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An Unusual Presentation of Bilateral Hypothenar Hammer Syndrome
JOURNAL OF VASCULAR SURGERY Volume 62, Number 3
Abstracts 801
popliteal artery with medial displacement suggestive of PAES. The patient was taken to the operating room for right popliteal artery exploration via posterior approach. A type III PAES was identified intraoperatively (Fig). The accessory slip of muscle from the medial head of gastrocnemius muscle was divided. A balloon thromboembolectomy was performed through a longitudinal arteriotomy and the artery was patched with bovine pericardium. Results: Postoperatively, the patient recovered well and was neurologically intact with normal pedal pulses. She was seen by obstetrics and underwent fetal heart rate monitoring. She was started on 81-mg aspirin daily and was discharged home on postoperative day 4. She was seen in follow-up by vascular surgery and in consultation with maternal fetal medicine because she was previously cared for by nurse midwives. Conclusions: Nonatheromatous popliteal artery pathology should be considered in young active patients who present with intermittent claudication or acute limb ischemia. The pregnant woman warrants a discussion of safe imaging modalities to establish a diagnosis and anesthesia considerations for surgical repair. Although we know strenuous exercise predisposes patients to symptomatic PAES, pregnancy is a hypercoagulable state and may be an independent risk factor.
Conclusions: This study suggests that technical skills can improve in a simulated AAA model irrespective of the stress level experienced by the participant. These findings raise questions about the impact of stress on surgical education and acquisition of technical skills. Studies using robust physiological stress measures are needed to potentially identify beneficial or detrimental levels of stress in training outcomes. Author Disclosures: M. Kiguchi: None; J. Bath: None; D. G. Winger: None; M. S. Makaroun: None; R. Chaer: None. Carotid Reconstruction With Bovine Carotid Heterograft After En Bloc Resection of Squamous Cell Carcinoma With Direct Internal Carotid Invasion Eric B. Trestman, MD, Pablo De Los Santos, MD, Evan Garfein, MD, Thomas Ow, MD, Evan C. Lipsitz, MD, Saadat Shariff, MD. Montefiore Medical Center, Bronx, NY Objectives: We report a novel use of the Artegraft (North Brunswick, NJ) bovine heterograft for carotid reconstruction after resection of a neck squamous cell carcinoma.
Author Disclosures: B. Song: None; M. Obmann: None; S. Nikam: None; D. Mariner: None; S. Wang: None; M. D. Leonard: None. An Unusual Presentation of Bilateral Hypothenar Hammer Syndrome John P. Phair, Charles S. Decarlo, Eric B. Trestman, Karan Garg This abstract has been published in the Abstracts of the 2015 Vascular Annual Meeting: The Society for Vascular Surgery. DOI: http://dx.doi. org/10.1016/j.jvs2015.04.207. The Effect of Stress on Task Acquisition in a Simulated Open Aortic Aneurysm Model Misaki Kiguchi, MD, MBA1, Jonathan Bath, MD2, Daniel G. Winger, MS3, Michel S. Makaroun, MD1, Rabih Chaer, MD1. 1University of Pittsburgh Medical Center, Pittsburgh, Pa; 2University of Cincinnati, Cincinnati, Ohio; 3University of Pittsburgh, Pittsburgh, Pa Objectives: This study evaluated high levels of teaching stress compared with a nonstressful environment and its effects on standardized performance measures on an open abdominal aortic aneurysm (AAA) model using validated psychological and hemodynamic parameters. Methods: Participants were randomly divided into two groups of simulated open aortic tube graft repair for three sessions. Session 1 involved familiarization with the model and baseline stress and performance measures. Sessions 2 and 3 involved the use of supportive feedback for the control group with no stress (NS), and verbal and situational stressors for the intervention or stress (S) group. Stress levels were assessed by heart rate, blood pressure, and self-reported validated measure of stress levels (State Trait Anxiety Index [STAI]), immediately after each session. Performance measures were assessed by Objective Structured Assessment of Technical Skills (OSATS) and Global Performance Rating (GPR) tools. Session 3 performance was compared with the baseline performance at session 1. Statistical methods for comparison involved the sampled t-test (P < .05). Results: Ten medical students participated. Within each group, OSATS scores significantly improved (3.88 points for NS, P ¼ .003; 4.33 points for S, P ¼ .003). GPR scores significantly improved (6.88 points for NS, P ¼ .004; 5.33 points for S, P ¼ .023). Between the two groups (Table), the S group’s stress level increased with a STAI increase of 9.17 points, whereas the NS group’s STAI score decreased 6.25 points (P ¼ .001). Despite the increase in the anxiety measure, OSATS and GPR performance did not differ significantly between the groups from session 1 to session 3.
Fig 1. Coronal maximum intensity projection reconstruction of large squamous cell carcinoma mass of the left neck.
Table. Between-group comparisons between session 3 and 1 Measurement OSATS GPR Blood pressure Systolic Diastolic Pulse pressure Pulse State Trait
Control group (NS) (n ¼ 4)
Intervention group (S) (n ¼ 6)
P value
3.875 6.875
4.333 5.333
.669 .496
15.5 9.50 6.00 7.00 6.250 3.250
9.00 3.33 5.67 0.667 9.167 4.667
.542 .263 .967 .263 .001 .802
GPR, Global Performance Rating; NS, no stress; OSATS, Objective Structured Assessment of Technical Skills; S, stress.
