Dr Raffi Qasabian: The thoracic aorta in the endovascular era
Dr Raffi Qasabian, Vascular surgeon at Royal Prince Alfred Hospital, discusses open surgery & endovascular interventions for thoracic aortic disease.
Dr. Robert Thompson, vascular surgeon specializing in Thoracic Outlet Syndrome
Dr. Robert Thompson, a vascular surgeon here at Barnes-Jewish Hospital, is the director of the Washington University Center for Thoracic Outlet Syndrome ...
Chris, please feel free to call our TOS office at 314-362-7410. We would
encourage you to speak with one of our nurses about your condition and
symptoms. We would also ask that you send your records from previous tests
and evaluations for our review, along with a referral letter from a
physician asking that we evaluate you for TOS. In order to provide you an
accurate diagnosis, it is necessary that you have a direct office visit and
examination. Please also keep in mind that our patients who undergo surgery
are expected to stay in St Louis 7-10 days after the operation and to come
back here for at least 1-2 postoperative follow-up visits in the first 2-3
months. We look forward to hearing from you. Thank you!
Dr. I had an aartiogrram many years ago and diagnosed with TOC (no pulse
either arm ) Ihad the right rib removed and no problem. I also had the left
removed (I thought) but found out many years later that only a partial
removal it was done near my sternum. I have had continous pain in neck
shoulder arm hand for years because I can't find a Dr who will do the
surgery and my insurance is a factor. It is so painfull. I have the extra
cervical ribs also. The pain radiates under my armpit down my ribs and
particularly in my left breast and occasionally in my breast bone. Could
you see me? What type of referal do I need? Thanks, Nancy
Short answer- Yes. The diagnosis of neurogenic TOS is a clinical diagnosis.
There is no other test or imaging study or lab test that can establish or
exclude the diagnosis of this condition, but they are used to exclude other
conditions for which they are appropriate. When negative, that does not
mean that the diagnosis of neurogenic TOS isn't present and they shouldn't
be interpreted that way. Physicians unfamiliar with neurogenic don't know
this and may interpret test results incorrectly.
DR. Thompson: What would you do if one of your TOS surgeries Failed like
mine did by Dr. G. James Avery in 2004??---see me on u tube under Bobbie
Jenke. With a paralyzed diaphragm--life is really really hard--and a
hanging scapula, and so much neck damage. I now have cervical torticollis
and kyphosis and can barely walk, breathe much of time. After surgery Dr.
Avery was cruel to me. I have a miserable, home bound life now 8 years
post-op. I was a successful teacher. Can you help me? How?
It is more important that the surgeon be expert in caring for patients with
TOS than their specialty (ie, not all vascular surgeons are well trained to
care for TOS). Vascular surgeons do tend to be more familiar with venous
and arterial reconstructions. For neurogenic TOS, there might be a variety
of specialties that treat patients, including neurosurgeons, vascular
surgeons, thoracic surgeons, and hand surgeons. I would be wary of
selecting a surgeon for based on specialty.
Chris - here's more info from Dr. Thompson: It is not uncommon for
neurogenic TOS to affect both upper extremities, although one limb is
usually more severe than the other (not always, but usually, the dominant
limb). In our practice, we see bilateral symptoms in approximately 15-20
percent of our patients with neurogenic TOS, about 10 percent with symptoms
that are equal on both sides. Venous and arterial TOS almost always affect
only one extremity.
Interesting. Thank you for that reply. What is odd about my symptoms is
that my pulse rate completely drops out (almost) when my left arm is raised
above my head and my arm extended back a little. My right hand is similar
but a milder pulse drop out. I would think this is a vascular issue. In
addition, my arms consistently go numb very fast at night when I try to
sleep in certain positions. I would think this is neurogenic, but I'm not
certain.
It is far more important that they are actually experienced in doing
operations for TOS. It is better if they are familiar with all 3 types of
TOS so that they can bring a complete perspective and understanding of the
anatomy to each operation. Surgeons who operate on fewer than 1 patient
with TOS a month, regardless of specialty, are simply not doing enough
operations in this area to be considered expert.
I was successfully surgically treated for venous TOS by Dr. Thompson, Dr.
Vemuri and their skilled team of vascular surgeons last week (4/17/15). I
am now back home recovering and doing physical therapy. I am up and walking
and have much less pain in my arm, shoulder and neck area. I can report
more in the future. Thank you to Barnes and everyone involved in my surgery
and recovery.
From Dr. Thompson: There are 3 types of TOS: neurogenic, venous and
arterial. These problems tend to fall into the cracks between specialties
so there are no firm "rules" about which specialty treats what. However, in
general the vascular forms of TOS (venous and arterial) are treated mostly
by vascular surgeons and by a few thoracic surgeons.
Doctor in your opinion, can TOS still be diagnosed if clinically someone
tests positive for TOS through physical examination yet all other tests
come back negative (MRA, MRI, EMG, etc.)? This is the most frustrating part
when medical tests are all negative yet physical exam is tested positive
with flying colors.
@bourquette1 the surgery went extremely well. The first couple of recovery
days sucked. But now 3 months down the line it was totally worth it! I feel
great and can do things that I was not able to at first
How did the surgery-recovery go? I am considering this surgery with Dr.
Thompson - soon. Can you contact me to let me know? Hope it went well for
you. Many thanks!
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how is this video a response to "I CANT COME TO ETHIOPIA"???
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