Infrapopliteal arterial recanalization: A true advance for limb salvage in diabetics.

The world is facing an epidemic of diabetes; consequently in the next years, critical limb ischemia (CLI) due to diabetic arterial disease, characterized by multiple and long occlusions of below-the-knee (BTK) vessels, will become a major issue for vascular operators. Revascularization is a key therapy in these patients as restoring adequate blood supply to the wound is essential for healing, thus avoiding major amputations. Endoluminal therapy for BTK arteries is now a key part of the vascular specialist armamentarium.

Is transcranial Doppler a worthwhile examination for preoperative evaluation of the Circle of Willis? Evaluation of 137 carotid endarterectomies performed under regional anesthesia.

Background: Transcranial Doppler is often proposed for evaluation of the Circle of Willis prior to carotid endarterectomy. The purpose of this study was to evaluate preoperative TCD before carotid surgery.

Methods: This is a retrospective report of 137 carotid endarterectomies performed under regional anesthesia operated between January 1992 on June 1996.

Evaluation of a polyester collagen-coated heparin bonded vascular graft.

This animal study was designed to compare a collagen coated heparin bonded vascular graft (CHG) versus a collagen coated vascular graft (CG) regarding intraoperative blood loss and healing process. 24 polyester vascular grafts (12 CHG and 12 CG) of 6 mm in diameter and 5 mm in length were implanted between the common iliac and external iliac artery in 12 adult dogs. The grafts were explanted between the first and the sixth months which followed the implantations.

Wrapped autologous greater saphenous vein bypass for severe limb ischemia in patients with varicose veins. Preliminary report.

The greater saphenous veins in patients with varicose veins has been overlooked as a conduit for arterial bypass. Greater saphenous veins is often normal and when only parts of the greater saphenous veins are of normal size, a veno-venous or a graft composite bypass may be performed. The goal of this preliminary study was to asses if wrapped autologous greater saphenous veins could be suitable conduits for arterial bypass in patients presenting with critical ischemia.

Arterial emboli of the lower limbs: analysis of risk factors for mortality and amputation. Association Universitaire de Recherche en Chirurgie.

To evaluate risk factors for mortality and amputation after arterial embolism of the lower limbs, we reviewed the records of 397 patients (201 men [mean age 69 +/- 14 years] and 196 women [mean age 79 +/- 12 years]) who were enrolled in a prospective study. The degree of ischemia was rated as follows: grade I in 26% of patients, grade II in 46%, and grade III in 27%. Among patients with complete obstruction, the emboli were located above the inguinal ligament in 213 limbs (46%), in the superficial or popliteal artery in 196 (43%), and at the infrapopliteal level in four (3%).

[Preservation of masculine sexual functions after treatment for abdominal aortic aneurysms].

Unlabelled: Preserving sexual function is an important objective in the treatment of aneurysms of the abdominal aorta in men.

Method: Two groups of patients with normal sexual function were operated for aneurysms of the abdominal aorta. In group 1 (n = 22) a small opening in the infra-renal aorta was made for insertion of an aorto-bi-iliac prosthesis; in 4 of them, the aneurysm was not opened but simply excluded.

[Long occlusion of the superficial femoral artery: revascularization by venous graft].

In long occlusions of the superficial femoral artery, possibilities of revascularization depend on the patency of the above-knee popliteal artery. In case of occlusion of the above-knee popliteal artery, the distal anastomosis is to be performed at the below-knee level or more distally; in this situation, studies demonstrate a clearcut superiority of venous bypasses over prosthetic bypasses. Patency of the above-knee popliteal artery allows to perform a shorter bypass avoiding to cross the knee joint; given comparable results between venous and prosthetic above-knee bypasses in certain series, several authors advocated the preferential, if not systematic use of prosthetic materials at this level; this attitude having the advantage of preserving the saphenous vein for later coronary or distal grafting.

[A case of type I aortic dissection presenting as bilateral lower limb ischemia. Discussion of surgical strategy].

The authors report about one case of type I aortic dissection disclosed as bilateral lower limb ischemia. The rarity of this way of expression of dissections may result in a delay in diagnosis that can be highly pejorative in such diseases where mortality is high without surgical treatment. The timing and tactics of the surgery to be implemented between the cure of dissection and the removal of ischemia is discussed.

[Total anomalous pulmonary venous return in a 61 year-old adult].

The authors report a case of total anomalous pulmonary venous return successfully treated by surgery in a 61 year-old man. This case is unusual because of the late discovery of this congenital malformation which is usually rapidly fatal in the absence of surgical correction. This prolonged survival can be explained by the large atrial septal defect and the absence of obstruction, to pulmonary venous return and associated malformations.