Fig 2. Interposition bypass reconstruction of the left internal carotid artery with the Artegraft.
Abstracts 801
popliteal artery with medial displacement suggestive of PAES. The patient was taken to the operating room for right popliteal artery exploration via posterior approach. A type III PAES was identified intraoperatively (Fig). The accessory slip of muscle from the medial head of gastrocnemius muscle was divided. A balloon thromboembolectomy was performed through a longitudinal arteriotomy and the artery was patched with bovine pericardium. Results: Postoperatively, the patient recovered well and was neurologically intact with normal pedal pulses. She was seen by obstetrics and underwent fetal heart rate monitoring. She was started on 81-mg aspirin daily and was discharged home on postoperative day 4. She was seen in follow-up by vascular surgery and in consultation with maternal fetal medicine because she was previously cared for by nurse midwives. Conclusions: Nonatheromatous popliteal artery pathology should be considered in young active patients who present with intermittent claudication or acute limb ischemia. The pregnant woman warrants a discussion of safe imaging modalities to establish a diagnosis and anesthesia considerations for surgical repair. Although we know strenuous exercise predisposes patients to symptomatic PAES, pregnancy is a hypercoagulable state and may be an independent risk factor.
Conclusions: This study suggests that technical skills can improve in a simulated AAA model irrespective of the stress level experienced by the participant. These findings raise questions about the impact of stress on surgical education and acquisition of technical skills. Studies using robust physiological stress measures are needed to potentially identify beneficial or detrimental levels of stress in training outcomes. Author Disclosures: M. Kiguchi: None; J. Bath: None; D. G. Winger: None; M. S. Makaroun: None; R. Chaer: None. Carotid Reconstruction With Bovine Carotid Heterograft After En Bloc Resection of Squamous Cell Carcinoma With Direct Internal Carotid Invasion Eric B. Trestman, MD, Pablo De Los Santos, MD, Evan Garfein, MD, Thomas Ow, MD, Evan C. Lipsitz, MD, Saadat Shariff, MD. Montefiore Medical Center, Bronx, NY Objectives: We report a novel use of the Artegraft (North Brunswick, NJ) bovine heterograft for carotid reconstruction after resection of a neck squamous cell carcinoma.
Author Disclosures: B. Song: None; M. Obmann: None; S. Nikam: None; D. Mariner: None; S. Wang: None; M. D. Leonard: None. An Unusual Presentation of Bilateral Hypothenar Hammer Syndrome John P. Phair, Charles S. Decarlo, Eric B. Trestman, Karan Garg This abstract has been published in the Abstracts of the 2015 Vascular Annual Meeting: The Society for Vascular Surgery. DOI: http://dx.doi. org/10.1016/j.jvs2015.04.207. The Effect of Stress on Task Acquisition in a Simulated Open Aortic Aneurysm Model Misaki Kiguchi, MD, MBA1, Jonathan Bath, MD2, Daniel G. Winger, MS3, Michel S. Makaroun, MD1, Rabih Chaer, MD1. 1University of Pittsburgh Medical Center, Pittsburgh, Pa; 2University of Cincinnati, Cincinnati, Ohio; 3University of Pittsburgh, Pittsburgh, Pa Objectives: This study evaluated high levels of teaching stress compared with a nonstressful environment and its effects on standardized performance measures on an open abdominal aortic aneurysm (AAA) model using validated psychological and hemodynamic parameters. Methods: Participants were randomly divided into two groups of simulated open aortic tube graft repair for three sessions. Session 1 involved familiarization with the model and baseline stress and performance measures. Sessions 2 and 3 involved the use of supportive feedback for the control group with no stress (NS), and verbal and situational stressors for the intervention or stress (S) group. Stress levels were assessed by heart rate, blood pressure, and self-reported validated measure of stress levels (State Trait Anxiety Index [STAI]), immediately after each session. Performance measures were assessed by Objective Structured Assessment of Technical Skills (OSATS) and Global Performance Rating (GPR) tools. Session 3 performance was compared with the baseline performance at session 1. Statistical methods for comparison involved the sampled t-test (P < .05). Results: Ten medical students participated. Within each group, OSATS scores significantly improved (3.88 points for NS, P ¼ .003; 4.33 points for S, P ¼ .003). GPR scores significantly improved (6.88 points for NS, P ¼ .004; 5.33 points for S, P ¼ .023). Between the two groups (Table), the S group’s stress level increased with a STAI increase of 9.17 points, whereas the NS group’s STAI score decreased 6.25 points (P ¼ .001). Despite the increase in the anxiety measure, OSATS and GPR performance did not differ significantly between the groups from session 1 to session 3.
Fig 1. Coronal maximum intensity projection reconstruction of large squamous cell carcinoma mass of the left neck.
Table. Between-group comparisons between session 3 and 1 Measurement OSATS GPR Blood pressure Systolic Diastolic Pulse pressure Pulse State Trait
Control group (NS) (n ¼ 4)
Intervention group (S) (n ¼ 6)
P value
3.875 6.875
4.333 5.333
.669 .496
15.5 9.50 6.00 7.00 6.250 3.250
9.00 3.33 5.67 0.667 9.167 4.667
.542 .263 .967 .263 .001 .802
GPR, Global Performance Rating; NS, no stress; OSATS, Objective Structured Assessment of Technical Skills; S, stress.
Fig 2. Interposition bypass reconstruction of the left internal carotid artery with the Artegraft.