Radiation dose reduction during venous access port implantation: the importance of upgrading equipment and radiation-protection training.

Background: Implantable central venous port systems are widely used in oncology. We upgraded our fluoroscopy machines, and all anesthetists completed two training courses focusing on the risks of ionizing radiation for patients and health workers.

Aims: This study aimed to evaluate the impact of upgrading the machines and the radiation-protection training on ionizing radiation exposure during venous port system implantation.

Assessing Long-term Treatment Benefits Using Complementary Statistical Approaches: An In Silico Analysis of the Phase III Keynote-045 and Checkmate-214 Immune Checkpoint Inhibitor Trials.

Background: The Keynote-045 trial illustrates that the long-term benefit (LTB) of treatment does not always translate to improved progression-free survival (PFS). Milestone survival and flexible parametric survival model with cure (FPCM) have been proposed as complementary statistical approaches to more comprehensively evaluate LTBs of treatments.

Objective: The current study compares milestone survival and FPCM analyses to evaluate treatment effects of immune checkpoint inhibitor (ICI) phase III trials.

[Vascular access-site infections in percutaneous cardiac interventions: A significant risk?].

Vascular access site infections are infrequent and rarely reported as a potential complication of percutaneous cardiac intervention. A case of access site infection is reported with a literature review. Femoral access is mainly concerned in some circumstances: delayed sheath withdrawal, vascular complications (hematoma, false-aneurysm, arteriovenous fistula), or use of hemostatic closure device.

Cryopreserved arterial allografts used for the treatment of infected vascular grafts.

In this study, 18 patients (17 men and 1 woman; mean age 61 years) with a previously infected vascular graft underwent vascular reconstruction with cryopreserved arterial allografts. Treatment consisted of first total (n = 11) or partial removal (n = 7) of infected prosthetic grafts. Revascularizations were aortoaortic (n = 2), aortobifemoral (n = 8), aortounifemoral (n = 3), femorofemoral (n = 2), iliofemoral (n = 1), or femoropopliteal (n = 2) bypasses.

Are femoro-infrapopliteal bypasses worthwhile for limb salvage?

Objective: This study was performed in order to determine if: 1-- femoral bypasses ending below the popliteal artery are justified in aged patients or in patients with poor general conditions, 2-- if the use of prosthetic material is justified when no vein is available, 3-- if reintervention is beneficial in case of bypass occlusion.

Experimental Design: Retrospective study of 162 infrapopliteal bypasses followed during 1 to 12 years (mean: 1.5).

Some popliteal aneurysms are congenital.

Although the majority of popliteal aneurysms are of atherosclerotic origin and are discovered in patients aged more than 50, the aetiology of a small minority may be attributed to arterial trauma, septic disruption, Behcet's disease, a medial fibromuscular dysplasia, or popliteal entrapment. The aim of this study was to propose a possible congenital origin for popliteal aneurysms without evidence of any other aetiology. A retrospective review of five younger patients (aged 20-45 years) with seven non-atherosclerotic popliteal aneurysms was performed.

[Simultaneous endoluminal dilatation and conventional surgery. Importance of programmed revascularization of the legs].

Objective: evaluate the benefit of synchronous arterial reconstruction and endoluminal balloon dilatation for occlusive arterial disease during non-urgent procedures.

Method: late results of forty arterial reconstructions combining open surgery with simultaneous endoluminal dilatation have been reviewed. Balloon dilatation was performed on iliac (N = 18), femoral (N = 18), popliteal (N = 3) and infra-popliteal arteries (N = 2).

Management of radiation-induced occlusive arterial disease: a reassessment.

Background: The goal of this study was to evaluate the operative hazards, therapeutic procedures, and late results of arterial reconstruction for radiation-induced occlusive disease.

Methods: Twenty-five patients were referred to our institution for radiation-induced occlusive arterial disease. Group 1: carotid artery stenosis or occlusion was encountered in seven patients.

Polytetrafluoroethylene grafts for carotid repair.

Polytetrafluoroethylene grafts are well established for bypassing occlusive disease in the lower limb but there are few reports which deal with the long-term results of such grafts in the neck. The present study was undertaken to evaluate the immediate and long-term results of polytetrafluoroethylene grafts for carotid repair. Between 1982 and 1991, 591 carotid operations (mostly endarterectomies) were performed by the authors.

[False anastomotic aneurysms after aorto-femoral prosthesis. Detection, prevention and treatment].

Objective: The aim of this study was to evaluate screening, prevention and treatment of false anastomotic aneurysms (FAA).

Method: A retrospective analysis of 95 FAA observed in 72 patients (67 males, 5 females, age range 48 to 93 years was conducted. Mean delay to onset was 7.

[Severe limb ischemia due to iatrogenic trauma].

Objectives: Assess the frequency, severity and technical problems raised by iatrogenic trauma to the arteries.

Method: A retrospective study of 45 cases of iatrogenic arterial trauma treated over a 25-year period was studied.

