostic and therapeutic challenge-particularly for cardiologists evaluating upper-extremity ischemia, suspected arm emboli, or unexplained swelling. This article provides a cardiology-focused overview of TOS, emphasizing the condition's subtypes (neurogenic, venous, and arterial), key diagnostic approaches, comparative surgical outcomes, and considerations relevant to cardiovascular specialists. Literature pertaining to TOS pathophysiology, clinical diagnosis, imaging, and surgical management was reviewed. Where available, quantitative outcome data and success rates are highlighted to guide evidence-based decision-making. TOS is commonly categorized into neurogenic, venous, and arterial forms. Each subtype necessitates a distinct approach. Developments in imaging (magnetic resonance imaging, computed tomography angiography, and dynamic ultrasound) and refined surgical techniques have improved diagnostic accuracy and therapeutic success: yet questions remain regarding long-term efficacy and optimal procedural approaches. Prompt differentiation between TOS and intrinsic cardiac or major vascular etiologies is essential for preventing severe complications such as limb ischemia and permanent nerve damage. A multidisciplinary model integrating cardiologists, vascular surgeons, neurologists, and physical therapists offers the best outcomes. Further studies, particularly large-scale comparative trials, are needed to standardize diagnostic protocols and evaluate emerging surgical approaches.
PMID: 40810529
ISSN: 1538-4683
CID: 5907562
Contemporary Strategies for Mesenteric Malperfusion in Acute Aortic Dissection
Ye, Ivan B; D'Arduini, Matteo; Cayne, Neal S; Hines, George L
Mesenteric malperfusion is a rare complication of aortic dissection associated with high mortality. Diagnosis requires a high degree of suspicion as treatment is time-sensitive, necessitating early revascularization to prevent bowel necrosis, sepsis, and multi-organ failure. Advances in endovascular techniques have improved outcomes and survival over traditional approaches. Management of type A aortic dissection with mesenteric malperfusion has shifted from central aortic repair first to a two-stage approach with revascularization and delayed aortic repair. Thoracic endovascular aortic repair has become the standard treatment for type B aortic dissection with mesenteric malperfusion. However, finding the balance between aortic repair and treating mesenteric malperfusion remains a challenge. This review highlights current strategies and promising research into new endovascular techniques and refining treatment pathways.
PMID: 40372259
ISSN: 1538-4683
CID: 5844582
Roy K. Greenberg and His Work on Endovascular Aortic Aneurysm Repair
Tan, Sally; Hines, George L
PMID: 39898645
ISSN: 1538-4683
CID: 5783702
A Life Dedicated to Surgical Innovation: Harvey Cushing (1869-1939)
Fountain, Samantha; Hines, George
PMID: 40110981
ISSN: 1538-4683
CID: 5813552
Frank J. Veith, MD: Vascular Surgeon, Pioneer, Leader
Fountain, Samantha; Hines, George; Wain, Reese
PMID: 39899511
ISSN: 1538-4683
CID: 5783742
The Life and Lessons of Dr. John Gibbon Jr. Creator of the Heart-Lung Machine (September 29, 1903-February 5, 1973)
Cimaroli, Sawyer; Hines, George
PMID: 39637353
ISSN: 1538-4683
CID: 5804562
Robert Gross MD and the Birth of Pediatric Heart Surgery
Krell, Matthew; Hines, George L
Robert Gross performed the first repair of a patent ductus arteriosus in 1938. His life and career were dedicated to the advancement of vascular, cardiac, pediatric surgery, and the unrelenting care of his patients.
PMID: 38833498
ISSN: 1538-4683
CID: 5665192
Francis Moore a Surgeon-Scientist: Career in Retrospect
Cimaroli, Sawyer; Hines, George
PMID: 36883819
ISSN: 1538-4683
CID: 5432742
Therapeutic Angiogenesis and Cardiovascular Disease: A Review
Ye, Ivan B; Hines, George L
After the success of novel angiogenesis inhibitors in cancer treatment, angiogenesis promotors for the treatment of peripheral vascular disease and coronary artery disease became the target of significant research. Promising results in animal models led to numerous randomized control trials that failed to translate into meaningful clinical results. The goal of this review is to describe the history of investigation into therapeutic angiogenesis for cardiovascular disease and discuss the lessons learned and future directions.
PMID: 38814076
ISSN: 1538-4683
CID: 5663742
The Evolution of Current Management for Carotid Artery Bifurcation Disease
Zohourian, Tirajeh; Hines, George
Options for treatment of symptomatic carotid bifurcation disease include carotid endarterectomy (CEA) and carotid artery stenting (CAS). While over the years CEA has established itself as the gold standard for carotid artery revascularization, results from recent trials have shown CAS to be safe and effective in selected patients. This review details the evolution of carotid artery bifurcation disease by highlighting key clinical trials.
PMID: 36729106
ISSN: 1538-4683
CID: 5420292