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2. Meta‐analysis of individual‐patient data from EVAR‐1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

Author

Powell, J. T., Sweeting, M. J., Ulug, P., Blankensteijn, J. D., Lederle, F. A., Becquemin, J.‐P., Greenhalgh, R. M., Greenhalgh, R. M., Beard, J. D., Buxton, M. J., Brown, L. C., Harris, P. L., Powell, J. T., Rose, J. D. G., Russell, I. T., Sculpher, M. J., Thompson, S. G., Lilford, R.J., Bell, P. R. F., Greenhalgh, R. M., Whitaker, S.C., Poole‐Wilson, the late P.A., Ruckley, C. V., Campbell, W. B., Dean, M. R. E., Ruttley, M. S. T., Coles, E. C., Powell, J. T., Halliday, A., Gibbs, S. J., Brown, L. C., Epstein, D., Sculpher, M. J., Thompson, S. G., Hannon, R. J., Johnston, L., Bradbury, A. W., Henderson, M. J., Parvin, S. D., Shepherd, D. F. C., Greenhalgh, R. M., Mitchell, A. W., Edwards, P. R., Abbott, G. T., Higman, D. J., Vohra, A., Ashley, S., Robottom, C., Wyatt, M. G., Rose, J. D. G., Byrne, D., Edwards, R., Leiberman, D. P., McCarter, D. H., Taylor, P. R., Reidy, J. F., Wilkinson, A. R., Ettles, D. F., Clason, A. E., Leen, G. L. S., Wilson, N. V., Downes, M., Walker, S. R., Lavelle, J. M., Gough, M. J., McPherson, S., Scott, D. J. A., Kessell, D. O., Naylor, R., Sayers, R., Fishwick, N. G., Harris, P. L., Gould, D. A., Walker, M. G., Chalmers, N. C., Garnham, A., Collins, M. A., Beard, J. D., Gaines, P. A., Ashour, M. Y., Uberoi, R., Braithwaite, B., Whitaker, S. C., Davies, J. N., Travis, S., Hamilton, G., Platts, A., Shandall, A., Sullivan, B. A., Sobeh, M., Matson, M., Fox, A. D., Orme, R., Yusef, W., Doyle, T., Horrocks, M., Hardman, J., Blair, P. H. B., Ellis, P. K., Morris, G., Odurny, A., Vohra, R., Duddy, M., Thompson, M., Loosemore, T. M. L., Belli, A. M., Morgan, R., Adiseshiah, M., Brookes, J. A. S., McCollum, C. N., Ashleigh, R., Aukett, M., Baker, S., Barbe, E., Batson, N., Bell, J., Blundell, J., Boardley, D., Boyes, S., Brown, O., Bryce, J., Carmichael, M., Chance, T., Coleman, J., Cosgrove, C., Curran, G., Dennison, T., Devine, C., Dewhirst, N., Errington, B., Farrell, H., Fisher, C., Fulford, P., Gough, M., Graham, C., Hooper, R., Horne, G., Horrocks, L., Hughes, B., Hutchings, T., Ireland, M., Judge, C., Kelly, L., Kemp, J., Kite, A., Kivela, M., Lapworth, M., Lee, C., Linekar, L., Mahmood, A., March, L., Martin, J., Matharu, N., McGuigen, K., Morris‐Vincent, P., Murray, S., Murtagh, A., Owen, G., Ramoutar, V., Rippin, C., Rowley, J., Sinclair, J., Spencer, S., Taylor, V., Tomlinson, C., Ward, S., Wealleans, V., West, J., White, K., Williams, J., Wilson, L., Grobbee, D. E., Blankensteijn, J. D., Bak, A. A. A., Buth, J., Pattynama, P. M., Verhoeven, E. L. G., van Voorthuisen, A. E., Blankensteijn, J. D., Balm, R., Buth, J., Cuypers, P. W. M., Grobbee, D. E., Prinssen, M., van Sambeek, M. R. H. M., Verhoeven, E. L. G., Baas, A. F., Hunink, M. G., van Engelshoven, J. M., Jacobs, M. J. H. M., de Mol, B. A. J. M., van Bockel, J. H., Balm, R., Reekers, J., Tielbeek, X., Verhoeven, E. L. G., Wisselink, W., Boekema, N., Heuveling, L. M., Sikking, I., Prinssen, M., Balm, R., Blankensteijn, J. D., Buth, J., Cuypers, P. W. M., van Sambeek, M. R. H. M., Verhoeven, E. L. G., de Bruin, J. L., Baas, A. F., Blankensteijn, J. D., Prinssen, M., Buth, J., Tielbeek, A.V., Blankensteijn, J. D., Balm, R., Reekers, J. A., van Sambeek, M. R. H. M., Pattynama, P., Verhoeven, E. L. G., Prins, T., van der Ham, A. C., van der Velden, J. J. I. M., van Sterkenburg, S. M. M., ten Haken, G. B., Bruijninckx, C. M. A., van Overhagen, H., Tutein Nolthenius, R. P., Hendriksz, T. R., Teijink, J. A. W., Odink, H. F., de Smet, A. A. E. A., Vroegindeweij, D., van Loenhout, R. M. M., Rutten, M. J., Hamming, J. F., Lampmann, L. E. H., Bender, M. H. M., Pasmans, H., Vahl, A. C., de Vries, C., Mackaay, A. J. C., van Dortmont, L. M. C., van der Vliet, A. J., Schultze Kool, L. J., Boomsma, J. H. B., van Dop, H. R., de Mol van Otterloo, J. C. A., de Rooij, T. P. W., Smits, T. M., Yilmaz, E. N., Wisselink, W., van den Berg, F. G., Visser, M. J. T., van der Linden, E., Schurink, G. W. H., de Haan, M., Smeets, H. J., Stabel, P., van Elst, F., Poniewierski, J., Vermassen, F. E. G., Lederle, F. A., Freischlag, J. A., Kohler, T. R., Latts, E., Matsumura, J., Padberg, F. T., Jr, Kyriakides, T. C., Swanson, K. M., Guarino, P., Peduzzi, P., Antonelli, M., Cushing, C., Davis, E., Durant, L., Joyner, S., Kossack, the late A., Kyriakides, T. C., LeGwin, Mary, McBride, V., OʼConnor, T., Poulton, J., Stratton, the late S., Zellner, S., Snodgrass, A. J., Thornton, J., Swanson, K. M., Haakenson, C. M., Stroupe, K.T., Jonk, Y., Hallett, J. W., Hertzer, N., Towne, J., Katz, D. A., Karrison, T., Matts, J. P., Marottoli, R., Kasl, S., Mehta, R., Feldman, R., Farrell, W., Allore, H., Perry, E., Niederman, J., Randall, F., Zeman, M., Beckwith, the late D., OʼLeary, T. J., Huang, G. D., Latts, E., Bader, M., Ketteler, E. R., Kingsley, D. D., Marek, J. M., Massen, R. J., Matteson, B. D., Pitcher, J. D., Langsfeld, M., Corson, J. D., Goff, J. M., Jr, Kasirajan, K., Paap, C., Robertson, D. C., Salam, A., Veeraswamy, R., Milner, R., Kasirajan, K., Guidot, J., Lal, B. K., Busuttil, S. J., Lilly, M. P., Braganza, M., Ellis, K., Patterson, M. A., Jordan, W. D., Whitley, D., Taylor, S., Passman, M., Kerns, D., Inman, C., Poirier, J., Ebaugh, J., Raffetto, J., Chew, D., Lathi, S., Owens, C., Hickson, K., Dosluoglu, H. H., Eschberger, K., Kibbe, M. R., Baraniewski, H. M., Matsumura, J., Endo, M., Busman, A., Meadows, W., Evans, M., Giglia, J. S., El