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The current issue of Vascular Rounds presents a collection of six unusual vascular vignettes that are not directly related to atherosclerotic disease, often misconstrued as the only underlying pathology that affects our blood vessels. We have listened to some of your comments requesting more case presentations, especially those that are somewhat obscure and controversial and go beyond the usual menu of vascular topics. We hope you will be interested in this format that we intend to provide once a year to add to the usual write-ups about new therapies and devices for the treatment of more common vascular problems.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Describe the typical presentation of nutcracker syndrome, treatment options, and what types of patients are most likely to have the condition.
  • Identify the best treatment option for neurogenic thoracic outlet syndrome, as well as the most common type of thoracic outlet syndrome.
  • Describe coarctation of the aorta and discuss the most common symptom of the condition.

Reading Resources:

  1. Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vasc Surg 2007;46(3):601-4.
  2. Balci AE, Balci TA, Cakir O, Eren S, Eren MN. Surgical treatment of thoracic outlet syndrome: effect and results of surgery. Ann Thorac Surg 2003;75(4):1091-6.
  3. Illig KA, Thompson RW, Freischlag JA, Donahue DM, Jordan SE, Edgelow PI. Thoracic Outlet Syndrome. Springer-Verlag London 2013.
  4. Rohren EM, Kliewar MA, Carroll BA, Hertzberg BS. A Spectrum of Doppler Waveforms in the Carotid and Vertebral Arteries. AJR 2003; 181:1695-1704 0361-803X/03/1816-1695.
  5. Patel AS, Bell R, Hunt BJ, Taylor PR. Disseminated intravascular coagulation after endovascular aneurysm repair: resolution after aortic banding. J Vasc Surg 2009;49:1046-9.
  6. Keo HH, Diehm N, Baumgartner I, Schmidli J, Do DD. Disseminated intravascular coagulopathy caused by endoleak type I: successful treat-ment by endovascular stent-graft extension. EJVES Extra 2006;12:68-70.
  7. Higashiura W, Kichikawa K, Sakaguchi S, Kubota Y, Nagata T, ishimine K, et al. Deteriorating consumptive coagulopathy with type III endoleak following endovascular repair for abdominal aortic aneu-rysm associated with liver cirrhosis. J Endovasc Ther 2007;14:421-5.
  8. Nienaber JJ Duncan AA, Oderich GS, Pruthi RK, Nichols WL. Operative and nonoperative management of chronic disseminated intravascular coagulation due to persistent aortic endoleak. J Vasc Surg 2014;59:1426-9
  9. Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. J Intensive Care 2014;2:15


Drs. Makaroun, Hager, Leers, Chaer, Eid,  Avegerinos have reported no relevant relationships with any entities producing health care goods or services.

Dr. Singh has financial interests with the following any entity or entities producing health care goods or services as indicated below:

  • CE Speakers’ Bureau: Covidien Medical

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.5) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 2/10/16 | Last Modified On: 2/10/16 | Expires: 2/10/17

This course has been expired.