Results: The most frequent cause was arterial catheterization (n = 32 including 24 of the lower limbs and 8 for the upper limbs) performed for arteriography (n = 16), coronarography (n = 13) or endovascular therapy (n = 3).

[Collective self-evaluations in vascular surgery: indispensable lever for optimizing results].

The quality of the results obtained for a given surgical team cannot be guaranteed by simply applying the recommendations of scientific research and consensus conferences. Self-evaluations is as important as continuous training. It is essential for each surgical team to regularly evaluate its results and compare them with those published in the literature in order to make necessary improvements.

[Antibiotic-impregnated prostheses: eclectic indications].

Objective: Infection is a major complication in vascular stents. Stents impregnated with gelatine and dipped in Rifampicin have been shown to resist methicillin-resistant Staphylococcus aureus in both animal experiments and in man. It has been suggested that all aorto-ilio-femoral stents should be treated.

[Impregnated polyester prostheses: a theoretical advantage].

Leak-proof polyester grafts impregnated with collagen, gelatine or albumin are routinely used in vascular surgery. Theoretically, there are several advantages: no need for pre-coagulation, reduced operation time and graft manipulation, less blood loss during the operative period, better healing with a potentially greater resistance to infection. We analyzed all the publications in scientific journals to verify whether these theoretical advantages are validated by clinical trials.

Conventional versus endovascular surgical procedures: a no choice option.

The on-going debates on the competitiveness of endovascular and conventional surgery in the treatment of peripheral occlusive vascular diseases are justified by the fact that endovascular procedures are associated with a lower mortality and morbidity, require a shorter hospital stay, and are less costly than conventional surgery. However, scientific and economic comparisons between the two techniques are difficult because they cannot strictly be applied to the same patients. Patients who may benefit from endovascular surgery are generally at an earlier stage of the disease, they have claudication and short stenoses or occlusion.

Iliac and femoropopliteal lesions: evaluation of balloon angioplasty and classical surgery.

Purpose: The purpose of this study was to compare the characteristics of patients treated for atherosclerotic disease of the lower extremities with balloon angioplasty (BA) or classical surgery (CS) and to assess the outcome of both techniques.

Methods: The records of 1364 patients who were treated with BA or CS for chronic lower limb ischemia between 1986 and 1993 were analyzed. Demographic features of patients, immediate and long-term survival, patency, and amputation rates were compared in both groups according to the level of the revascularization (iliac or femoropopliteal).

[Patients operated on for aneurysms of the abdominal aorta: risk factors and survival].

Patients requiring radical cure of an aneurysm of the abdominal aorta often have associated conditions increasing the risk of peri-operative complications and immediate or short-term mortality. Detecting such associated lesions is thus of major importance to adapt patient management and treatment strategy. We assessed the following parameters associated with increased risk of peri-operative death in a series of 418 patients who underwent elective surgery for aneurysms of the abdominal aorta between 1986 and 1994: chronic renal failure (with or without dialysis), clinically apparent coronary artery disease, age over 75 years, defective left ventricular function.

[Surgical treatment of sclerotic arterial diseases of the lower limbs].

Among arterial reconstruction procedures, thromboendarterectomy has progressively left place to prosthetic grafts for aorto-iliac surgery. At infra-inguinal level, inversed or in situ venous grafts allow distal revascularisations down to the foot. Lumbar sympathectomy keeps some indications.

Thrombogenicity of an elastomer-coated aortofemoral Dacron prosthetic graft in humans.

To determine the potential benefit of Dacron prostheses impregnated with silicon polymer, an elastomer-coated prosthetic graft (Intervascular [I]) was implanted in 30 patients with aortic occlusive arterial disease or infrarenal abdominal aortic aneurysm. These patients were compared with two other groups who underwent vascular reconstruction with either a knitted double-velour prosthesis (Meadow [M] or a knitted prosthesis (Bard-USCI [U]). The different prostheses were randomly allocated just prior to their insertion.

Surgical transluminal femoropopliteal angioplasty: multivariate analysis outcome.

Purpose: The purpose of this study was to determine the efficacy of femoropopliteal transluminal angioplasty performed in the operating room by vascular surgeons and the factors that might influence outcome.

Methods: The clinical, biologic, and angiographic, findings of 103 consecutive transluminal angioplasties performed in the operating suite in 95 patients for occlusive disease of the femoral or popliteal arteries were analyzed. With each variable, patency was compared according to the log rank test, and a Cox multivariate analysis was applied to the statistically significant variables.

[Bilateral stenosis of the renal arteries: transaortic endarterectomy].

Transaortic renal endarterectomy with infra-renal aortic prosthetic graft may be used to treat combined aortic and renal atherosclerosis. We present herein the technics we used in seven patients, which represented 0.4% of our aortic revascularizations and 15% of our combined aortic and renal revascularizations.

[Congenital stenosis of the esophagus due to tracheobronchial heterotopia. Review of the literature. Apropos of a case].

A case of congenital esophageal stenosis due to tracheobronchial remnants is reported. This is a very rare condition. Only 46 previous cases have been reported in the French and English literature.