Sayed, H., Reed, A. B., Ruf, M., Ross, S., Jean‐Claude, J. M., Pinault, G., Kang, P., White, N., Eiseman, M., Jones, the late R., Timaran, C. H., Modrall, J. G., Welborn, M. B., III, Lopez, J., Nguyen, T., Chacko, J. K. Y., Granke, K., Vouyouka, A. G., Olgren, E., Chand, P., Allende, B., Ranella, M., Yales, C., Whitehill, T. A., Krupski, the late W. C., Nehler, M. R., Johnson, S. P., Jones, D. N., Strecker, P., Bhola, M. A., Shortell, C. K., Gray, J. L., Lawson, J. H., McCann, R., Sebastian, M.W., Kistler Tetterton, J., Blackwell, C., Prinzo, P. A., Lee, N., Padberg, F. T., Jr, Cerveira, J. J., Lal, B. K., Zickler, R. W., Hauck, K. A., Berceli, S. A., Lee, W. A., Ozaki, C. K., Nelson, P. R., Irwin, A. S., Baum, R., Aulivola, B., Rodriguez, H., Littooy, F. N., Greisler, H., OʼSullivan, M. T., Kougias, P., Lin, P. H., Bush, R. L., Guinn, G., Bechara, C., Cagiannos, C., Pisimisis, G., Barshes, N., Pillack, S., Guillory, B., Cikrit, D., Lalka, S. G., Lemmon, G., Nachreiner, R., Rusomaroff, M., OʼBrien, E., Cullen, J. J., Hoballah, J., Sharp, W. J., McCandless, J. L., Beach, V., Minion, D., Schwarcz, T. H., Kimbrough, J., Ashe, L., Rockich, A., Warner‐Carpenter, J., Moursi, M., Eidt, J. F., Brock, S., Bianchi, C., Bishop, V., Gordon, I. L., Fujitani, R., Kubaska, S. M., III, Behdad, M., Azadegan, R., Ma Agas, C., Zalecki, K., Hoch, J. R., Carr, S. C., Acher, C., Schwarze, M., Tefera, G., Mell, M., Dunlap, B., Rieder, J., Stuart, J. M., Weiman, D. S., Abul‐Khoudoud, O., Garrett, H. E., Walsh, S. M., Wilson, K. L., Seabrook, G. R., Cambria, R. A., Brown, K. R., Lewis, B. D., Framberg, S., Kallio, C., Barke, R. A., Santilli, S. M., dʼAudiffret, A. C., Oberle, N., Proebstle, C., Johnson, L. L., Jacobowitz, G. R., Cayne, N., Rockman, C., Adelman, M., Gagne, P., Nalbandian, M., Caropolo, L. J., Pipinos, I. I., Johanning, J., Lynch, T., DeSpiegelaere, H., Purviance, G., Zhou, W., Dalman, R., Lee, J. T., Safadi, B., Coogan, S. M., Wren, S. M., Bahmani, D. D., Maples, D., Thunen, S., Golden, M. A., Mitchell, M. E., Fairman, R., Reinhardt, S., Wilson, M. A., Tzeng, E., Muluk, S., Peterson, N. M., Foster, M., Edwards, J., Moneta, G. L., Landry, G., Taylor, L., Yeager, R., Cannady, E., Treiman, G., Hatton‐Ward, S., Salabsky, the late B., Kansal, N., Owens, E., Estes, M., Forbes, B. A., Sobotta, C., Rapp, J. H., Reilly, L. M., Perez, S. L., Yan, K., Sarkar, R., Dwyer, S. S., Perez, S., Chong, K., Kohler, T. R., Hatsukami, T. S., Glickerman, D. G., Sobel, M., Burdick, T. S., Pedersen, K., Cleary, P., Back, M., Bandyk, D., Johnson, B., Shames, M., Reinhard, R. L., Thomas, S. C., Hunter, G. C., Leon, L. R., Jr, Westerband, A., Guerra, R. J., Riveros, M., Mills, J. L., Sr, Hughes, J. D., Escalante, A. M., Psalms, S. B., Day, N. N., Macsata, R., Sidawy, A., Weiswasser, J., Arora, S., Jasper, B. J., Dardik, A., Gahtan, V., Muhs, B. E., Sumpio, B. E., Gusberg, R. J., Spector, M., Pollak, J., Aruny, J., Kelly, E. L., Wong, J., Vasilas, P., Joncas, C., Gelabert, H. A., DeVirgillio, C., Rigberg, D. A., Cole, L., Becquemin, J.‐P., Marzelle, J., Becquemin, J.‐P., Sapoval, M., Becquemin, J.‐P., Favre, J.‐P., Watelet, J., Lermusiaux, P., Sapoval, M., Lepage, E., Hemery, F., Dolbeau, G., Hawajry, N., Cunin, P., Harris, P., Stockx, L., Chatellier, G., Mialhe, C., Fiessinger, J.‐N., Pagny, L., Kobeiter, H., Boissier, C., Lacroix, P., Ledru, F., Pinot, J.‐J., Deux, J.‐F., Tzvetkov, B., Duvaldestin, P., Watelet, J., Jourdain, C., David, V., Enouf, D., Ady, N., Krimi, A., Boudjema, N., Jousset, Y., Enon, B., Blin, V., Picquet, J., LʼHoste, P., Thouveny, F., Borie, H., Kowarski, S., Pernes, J.‐M., Auguste, M., Becquemin, J.‐P., Desgranges, P., Allaire, E., Marzelle, J., Kobeiter, H., Meaulle, P.‐Y., Chaix, D., Juliae, P., Fabiani, J. N., Chevalier, P., Combes, M., Seguin, A., Belhomme, D., Sapoval, M., Baque, J., Pellerin, O., Favre, J. P., Barral, X., Veyret, C., Watelet, J., Peillon, C., Plissonier, D., Thomas, P., Clavier, E., Lermusiaux, P., Martinez, R., Bleuet, F., C, Dupreix, Verhoye, J. P., Langanay, T., Heautot, J. F., Koussa, M., Haulon, S., Halna, P., Destrieux, L., Lions, C., Wiloteaux, S., Beregi, J. P., Bergeron, P., Pinot, J.‐J., Patra, P., Costargent, A., Chaillou, P., DʼAlicourt, A., Goueffic, Y., Cheysson, E., Parrot, A., Garance, P., Demon, A., Tyazi, A., Pillet, J.‐C., Lescalie, F., Tilly, G., Steinmetz, E., Favier, C., Brenot, R., Krause, D., Cercueil, J. P., Vahdat, O., Sauer, M., Soula, P., Querian, A., Garcia, O., Levade, M., Colombier, D., Cardon, J.‐M., Joyeux, A., Borrelly, P., Dogas, G., Magnan, P.‐É., Branchereau, A., Bartoli, J.‐M., Hassen‐Khodja, R., Batt, M., Planchard, P.‐F., Bouillanne, P.‐J., Haudebourg, P., Bayne, J., Gouny, P., Badra, A., Braesco, J., Nonent, M., Lucas, A., Cardon, A., Kerdiles, Y., Rolland, Y., Kassab, M., Brillu, C., Goubault, F., Tailboux, L., Darrieux, H., Briand, O., Maillard, J.‐C., Varty, K., and Cousins, C.

