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A case of superior vena cava thrombosis secondary to the thoracic outlet syndrome is reported. The diagnosis was revealed by CT-scan and confirmed by phlebography performed to insert a catheter for intrathrombotic infusion of urokinase. The thrombolytic treatment was followed by complete clot lysis. A hyperabduction manoeuvre confirmed costoclavicular compression as the cause of the subclavian-axillary vein thrombosis for which the patient underwent first rib resection. Axillary-subclavian vein thrombosis (or Paget-von Schroetter syndrome) is a relatively frequent complication of the thoracic outlet syndrome often treated with anticoagulants on the basis of a duplex examination. Involvement of the superior vena cava is not readily detected by duplex ultrasound so a partial thrombosis, with a possible fatal outcome could remain undiagnosed. Full investigation by phlebography or CT-scan is therefore recommended. In addition, transcatheter thrombolytic therapy has a lower incidence of follow-up complications than heparin.

The authors report their experience in studying patients undergoing carotid endarterectomy with simple photon emission computed tomography (SPECT). This technique made it possible to identify areas of preoperative cerebral hypoperfusion in 54.8% of the patients which had a good correlation with neurological symptoms. To distinguish gradual changes in the ischemic lesions, a method of assessing the surface of the hypoperfused areas was adopted. In addition, SPECT made it possible to detect a greater number of hypoperfused areas even in sites other than those revealed by CT. Moreover, there was good correlations between the SPECT data and the grade and site of the carotid lesion and the data provided by some intraoperative monitoring procedures. The Authors therefore propose the use of SPECT in the evaluation of patients with cerebrovascular insufficiency following a carotid disease.

The results of carotid endarterectomy in 521 patients were analyzed to verify whether the early and late outcome in young patients is worse than in older patients, such as the results observed in peripheral arterial reconstruction in young adults. The patients were subdivided into 3 groups: 105 under 55 years, 397 aged between 56 and 74 years and 19 over 75 years. Young patients presented less risk factors and associated diseases than older ones, with the exception of smoking-habit; on the other hand, they presented a higher incidence of early post-operative thrombosis, myocardial infarction and of recurrent stenosis at follow-up. This trend has already been observed in other series. Young age and smoking habit have also been significantly related with recurrent carotid stenosis. In spite of these complications, carotid endarterectomy is indicated in severe stenosis or complicated carotid plaques, in young adults, because of a low operative mortality and a better trend in the follow-up period; however, the pre-operative evaluation needs a more accurate study and, when possible, the normalization of metabolic risk factors and the elimination of smoking.

The records of 304 patients operated on for vascular injuries were reviewed; 76 (25%) of these presented an iatrogenic vascular injury: 13 involved the upper limbs, 49 the lower limbs and 14 the neck and trunk. The lesions were due to a vascular catheterism in 40 patients, to orthopaedic treatment in 27 patients, to general surgery procedure in 3 patients, to urologic surgery in 3 and to otorhinolaryngologic surgery in 3. In vascular catheterism the prevalent complications were thromboses and embolisms; 3 patients needed an amputation after the surgical repair. In orthopaedic surgery, vascular complications were linked prevalently to hip surgery, exchange arthroplasty and upper tibial osteotomy. In urologic, otorhinolaryngologic and general surgery, vascular lesions were prevalently related to haemorrhagic complications, followed by incorrect haemostatic manoeuvres. Retroperitoneal fibrosis or previous surgery increased the risk of vascular injuries. Delay in treatment was responsible for post-operative death or incomplete recovery.