Extraanatomical revascularization of the artery of Adamkiewicz: anatomical study.

Spinal cord ischemia is a major cause of complications after operative and endovascular treatment of descending thoracic or thoracoabdominal aortic aneurysms. Prior revascularization of the intercostal artery (IA) giving rise to the artery of Adamkiewicz (AA) using an artery of the thoracic wall would preserve circulation in the AA and allow obstruction of the IA at its origin. The purpose of this study was to determine the feasibility of revascularization of the IA giving rise to the AA using three thoracic wall arteries, i.

Assessment of cardiac risk before aortic reconstruction: noninvasive work-up using clinical examination, exercise testing, and dobutamine stress echocardiography versus routine coronary arteriography.

In this prospective study we evaluated the efficacy of a battery of noninvasive tests including clinical evaluation (CE), exercise testing (ET), and dobutamine stress echocardiography (DSE) for assessment of cardiac risk in 90 patients indicated for aortic reconstruction. As the gold-standard reference technique, coronary arteriography was performed in each patient after noninvasive evaluation. The sensitivity of CE was low (61%).

[Angioplasty of renal artery stenoses before surgical treatment of subrenal abdominal aortic lesions].

Purpose: To evaluate the results of the association of a percutaneous transluminal renal angioplasty before a surgical revascularization of the infra-renal aorta.

Patients And Methods: Percutaneous transluminal angioplasty of one (n = 12) or two (n = 2) renal arteries have been performed in 14 patients (11 hypertensive and one with azotemia), 2 to 240 days (mean 54) before infra-renal aortic surgery (aneurysms: 8, occlusive disease: 6).

Results: 15 of the 16 dilatations were completely technically successful (residual stenosis less than 20%), with one groin hematoma treated medically.

[Spontaneous remission of renal artery stenosis].

Retrogression of a renal artery stenosis after a six months follow-up is reported in a 43 years old woman who stopped smoking after the first angiography and was treated with antiplatelet, suggesting spontaneous atherosclerosis injury revision.

[Evaluation of the analgesic effect of naftidrofuryl in permanent ischemia in patients with arterial diseases. Double-blind versus placebo study].

Ischemic rest pain, with or without trophic disorders and occurring very frequently at night, is responsible for insomnia and complications such as positional oedema. The pathophysiological mechanisms underlying the analgesic effect of naftidrofuryl led us to evaluate the efficacy of this treatment. 37 selected patients were given 2 daily infusions of 400 mg of naftidrofuryl for 8 days, under double-blind conditions.

Local fibrinolysis for superior mesenteric artery thromboembolism.

A 66-year-old man with atrial fibrillation was referred soon after developing left lower limb and abdominal pain with rectal bleeding. An immediate flush aortogram showed embolic occlusion of the left distal superficial femoral artery and superior mesenteric artery (SMA), 3 cm from its ostium. Recombinant tissue plasminogen activator (rtPA) 40 mg was selectively instilled in the SMA in two boluses.

[Percutaneous transluminal angioplasty of subclavian, axillary and brachiocephalic trunk arteries. Apropos of 18 patients].

The authors report the immediate and mid term results of percutaneous transluminal angioplasty of stenosis of the subclavian (16 cases), brachiocephalic (1 case) and axillary arteries (1 case) in a series of 18 patients. These lesions were responsible for isolated ischaemia of the arm in 6 cases, vertebrobasilar insufficiency in 6 cases and an association of the two presentations in 2 cases; in 4 asymptomatic patients, the procedure was undertaken to maintain cerebral perfusion. A technical success was obtained in all cases, with one femoral haematoma and one episode of transient visual disturbance, which were spontaneously regressive, as the only complications.

[Study of the supra-aortic trunks using the humeral Seldinger technique and digitalized angiography of the aortic arch. Apropos of 175 cases].

Screening of cerebrovascular disease by transbranchial arch injection. One hundred and seventy five patients underwent non selective intra arterial digital subtraction angiography using a transbranchial approach. Unilateral failure occurred in eight patients, but contralateral approach was then possible.

Type IV Ehlers-Danlos syndrome with isolated arterial involvement.

Ehlers-Danlos syndrome is a connective tissue disorder characterized by skin hyperelasticity and friability, hyperextensible small articulations, vascular fragility, and ocular and visceral symptoms. Ten types of Ehlers-Danlos syndrome have been described to date. Type IV is characterized by isolated arterial involvement with the risk of rupture, making diagnosis difficult.

Aseptic periprosthetic fluid collection: a late complication of Dacron arterial bypass.