Published
2017
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15. Transluminal angioplasty of failing infrainguinal arterial by-pass grafts: initial and long-term results in 13 patients.

Author

Laissy, Jean-Pierre, Peillon, Christophe, Clavier, Erick, Pernes, Jean-Marc, Gaux, Jean-Claude, Watelet, Jacques, Testart, Jacques, Benozio, Michel, Laissy, J P, Peillon, C, Clavier, E, Pernes, J M, Gaux, J C, Watelet, J, Testart, J, and Benozio, M

Abstract

Thirteen stenotic infrainguinal arterial bypasses (12 venous, 1 Gore-tex graft) were treated by transluminal angioplasty, either percutaneously (10 patients) or surgically (3 patients). Eleven procedures were immediately successful (two at the proximal portions of femoropopliteal grafts, six near the distal anastomoses, and three at the distal parts of femoroinfrapopliteal grafts) and dilated stenoses are still patent with a mean duration of 24 months in all patients except 2 who died during the follow-up period. The calculated cumulative patency rate is 85% at 36 months. Two procedures were followed by immediate disruption near the distal end of an in situ saphenous bypass graft where balloon inflation was performed. These required immediate surgical repair. Dilatation of the distal ends of in situ saphenous femoropopliteal bypasses may not be as safe as in other locations. [ABSTRACT FROM AUTHOR]

Published
1990
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21. Renal Vein Embolization during Type II Endoleak Embolization.

Author

Palmier M, Curado A, Plissonnier D, and Clavier E

Subjects
Aged, Dimethyl Sulfoxide adverse effects, Endoleak diagnostic imaging, Endoleak etiology, Humans, Male, Polyvinyls adverse effects, Treatment Outcome, Aortic Aneurysm, Abdominal surgery, Dimethyl Sulfoxide administration & dosage, Embolization, Therapeutic adverse effects, Endoleak therapy, Endovascular Procedures adverse effects, Polyvinyls administration & dosage, Renal Veins diagnostic imaging
Published
2020
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23. Adjuvant I-131 Lipiodol After Resection or Radiofrequency Ablation for Hepatocellular Carcinoma.

Author

Schwarz L, Bubenheim M, Gardin I, Huet E, Riachi G, Clavier E, Goria O, Vera P, and Scotté M

Subjects
Aged, Catheter Ablation, Combined Modality Therapy, Disease-Free Survival, Female, Hepatectomy, Humans, Injections, Intra-Arterial, Male, Middle Aged, Survival Rate, Antineoplastic Agents administration & dosage, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic, Ethiodized Oil administration & dosage, Iodine Radioisotopes administration & dosage, Liver Neoplasms therapy, Neoplasm Recurrence, Local
Abstract

Background and Objectives: High rates of recurrence have been observed after curative treatment for hepatocellular carcinoma (HCC). The main aim of this study was to establish the influence of adjuvant transarterial radioembolization-based I-131 lipiodol on survival and recurrence., Methods: Between 2004 and 2010, 38 patients were treated with adjuvant I-131 lipiodol therapy, at a dosage of 2220 MBq, within 4 months after surgery. This treated cohort was compared to a control cohort consisting of 42 consecutive patients operated prior to the time the I-131 lipiodol treatment became available., Results: Recurrence-free survival in the control and in the I-131 lipiodol cohort was 12.6 and 18.7 months, respectively (HR = 1.871, p = 0.025). At 2 and 5 years, the cumulative incidence of a first recurrence or death was, respectively, 50 % and 61 % in the treated cohort versus 69 % and 74 % in the control cohort. Median overall survival was 55 and 29 months, respectively (p = 0.051). Among patients with a recurrence at 2 years, more patients had already experienced such recurrence at 1 year in the control cohort (70 % vs 33 %, p = 0.014)., Conclusions: Adjuvant I-131 lipiodol improves disease-free survival in patients with HCC.

Published
2016
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24. Aortic aneurysm surgery: long-term patency of the reimplanted intercostal arteries.

