[Arterialization of the distal veins of the foot for limb salvage in arteritis. Techniques and results].

Study Aim: The aim of this retrospective study was to report the long term results with arterialisation of the veins of the foot as the final attempt to save an ischaemic limb when classical techniques have proved ineffective or impossible.

Patients And Method: From January 1974 to July 2000, 60 arterialisations of the distal veins of the foot were performed in 59 patients with arteritis, associated in 25 of them with diabetes mellitus. There were 41 men and 18 women, their mean age was 72 years (range from 49 to 95 years).

Arteriovenous revascularization for lower limb salvage in unreconstructible arterial occlusive disease (long-term outcome).

Between February 1983 and June 1994 we attempted surgically to salvage twenty-six legs in twenty-five patients with insufficient distal run-off and severely ischemic feet; all of them had resting pain, and 23 had tissue necrosis. A saphenous venous graft was interposed between an artery of the lower extremity (femoral or popliteal) and the veins of the foot with obligatory end-to-side distal anastomosis. The patency of the venous circulation of the ischemic foot was ascertained by retrograde phlebography.

[Can distal vein arterialization be beneficial for the diabetic foot with necrosis?].

When arterial bypass cannot be used in cases of diabetic arteriopathy of the lower limbs, we have, since 1974, relied on the former method using the veins. Arterial blood is brought to the zone of ischaemia via an internal saphenous vein graft anastomosed distally to a vein in the foot, thus creating an arteriovenous fistula. Improvements in the technique include removing the valves in the dorsal venous arcade.

[Comparative study of two methods of arterialization of foot veins in ischemic crisis].

Between February 1974 and December 1991, a total of 28 arterializations of the venous network of foot were performed in patients with stage IIIB or IV arteriopathies presenting disseminated femoropopliteal and more distal lesions excluding revascularization by conventional arterial shunt operations. Two groups of patients could be distinguished. The first group, of 8 patients, underwent arterialization by shunt operation with end to end fistula at the distal part of leg and return blood emptying at the dorsal surface of foot (3 cases).

[Study of the veins of the foot by counter-current phlebography].

83 CF phlebographies of the foot veins were carried out in varicose vein sufferers of both sexes in order to better understand the return venous circulation of the foot in detail, its abnormalities, and also to attempt to explain edema of the foot suffered by many varicose vein patients to varying degrees of severity after saphenous stripping. Films were obtained by direct needle puncture at different sites on the fore-foot, after a tourniquet was placed around the ankle. The route taken by the contrast medium injected was followed on a fluoroscop screen and photographed.

[Treatment of fractures of the clavicle by closed pinning inside-out without back-and-forth].

Pinning of fractures of the clavicle is easily and safely done by introducing the pin through the medial fragment. The pointed tip is embedded into the cortex of the lateral fragment and the inner end of the pin is bent at a right angle to fix it to the bone. Insertion is made with image intensification to avoid vascular damage and to guide the passage of the pin through the medial fragment without danger.

Arteriovenous flow reversal, experimental investigations. II. Hemodynamic and blood gas analyses in incomplete arteriovenous flow reversal in hind extremities of dogs.

2 types of incomplete arteriovenous flow reversal were tested. When the major arteries were patent, 20% of the blood shunted into a peripheral vein was drained via the arteries whereas 80% was drained via the veins of the leg. If the pressure in the arteries was raised, the flow through the arteries was stopped when the outflow pressure reached 25% of the systemic blood pressure.

Arteriovenous flow reversal, experimental investigations. I. Complete flow reversal of the small intestine and of the rear extremity of the dog.

Segments of the small intestine and hind extremities of dogs were perfused under the condition of complete arterio-venous flow reversal (AVFR). In the intestinal segments, the peripheral resistance under AVFR conditions was 4.4 times higher than under orthograde perfusion.

Arterialization of the venous network of the foot through a bypass in severe arteriopathic ischemia.

With the object of saving a very ischemic extremity, when the classic procedures have been unsuccessful or impossible, the authors are using a modification of San Martin's operation. At present, we are making an A-V fistula with a graft interposed between the femoral or popliteal artery and the peripheral long saphenous vein at the foot or near to it. The distal valves are ruptured.

[Destruction of residual varicose collaterals by subcutaneous dilaceration with a needle].

The persistence of collaterals after a properly conducted surgical treatment of varicose veins of the lower limbs often presents a problem which is difficult to resolve. The authors put forward a simple and original method, in which a long and slightly curved triangular needle is used, without incisions, to destroy by dilaceration the collaterals whatever their degree of dilatation and their location. This technique has also been used as a first stage preceding stripping, and over a 5 year period has given results in 70 patients which are very satisfactory both from the point of view of efficacy as well as from the aesthetic point of view.

[Plea for better terminology in surgery of the profunda femoris artery (author's transl)].

Surgical publications on the profunda femoris artery rarely give information on the site of the operation and the technic used. Experience of 356 operations carried out from 1949 to 1978 by the authors and anatomical dissection of 100 profunda femoris arteries is reported. They suggest the elimination of all imprecise terms at present attached to these operations and their replacement by a more lengthy but more understandable vocabulary, together with an attempt to classify the profunda femoris artery in two groups and its nomenclature in 4 segments, more adaptable to surgery of this artery.

[New technic of retro-peritoneal renal transplantation in the left lumbar position in the child. Report of two cases (author's transl)].

In the child, renal transplantation is almost always carried out by placing the kidney within the peritoneum for a simple reason: the donors being adults, the kidneys are too large to be placed in extra-peritoneal position. However, all authors agree that placing the kidney in an extra-peritoneal position offers undoubted advantages.

[Arterialization technic of the venous net work in the foot].

The amputation of the lower extermity can be avoided in many patients, particularly in diabetics by means of the arterialization of thevenous net of the foot, whenever the classic techniques of revascularization cannot been used for the magnitud of the arterial lesions below the knee. This arterialization uses two venous autografts: one in the leg functionning as a channel and the second functionning as a regulator or a temporary discharge. This technique, used in three diabetic patients with gangrenous lesions of the foot, has allowed to avoid amputation in two of them.