Fluid collection encompassing an arterial prosthesis often leads one to suspect graft infection. Four cases of aseptic seroma occurring three to five years after insertion of knitted Dacron implants for bypass are reported. The collection was serohematic in three cases, puriform in the other.

[Aneurysms of the abdominal aorta. Fissures in the vena cava. Apropos of 4 cases].

Four cases of aortico-caval fistulae of atheromatous origin have been treated over a period of 5 years, a frequency (4.8%) much higher than that reported in the international literature. Diagnosis in each of these 4 cases was suggested by clinical features associating signs of a complicated aneurysm with those of a high-output arteriovenous fistula, angiography showing the arteriovenous communication in one patient only.

[White thrombus syndrome. Apropos of 4 new cases].

Four new cases of the white thrombus syndrome have been treated over the last 3 years. This is a rare but serious complication of heparin therapy, multifocal arterial thrombi developing in all three patients without signs of a hemorrhagic syndrome due to the thrombopenia. Physiopathologic mechanisms of this immunity phenomenon are discussed.

[Bullet wounds of the carotid axis. Apropos of 4 cases].

In three cases, there was an injury of primary carotid artery, and in one case a wound of bifurcation with a large destruction of vessels. In one, there was an A.V.

[Long-term result of the surgical treatment of funnel chest by Jung's method. Apropos of 32 cases].

A homogeneous series of 32 cases of pectus excavatum were treated by Jung's method of reversal of the breast-plate pedicle. Operation was usually performed at about puberty. The mortality is nill for this technique, which is simple and which, for a low morbidity, provides good functional and esthetic results in 87% of cases.

[Aneurysms of the subrenal abdominal aorta. Apropos of 115 cases].

115 of infra renal abdominal aorta have been operated upon between 1969 and 1984. 107 male patients (93%) and 8 female (7%) were treated. Age was 65.

[2 cases of uretero-arterial fistula].

Two cases of uretero-arterial fistulas are reported occurring in two patients after pelvic exenteration for cancer with cutaneous ureterostomy. In the first case a pelvic irradiation has been performed before surgery; in the other case a high degree of atherosclerosis was noted. Iliac artery-ureteral fistulas are uncommon and they are generally associated with several underlying pathogenic factors such as: arterial pathology, surgical complications, septis, prior x-ray therapy.

[Results of 68 revascularizations of the arteries of the leg].

Results with 68 infra popliteal revascularization inversed autogenous grafts are subjected to life table analysis. The patency rate at 1, 3 and 5 years are 63.8%, 53.

[Long-term results of reversed venous femoro-popliteal bypass. Apropos of 151 cases].

Of 151 inversed autogenous vein grafting done in 137 patients for femoro-popliteal disease, 97 (65%) have been done for severe ischemia (rest pain or gangrene); others (35%) have been done for severe walking pain or popliteal and/or femoro-popliteal aneurysms. The follow-up is of 13 years. Hospital mortality was 5 (3,3%).

[Abdominal aortic aneurysm due to Salmonella. Apropos of a rupture case treated surgically with an in situ prosthesis].

A patient with ruptured aneurysm of the infrarenal abdominal aorta was treated by reestablishing arterial continuity, by means of a prosthesis in situ, and has been followed up for 16 months. This type of lesion raises difficulties with respect to surgical strategy, conventional treatment consisting of total resection of sac with infrarenal ligature of abdominal aorta combined with revascularization by extra-anatomic bypass surgery. Results in the case reported were positive and demonstrate that the operation performed may be a valid alternative if, after effective long-term antibiotic therapy, findings on clinical, biologic and ultrasound follow-up reviews remain normal.

[Transdiaphragmatic clamping of the thoracic aorta for emergency surgery of the abdominal aorta (author's transl)].

The authors describe a very fast surgical technique which consists of clamping the lower thoracic aorta through the diaphragmatic opening without sectioning the pillars. The technique is mainly used as an emergency haemostatic measure when rupture of dissection of an aneurysm of the abdominal aorta is discovered during surgery.

[Principles and techniques of physiotherapy for arterial claudication of the limbs (author's transl)].

Exercise training of stage II arteriopathy is set in accordance with the localisation of the lesions the walking distance and the cardio respiratory state. It must procure an improvement of the respiratory function, a stimulation of the muscles and vessels situated downstream of the lesion and a re-training of the patient to a more economical way of walking. The passive technics use warmth, massages, postures.

[Interest of the local regional anesthesia in lumbar sympathectomy (author's transl)].

Authors report 163 cases of lumbar sympathectomy they did under local anesthesia from 1968 to 1975. All were older--and poor risk patients. Approach was always lumbar with resection of distal part of the 12th rib.