Author

David N, Roux N, Douvrin F, Clavier E, Bessou JP, and Plissonnier D

Subjects
Adult, Aged, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic mortality, Aortic Aneurysm, Thoracic physiopathology, Aortography, Arteries physiopathology, Arteries surgery, Female, France, Humans, Male, Middle Aged, Paraplegia etiology, Paraplegia physiopathology, Paraplegia prevention & control, Spinal Cord Ischemia etiology, Spinal Cord Ischemia mortality, Spinal Cord Ischemia physiopathology, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Replantation adverse effects, Replantation mortality, Spinal Cord blood supply, Spinal Cord Ischemia prevention & control, Vascular Patency
Abstract

Background: During aortic surgery, the long-term patency of reimplanted intercostal arteries is unknown, limiting the relevance to preserve spinal cord vascularization., Methods: Between January 2001 and January 2007, 40 patients were operated for either thoracic aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA). Twenty cases of aneurysms limited to the proximal descending thoracic aorta were treated using endovascular repair, without preoperative spinal cord artery identification. Twenty patients--seven with extensive TAA, seven with type I TAAA, two with type II TAAA, and four with type III TAAA--underwent open surgery. Before open surgery, preoperative angiography was performed to identify spinal cord vascularization; in one case, the angiography failed to identify it. The segmental artery destined to the spinal cord artery was identified as originating from outside the aneurysm in 7 patients and inside the aneurysm in 12 patients: T6 R (1), T8 L (2), T9 L (3), T10 L (3), T11 L (3), L1 L (1). During the surgery, normothermic and femorofemoral bypass was used for visceral protection. All segmental arteries identified as critical before surgery were reattached in the graft. Twenty-four months later, computed tomography scans were performed to assess the patency of the reattached segmental arteries., Results: Three patients died, including one with paraplegia (T9 L). No other cases of paraplegia were reported. Computed tomography scans were performed in 10 patients. Segmental artery reattachment was patent in nine patients., Conclusion: Our experience indicates the long-term patency of reimplanted segmental artery, without any convincing evidence of its utility in preventing neurologic events during TAA and TAAA direct repair., (Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Published
2012
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25. Open repair of extensive thoracoabdominal and thoracic aneurysm: a preliminary single-center experience with femorofemoral distal aortic perfusion with oxygenator and without cerebrospinal fluid drainage.

Author

David N, Roux N, Clavier E, Godier S, Brossard F, Bessou JP, and Plissonnier D

Subjects
Aged, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic mortality, Aortic Aneurysm, Thoracic physiopathology, Elective Surgical Procedures, Female, France, Hospital Mortality, Humans, Male, Paraplegia etiology, Paraplegia prevention & control, Perfusion adverse effects, Perfusion mortality, Regional Blood Flow, Retrospective Studies, Risk Assessment, Risk Factors, Spinal Cord Ischemia etiology, Spinal Cord Ischemia prevention & control, Survival Analysis, Survival Rate, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality, Drainage methods, Femoral Artery physiopathology, Femoral Vein physiopathology, Oxygenators, Perfusion instrumentation
Abstract

Thoracoabdominal aortic aneurysms (TAAA) and extensive thoracic descending aortic aneurysms (TDA) are not accessible through standard endovascular treatment. Fenestrated and branched endograft technology was developed rapidly without widespread application. The aim of this study was to review our open repair (OR) experience of TAAA and TDA. A total of 28 patients who underwent elective OR of TAAA or TDA between January 2001 and January 2009 were analyzed retrospectively. The mean age of the patients was 65.5 years (three women). The anatomic locations of the aneurysms were as follows: six in thoracic descending aorta and 22 in thoracoabdominal aorta (14 TAAA I, two TAAA II, six TAAA III). TDA (40 patients) available for ordinary endovascular treatment and TAAA IV (35 patients) were excluded from this study. To focus on spinal cord vascularization, 25 patients were submitted for angiography. Three patients suffering from back pain required quick treatment and were excluded from angiographic investigations. Angiography procedures were contributive in 23 patients (92%). Surgical repairs were driven through left thoraco-phreno-laparotomy, with the adjunct of distal aortic perfusion (femorofemoral bypass) including the use of an oxygenator and sequential aortic cross-clamping. Cerebrospinal fluid drainage was not used in this experience. The 30-day mortality rate was 14.3% (four of 28 patients): one multiorgan failure and three pulmonary sepsis. An immediate postoperative paraplegia occurred, affecting a patient with TDA who was previously submitted for infrarenal aorta replacement, despite angiographic identification and revascularization of intercostal artery destined to spinal artery. The 1-year survival rate was 82.1% (23 of 28 patients). In the preliminary experience of this study, OR of extensive TAAA and TDA with distal aortic perfusion and an oxygenator without use of cerebrospinal fluid drainage was associated with a significant perioperative mortality rate (14.2%), a reasonable rate of paraplegia (3%), and 1-year survival rate of 82.1%., (Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Published
2011
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26. Long-term psychological impact of severe postpartum hemorrhage.

Author

Sentilhes L, Gromez A, Clavier E, Resch B, Descamps P, and Marpeau L

Subjects
Adult, Antidepressive Agents administration & dosage, Depression drug therapy, Depression etiology, Embolization, Therapeutic, Fear, Female, France epidemiology, Hospitals, University, Humans, Intensive Care Units, Postpartum Hemorrhage epidemiology, Postpartum Hemorrhage therapy, Pregnancy, Pregnancy Complications drug therapy, Retrospective Studies, Severity of Illness Index, Surveys and Questionnaires, Telephone, Time Factors, Postpartum Hemorrhage psychology
Abstract

Objective: To estimate the long-term psychological impact of severe postpartum hemorrhage in women whose uterus was preserved., Design: Retrospective study., Setting: University-affiliated tertiary referral center., Population: All consecutive women who underwent embolization for postpartum hemorrhage between 1994 and 2007 and whose uterus was preserved were included., Methods: Data were retrieved from medical files and semi-structured telephone interviews. In semi-structured interviews, women were asked about their perceptions and memories of the experience., Main Outcome Measures: Perceptions and memories of the postpartum hemorrhage during and after delivery., Results: Follow-up was successful for 68 of the 91 (74.7%) women included. Of the 46 (67.6%) who reported negative memories of the delivery and postpartum period, the main memory for 24 was a fear of dying (35.3%). Of the 28 (41.2%) who reported continued repercussions, 16 (23.5%) thought about this delivery and its complications at least once a month, five (7.3%) reported persistent fear of dying, four (5.9%) reported sexual problems, and three (4.4%) women considered that the event was, at least in part, responsible for their subsequent divorce. Of the 15 women who had a subsequent full-term pregnancy, nine (60%) reported intense anxiety throughout the pregnancy, and one (6.7%) developed depression requiring antidepressant treatment during pregnancy., Conclusions: Severe postpartum hemorrhage may have a long-term psychological impact on women despite uterine preservation., (© 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.)

Published
2011
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27. Repair of intraoperative aortic dissection associated with malperfusion syndrome using a combination of open and endovascular techniques.

Author

Doguet F, Canville A, Lebreton G, Clavier E, Benichou R, and Bessou JP

Subjects
Aged, Aortic Dissection diagnosis, Aortic Dissection etiology, Aortic Aneurysm, Thoracic diagnosis, Aortography, Diagnosis, Differential, Echocardiography, Transesophageal, Female, Follow-Up Studies, Humans, Myocardial Ischemia complications, Tomography, X-Ray Computed, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Cardiopulmonary Bypass adverse effects, Endovascular Procedures methods, Intraoperative Complications, Myocardial Ischemia surgery
Abstract

Intraoperative aortic dissection is a rare but potentially fatal complication of cardiac surgery. In this report, we present a case of intraoperative aortic dissection that was complicated by intestinal ischaemia. The aorta was successfully repaired using both open and endovascular techniques., (© 2010 Wiley Periodicals, Inc.)

Published
2011
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28. Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients.

Author

Proust F, Gérardin E, Derrey S, Lesvèque S, Ramos S, Langlois O, Tollard E, Bénichou J, Chassagne P, Clavier E, and Fréger P

Subjects
Age Factors, Aged, Aneurysm, Ruptured mortality, Female, Humans, Hydrocephalus etiology, Hydrocephalus mortality, Intracranial Aneurysm mortality, Longitudinal Studies, Male, Neurologic Examination, Patient Care Team, Postoperative Complications mortality, Prospective Studies, Recurrence, Subarachnoid Hemorrhage mortality, Survival Rate, Tomography, X-Ray Computed, Aneurysm, Ruptured surgery, Embolization, Therapeutic, Intracranial Aneurysm surgery, Microsurgery, Postoperative Complications etiology, Subarachnoid Hemorrhage surgery
Abstract

Object: The aim of the study was to assess postprocedural neurological deterioration and outcome in patients older than 70 years of age in whom treatment was managed in an interdisciplinary context., Methods: This prospective longitudinal study included all patients 70 years of age or older treated for ruptured cerebral aneurysm over 10 years (June 1997-June 2007). The population was composed of 64 patients. The neurovascular interdisciplinary team jointly discussed the early obliteration procedure for each aneurysm. Neurological deterioration during the postprocedural 2 months and outcome at 6 months were assessed during consultation according to the modified Rankin Scale (mRS) as follows: favorable (mRS score < or = 2) and unfavorable (mRS score > 2)., Results: Aneurysm sac obliteration was performed by microvascular clipping in 34 patients (53.1%) and by endovascular coiling in 30 (46.9%). Postprocedural neurological deterioration occurred in 30 patients (46.9%), related to ischemia in 19 (29.7%), rebleeding in 1 (1.6%), and hydrocephalus in 10 (15.6%). At 6 months, the outcome was favorable in 39 patients (60.9%). By multivariate regression logistic analysis, the independent factors associated with unfavorable outcome were age exceeding 75 years (p = 0.005), poor initial grade (p < 0.0001), and the occurrence of ischemia (p < 0.0001)., Conclusions: The baseline characteristics of SAH in the elderly were only slightly different from those in younger patients. In the elderly, the interdisciplinary approach may be considered useful to decrease the ischemic consequences.

Published
2010
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29. Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage.

Author

Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, and Marpeau L

Subjects
Adult, Cohort Studies, Female, Gynatresia etiology, Humans, Infertility, Female etiology, Placenta Accreta etiology, Pregnancy, Pregnancy Outcome, Risk Factors, Secondary Prevention, Tissue Adhesions etiology, Young Adult, Embolization, Therapeutic adverse effects, Postpartum Hemorrhage therapy
Abstract

Objectives: To determine and compare the fertility and pregnancy outcomes following embolisation with or without uterine-sparing surgery for postpartum haemorrhage, and to attempt to identify specific risk factors associated with an increased likelihood of intrauterine synechia., Design: Retrospective study., Setting: University-affiliated tertiary referral centre., Population: All consecutive women who had an embolisation with or without uterine-sparing surgery (vessel ligation and/or uterine compression) for postpartum haemorrhage between 1994 and 2007 were included., Methods: Data were retrieved from medical files and telephone interviews., Main Outcome Measure(s): Fertility and pregnancy outcomes, synechia., Results: Data were available for 68 of the 85 women (80%) included in the study. Among the 15 women who complained of amenorrhoea or decreased flow of menstruation, synechia was found in all those who decided to undergo an ambulatory hysteroscopy (n = 8). Seventeen women had 26 pregnancies with 19 term deliveries, one ectopic pregnancy, two abortions and four miscarriages. The clinical courses of the 19 complete gestations were uneventful, but postpartum haemorrhage recurred in six women (31.6%) (caused by placenta accreta in two women). Fertility and pregnancy outcomes did not differ between women who had undergone embolisation versus both embolisation and a uterine-sparing surgical procedure. The occurrence of synechia was significantly associated with a higher rate of placenta accreta/percreta (P < 0.001) and postpartum fever above 38.5 degrees C (P = 0.04)., Conclusions: Embolisation, whether or not associated with a uterine-sparing surgical procedure, for postpartum haemorrhage does not appear to compromise a woman's subsequent fertility and obstetric outcome. Nevertheless, these women should be considered at high risk for postpartum haemorrhage during future deliveries.

Published
2010
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30. Usefulness of multislice computerized tomography angiography in preoperative diagnosis of ruptured cerebral aneurysms.

Author

Gerardin E, Daumas-Duport B, Tollard E, Langlois O, Dacher JN, Clavier E, and Proust F

Subjects
Angiography, Digital Subtraction methods, Brain blood supply, Brain diagnostic imaging, Female, Humans, Male, Middle Aged, Observer Variation, Retrospective Studies, Sensitivity and Specificity, Cerebral Angiography methods, Subarachnoid Hemorrhage diagnosis, Subarachnoid Hemorrhage diagnostic imaging, Tomography, X-Ray Computed methods
Abstract

Objective: Non-invasive imaging methods have become primordial in subarachnoid hemorrhage. The aim of our study was to evaluate the sensitivity and specificity of multislice computed tomographic angiography (MSCTA) for the diagnosis of cerebral aneurysm., Methods: The 28 included consecutive patients with SAH underwent both MSCTA and digital subtraction angiography (DSA). The MSCTA studies were interpreted by two independent readers (A and B) for the presence, the location and size of the aneurysm comparatively to the DSA as reference examination., Results: In 20 patients, 38 aneurysms were diagnosed and in eight no aneurysm was found. Per patient basis, the diagnostic sensitivity and specificity were excellent. Per aneurysm basis, the diagnostic sensitivity and specificity of MSCTA were, respectively, 97.4 and 100% for reader A, 100 and 100% for reader B. For aneurysms less than 3mm, sensitivity was 100% for both readers. Interobserver agreement was excellent for the detection of aneurysm (kappa=0.98, 95% CI [0.96-1]). Intertechnique and interobserver agreements were excellent for the measurement of aneurysms (slope=0.86, r=0.91 p=3.1x10(-7) and slope=1.04, r=0.99, p<10(-6), respectively)., Conclusion: MSCTA was an accurate and reproducible non-invasive imaging technique for preoperative diagnosis of ruptured cerebral aneurysm. The MSCTA may be proposed in first intention after the diagnosis of SAH was established, with special care regarding injection procedure and a strict reading method using native images and thin MPR.

Published
2009
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31. Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage.

Author

Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, and Marpeau L

Subjects
Adult, Cohort Studies, Female, Humans, Hysterectomy, Postpartum Hemorrhage etiology, Postpartum Hemorrhage pathology, Pregnancy, Retreatment, Retrospective Studies, Risk Factors, Treatment Failure, Young Adult, Postpartum Hemorrhage therapy, Uterine Artery Embolization
Abstract

Objectives: To estimate what factors are associated with a failed pelvic arterial embolization for postpartum hemorrhage and to attempt to estimate efficacy of pelvic arterial embolization in rare conditions., Methods: This was a retrospective cohort study including all consecutive women who underwent pelvic arterial embolization trial for postpartum hemorrhage between 1994 and 2007 at a tertiary care center. Pelvic arterial embolization failure was defined as the requirement for subsequent surgical procedure to control postpartum hemorrhage., Results: Pelvic arterial embolization was attempted in 0.3% of deliveries by the same radiologist in 87% of cases. Failures occurred in 11 of 100 cases (11%) and in 4 of 17 cases (24%) of placenta accreta or percreta. The major complication rate after pelvic arterial embolization was low (3%). Fifty patients (50%) were transferred from nine other institutions. Pelvic arterial embolization was performed in 11 cases (11%) after a failed conservative surgical procedure and in eight cases (8%) for secondary postpartum hemorrhage, with success rates of 91% and 88%, respectively. Pelvic arterial embolization demonstrated a patency throughout one ligated pedicle in 9 of the 11 cases of failed conservative surgical procedure (82%). Twin pregnancy, chorioamnionitis, operative vaginal delivery, hospital-to-hospital transfer, nature of embolizing agent and arteries embolized, failed surgical procedure, secondary postpartum hemorrhage, cause of postpartum hemorrhage, and more than one pelvic arterial embolization were not found to be significantly associated with failed pelvic arterial embolization., Conclusion: The only factors significantly associated with failed pelvic arterial embolization were a higher rate of estimated blood loss (more than 1,500 mL) and more than 5 transfused red blood cell units. Attempted pelvic arterial embolization after a failed vessel ligation procedure and for a secondary postpartum hemorrhage is a good option with high success rates.

Published
2009
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32. Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment.

Author

Proust F, Martinaud O, Gérardin E, Derrey S, Levèque S, Bioux S, Tollard E, Clavier E, Langlois O, Godefroy O, Hannequin D, and Fréger P

Subjects
Aged, Anxiety etiology, Anxiety psychology, Cohort Studies, Depression etiology, Depression psychology, Female, Follow-Up Studies, Glasgow Outcome Scale, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Mental Disorders etiology, Middle Aged, Prospective Studies, Subarachnoid Hemorrhage complications, Subarachnoid Hemorrhage surgery, Tomography, X-Ray Computed, Aneurysm, Ruptured surgery, Brain Damage, Chronic etiology, Brain Damage, Chronic psychology, Cerebral Revascularization, Embolization, Therapeutic, Intracranial Aneurysm surgery, Neuropsychological Tests, Quality of Life
Abstract

Object: For anterior communicating artery (ACoA) aneurysms, endovascular coil embolization constitutes a safe alternative therapeutic procedure to microsurgical clip occlusion. The authors' aim in this study was to evaluate the quality of life (QOL), cognitive function, and brain structure damage after the treatment of ruptured ACoA aneurysms in a group of patients who underwent microsurgical clipping (36 patients) compared with a reference group who underwent endovascular coiling (14 patients)., Methods: At 14 months posttreatment all patients underwent evaluations by independent observers. These observers evaluated global efficacy, executive functions using a frontal assessment battery of tests (Trail making test, Stroop tasks, dual task of Baddeley, verbal fluency, and Wisconsin Card Sorting test), behavior dysexecutive syndrome (the Inventaire du Syndrome Dysexécutif Comportemental questionnaire [ISDC]), and QOL by using the Reintegration To Normal Living Index. Brain damage was analyzed using MR imaging., Results: In the microsurgical clipping and endovascular coiling groups, the distribution on the modified Rankin Scale (p = 0.19) and mean QOL score (85.4 vs 83.4, respectively) were similar. Moreover, the proportion of executive dysfunctions (19.4 vs 28.6%, respectively) and the mean score on the ISDC questionnaire (8.9 vs 8.5, respectively) were not significant, but verbal memory was more altered in the microsurgical clipping group (p = 0.055). Magnetic resonance imaging revealed that the incidence of local encephalomalacia and the median number of lesions per patient increased significantly in the microsurgical clipping group (p = 0.003)., Conclusions: In the 2 groups, no significant difference was observed regarding QOL, executive functions, and behavior. Despite the significant decrease in verbal memory after microsurgical clipping, the interdisciplinary approach remains a safe and useful strategy.

Published
2009
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34. Subarachnoid hemorrhage due to cerebral aneurysmal rupture during pregnancy.

Author

Roman H, Descargues G, Lopes M, Emery E, Clavier E, Diguet A, Freger P, Marpeau L, and Proust F

Subjects
Adult, Female, Gestational Age, Humans, Infant, Newborn, Pregnancy, Pregnancy Outcome, Retrospective Studies, Subarachnoid Hemorrhage etiology, Treatment Outcome, Aneurysm, Ruptured complications, Intracranial Aneurysm complications, Pregnancy Complications, Cardiovascular diagnosis, Pregnancy Complications, Cardiovascular therapy, Subarachnoid Hemorrhage diagnosis, Subarachnoid Hemorrhage therapy
Abstract

Cerebral aneurysmal complications rarely occur during pregnancy. Telling the difference between eclampsia and cerebral hemorrhage due to aneurysmal rupture can prove to be difficult. Aneurysmal management should be performed in an emergency but fetal prognosis should be considered. We report a series of eight pregnant women presenting aneurysmal complications and we have assessed their management and outcome. Both maternal and perinatal mortality rates were correlated with the maternal clinical score. We stress the role of combined care by both neurosurgeons and obstetricians. An emergency cesarean section followed by aneurysmal treatment appears to be a widely accepted strategy in pregnant women with cerebral aneurysmal complications.

Published
2004
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35. Combined endovascular and video-assisted thoracoscopic procedure for treatment of a ruptured pulmonary arteriovenous fistula: Case report and review of the literature.

Author

Litzler PY, Douvrin F, Bouchart F, Tabley A, Lemercier E, Baste JM, Redonnet M, Haas-Hubscher C, Clavier E, and Bessou JP

Subjects
Adult, Blood Vessel Prosthesis Implantation, Embolization, Therapeutic, Female, Hemothorax surgery, Humans, Lip blood supply, Pulmonary Artery, Rupture, Spontaneous, Telangiectasia, Hereditary Hemorrhagic therapy, Arteriovenous Fistula therapy, Pulmonary Veins, Thoracic Surgery, Video-Assisted methods
Published
2003
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36. Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures.

Author

Proust F, Debono B, Hannequin D, Gerardin E, Clavier E, Langlois O, and Fréger P

Subjects
Albumins therapeutic use, Calcium Channel Blockers therapeutic use, Cerebral Angiography, Cimetidine therapeutic use, Endothelium, Vascular surgery, Enzyme Inhibitors therapeutic use, Female, Follow-Up Studies, Glasgow Coma Scale, Humans, Incidence, Intracranial Aneurysm complications, Intracranial Aneurysm diagnostic imaging, Male, Middle Aged, Postoperative Care, Postoperative Complications epidemiology, Preoperative Care, Prospective Studies, Severity of Illness Index, Subarachnoid Hemorrhage diagnosis, Subarachnoid Hemorrhage etiology, Subarachnoid Hemorrhage surgery, Intracranial Aneurysm surgery, Microsurgery methods, Vascular Surgical Procedures methods
Abstract

Object: Endovascular and surgical treatment must be clearly defined in the management of anterior communicating artery (ACoA) aneurysms. In this study the authors report their recent experience in using a combined surgical and endovascular team approach for ACoA aneurysms, and compare these results with those obtained during an earlier period in which surgical treatment was used alone. Morbidity and mortality rates, causes of unfavorable outcomes, and morphological results were also assessed., Methods: The prospective study included 223 patients who were divided into three groups: Group A (83 microsurgically treated patients, 1990-1995); Group B (103 microsurgically treated patients, 1996-2000); and Group C (37 patients treated with Guglielmi Detachable Coil [GDC] embolization, 1996-2000). Depending on the direction in which the aneurysm fundus projected, the authors attempted to apply microsurgical treatment to Type 1 aneurysms (located in front of the axis formed by the pericallosal arteries). They proposed the most adapted procedure for Type 2 aneurysms (located behind the axis of the pericallosal arteries) after discussion with the neurovascular team, depending on the physiological status of the patient, the treatment risk, and the size of the aneurysm neck. In accordance with the classification of Hunt and Hess, the authors designated those patients with unruptured aneurysms (Grade 0) and some patients with ruptured aneurysms (Grades I-III) as having good preoperative grades. Patients with Grade IV or V hemorrhages were designated as having poor preoperative grades. By performing routine angiography and computerized tomography scanning, the causes of unfavorable outcome (Glasgow Outcome Scale [GOS] score < 5) and the morphological results (complete or incomplete occlusion) were analyzed. Overall, the clinical outcome was excellent (GOS Score 5) in 65% of patients, good (GOS Score 4) in 9.4%, fair (GOS Score 3) in 11.6%, poor (GOS Score 2) in 3.6%, and fatal in 10.3% (GOS Score 1). Among 166 patients in good preoperative grades, an excellent outcome was observed in 134 patients (80.7%). The combined permanent morbidity and mortality rate accounted for up to 19.3% of patients. The rates of permanent morbidity and death that were related to the initial subarachnoid hemorrhage were 6.2 and 1.5% for Group A, 6.6 and 1.3% for Group B, and 4 and 4% for Group C, respectively. The rates of permanent morbidity and death that were related to the procedure were 15.4 and 1.5% for Group A, 3.9 and 0% for Group B, and 8 and 8% for Group C, respectively. When microsurgical periods were compared, the rate of permanent morbidity or death related to microsurgical complications decreased significantly (Group A, 11 patients [16.9%] and Group B, three patients [3.9%]); Fisher exact test, p = 0.011) from the period of 1990 to 1995 to the period of 1996 to 2000. The combined rate of morbidity and mortality that was related to the endovascular procedure (16%) explained the nonsignificance of the different rates of procedural complications for the two periods, despite the significant decrease in the number of microsurgical complications. Among 57 patients in poor preoperative grade, an excellent outcome was observed in 11 patients (19.3%); however, permanent morbidity (GOS Scores 2-4) or death (GOS Score 1) occurred in 46 patients (80.7%). With regard to the correlation between vessel occlusion (the primary microsurgical complication) and the morphological characteristics of aneurysms, only the direction in which the fundus projected appeared significant as a risk factor for the microsurgically treated groups (Fisher exact test: Group A, p = 0.03; Group B, p = 0.002). The difference between endovascular and microsurgical procedures in the achievement of complete occlusion was considered significant (chi2 = 6.13, p = 0.01)., Conclusions: The direction in which the fundus projects was chosen as the morphological criterion between endovascular and surgical methods. The authors propose that microsurgical clip application should be the preferred option in the treatment of ACoA aneurysms with anteriorly directed fundi and that endovascular packing be selected for those lesions with posteriorly directed fundi, depending on morphological criteria.

Published
2003
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37. Abnormal placentation and selective embolization of the uterine arteries.

Author

Descargues G, Douvrin F, Degré S, Lemoine JP, Marpeau L, and Clavier E

Subjects
Adult, Arteries surgery, Female, Humans, Placenta Diseases surgery, Postpartum Hemorrhage prevention & control, Pregnancy, Uterine Hemorrhage prevention & control, Uterus surgery, Embolization, Therapeutic methods, Placenta Diseases therapy
Abstract

Objective: Abnormal placentation accounts for more than 50% of uterine artery embolization failure. The authors report their experience in this situation., Study Design: Seven women presented with abnormal placentation. Uterine artery embolization was carried out in emergency or prophylactic control of postpartum bleeding., Results: In five patients, control of postpartum hemorrhage was obtained without hysterectomy. In two cases with no placental removal and prophylactic procedures, hysterectomy and blood transfusion were not necessary. The manual removal of the placenta was achieved secondarily, respectively on the 25th and the 12th day., Conclusions: The success rate of uterine artery embolization for postpartum bleeding appears to be lower with abnormal placentation. In none of the cases with the placenta present was it possible to leave the residual placenta in place. However, embolization may permit a safe waiting period and spontaneous migration of the placenta. When the diagnosis is made before delivery, prophylactic uterine artery embolization without placental removal should be considered to reduce blood transfusion and preserve fertility.

Published
2001
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38. Arterial erosions in acute pancreatitis.

Author

Testart J, Boyet L, Perrier G, Clavier E, and Peillon C

Subjects
Adult, Aged, Angiography, Duodenum diagnostic imaging, Endoscopy, Digestive System, Female, Hemorrhage diagnosis, Hemostatic Techniques, Humans, Male, Middle Aged, Pancreas diagnostic imaging, Retrospective Studies, Rupture, Spontaneous diagnosis, Rupture, Spontaneous etiology, Rupture, Spontaneous therapy, Splenic Artery diagnostic imaging, Splenic Artery pathology, Tomography, X-Ray Computed, Duodenum blood supply, Duodenum injuries, Embolization, Therapeutic, Hemorrhage etiology, Hemorrhage therapy, Pancreas blood supply, Pancreas injuries, Pancreatitis, Acute Necrotizing complications, Pancreatitis, Acute Necrotizing therapy, Splenic Artery injuries
Abstract

Acute pancreatitis was observed in 492 patients. Fourteen (2.8%) developed an arterial erosion revealed by a haemorrhage either in the digestive lumen, in the peritoneum or via previously placed drainage. The eroded artery was the splenic artery in six patients, a pancreatico-duodenal artery in five patients. An initial haemostasis was attempted by: a) embolization in four patients: one died; the three others had bleeding recurrence. b) splenocorporeal pancreatectomy in four patients, three had bleeding recurrence. c) arterial ligature in four patients: three had bleeding recurrence. Secondary haemostatic procedures were performed in ten patients but a durable haemostasis was achieved in only five patients: two had a pancreatic resection and three were treated by a redo-binding. It is noteworthy that durable haemostasis could not be obtained neither by embolization nor by ligature in necrotic tissues. This could explain the difference in the results of arterial erosion treatments in chronic and in acute pancreatitis. Therefore, it is suggested that haemostatic procedures should be performed away from necrotic tissues, or eventually done after their removal.

Published
2001

39. False aneurysm of the uterine pedicle: an uncommon cause of post-partum haemorrhage after caesarean section treated with selective arterial embolization.

Author

Descargues G, Douvrin F, Gravier A, Lemoine JP, Marpeau L, and Clavier E

Subjects
Adult, Aneurysm, False therapy, Angiography, Arteries, Female, Gestational Age, Humans, Hysterotomy adverse effects, Ovary blood supply, Pelvis blood supply, Pregnancy, Aneurysm, False complications, Aneurysm, False diagnosis, Cesarean Section, Embolization, Therapeutic, Postpartum Hemorrhage etiology, Uterus blood supply
Abstract

We report three cases of post-partum haemorrhage following caesarean delivery attributed to a false aneurysm of the uterine pedicle and treated with artery embolization. These lesion were probably post-traumatic in origin related to hysterotomy. Angiographic study of the anterior division of hypogastric arteries confirmed the diagnosis and embolization of the false aneurysm was successful in controlling the haemorrhage.

Published
2001
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40. Traumatic subclavian artery pseudoaneurysm: periprocedural salvage of failed stent-graft exclusion using coil embolization.

Author

Watelet J, Clavier E, Reix T, Douvrin F, Thomas P, and Testart J

Subjects
Adult, Catheterization, Embolization, Therapeutic, Humans, Male, Salvage Therapy methods, Stents adverse effects, Aneurysm, False therapy, Subclavian Artery injuries
Abstract

Purpose: To report the exclusion of a subclavian pseudoaneurysm by a combination of covered stent implantation and coil embolization., Case Report: A 30-year-old man presented with a posttraumatic pseudoaneurysm of the left subclavian artery. A covered Jostent was inserted via a percutaneous femoral approach and deployed in the injured subclavian artery. Because of tapering of the artery proximally, apposition of the covered stent to the arterial wall was insufficient, leading to persistent filling of the pseudoaneurysm. Exclusion of the pseudoaneurysm was achieved by coil embolization through a gap between the stent-graft and the arterial wall., Conclusions: This report illustrates that successful endovascular treatment of a left subclavian pseudoaneurysm may require a combination of catheter-based techniques.

Published
2001
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45. Common origin of the arterial blood flow for an arteriovenous medullar fistula and the anterior spinal artery: a case report.

Author

Clavier E, Tadie M, Thiebot J, Presles O, and Benozio M

Subjects
Angiography, Arteriovenous Fistula diagnostic imaging, Dura Mater blood supply, Humans, Male, Middle Aged, Arteriovenous Fistula surgery, Spinal Cord blood supply
Abstract

A common origin of the blood supply to a dural arteriovenous malformation and to the spinal cord from the same segmental artery is very rare. This obviously contraindicates embolization of the fistula. Demonstrating the location of the normal spinal blood supply system is therefore mandatory to avoid postoperative complications. The visualization of the normal blood vessels can be masked by a steal phenomenon, but it must at all costs be obtained. The authors describe one such case.

Published
1986
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46. Antidepressant side effects in the medically ill: the value of psychiatric consultation.

Author

Schwartz J, Speed N, and Clavier E

Subjects
Adult, Aged, Aged, 80 and over, Amitriptyline adverse effects, Delirium chemically induced, Doxepin adverse effects, Humans, Male, Middle Aged, Physicians, Family, Antidepressive Agents adverse effects, Psychiatry, Referral and Consultation
Abstract

In this study we evaluated the side effects of antidepressant use in medically ill patients. The authors evaluated fifty-one general hospital inpatients who were later prescribed antidepressant medications by their primary care physicians. These patients' medical records were reviewed one year later for evidence of serious complications. The overall complication rate was 43 percent. When the psychiatrist recommended antidepressant therapy, there was a 30 percent incidence of major complications. When the psychiatrist did not recommend antidepressants, but the patient was treated anyway, the incidence of treatment-limiting side effects was 67 percent. These results suggest that psychiatrists can predict which medically ill patients are at risk for complications. Since most antidepressants are prescribed by non-psychiatrists, an important role for consultants is to identify those patients at high risk for significant complications.

Published
1988
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