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Restenosis rates after peripheral and coronary angioplasties have been assessed only in patients who had either peripheral angioplasty or coronary angioplasty but never in patients who had both types. Among the 6364 angioplasties performed in the authors' institution since 1980, they studied 38 patients (36 men, 2 women, mean age fifty-five years, range thirty-four to seventy-seven) who had both peripheral and coronary angio plasty. The peripheral angioplasties were most often performed on iliac artery stenoses. They were performed before coronary angioplasty in 22 patients (58%) and after coronary angioplasty in 16 patients (42%). The follow-up after peripheral angioplasty was based on clinical data; ultrasound investigation was performed when the result of the clinical follow-up was poor (maximal walking distance lower than 500 meters). Follow- up after coronary angioplasty was assessed by a systematic coronary angiography at six months and with long-term clinical follow-up. The mean durations of the follow-up after peripheral or coronary angioplasty were not significantly different (respectively fifty-six ±eleven and forty-two ±nine months [mean ±2 SEM]). No patient was lost to clinical follow-up; 17 (45%) ultrasound investigations, 12 (32%) peripheral angiographies, and 34 (89%) coronary angiographies were performed. The restenosis rate after peripheral angioplasty was 18% and that after coronary angioplasty was 34%. These rates are similar to the classic rates observed in the literature. In conclusion, as reported for either procedure alone, the restenosis rates after peripheral angioplasty and after coronary angioplasty are different when assessed in patients who undergo both types of angioplasty.

Systemic thrombolysis is less than optimal in total occlusions of the iliac vein in which patency is 20% or less. We describe an interventional therapeutic procedure that may be effective in such cases. We selected 18 patients (average age, 29.5 years; range, 16 to 71 years) with complete iliac vein occlusion that persisted after 24 to 48 hours of systemic thrombolysis (streptokinase 100,000 U/hr). The ipsilateral femoral vein was punctured, and a guide wire was gently advanced through the thrombus into the inferior vena cava. Multiple inflations were performed with a balloon catheter that was advanced on the wire. A temporary vena cava filter was placed as a protection against possible embolic migration. Systemic thrombolysis was administered for 24 to 48 hours. Control venography and pulmonary angiography were performed. Venography showed good recanalization in seven cases, incomplete recanalization in five cases, and failure in six cases. Patency was maintained for a long time (15.6 months). In conclusion, (1) percutaneous transluminal venous angioplasty is a valuable adjunct to systemic thrombolysis when the latter alone fails; (2) segmental flow and mechanical obstruction were the critical factors, since the pharmaceutical factors were held constant, and (3) a more aggressive incremental interventional strategy warrants consideration.

We have endeavored to define the incidence of pancreaticoduodenal artery aneurysm associated with stenosis of the celiac axis and to address modalities in this setting. This association was found in 23 of 34 cases. Aneurysmal dilation of the pancreatic arteries associated with celiac axis stenosis is not accidental and seems to be due to increased flow through the peripancreatic arteries. Hemorrhagic complications, i.e., peripancreatic hematoma, hemoperitoneum, ductal hemorrhage, were the initial manifestation in 16 of 34 cases. Isolated aneurysms were treated by resection, exclusion or embolization without any complications. For associated aneurysms, resection and exclusion were employed. Pancreatoduodenectomy was required in three cases in which bleeding was uncontrollable. In six cases, the celiac axis was restored either by arterial reconstruction, aortohepatic bypass, or division of the arcuate ligament. Four patients died. All had been operated on for ruptured aneurysm. None of the deaths was directly due to ischemic compromise of the celiac artery bed. Because of the risk of rupture, all pancreaticoduodenal artery aneurysms should be treated surgically after appropriate investigation to detect associated celiac axis stenosis. Revascularization of the celiac axis is indicated whenever blood flow is reduced or, routinely, to reduce high peripancreatic collateral flow, particularly when collaterality is due to arcuate ligament-related stenosis.

Background: Few studies have compared sensitivities of ankle-to-brachial index (ABI) and transcutaneous oxygen tension (TcPO2) in a large group of patients with Leriche stage II intermittent claudication. Method and Results: 111 patients (138 limbs) with a stable chronic (> three months) intermittent claudication and significant peripheral vascular disease (PVD) proved by angiography were studied. They performed a treadmill test (10%, 3 km/hr) limited by limb pain. ABI and TcPO2 were measured before, just after exercise, and after three and ten minutes of recovery in supine position. Sensitivities per patient for ABI and TcPO2 were respectively at rest: 82.9% and 28.8%, and after exercise: 88.3% and 62.2%. Sensitivities per leg (n=138) for ABI and TcPO2 were respectively at rest: 73.9% and 26.8%, and after exercise: 82.6% and 34%. The sensitivity of TcPO2 increased to 56.5% after three minutes of recovery but was always less than that of ABI, which was maximal just after exercise (82.6%). The sensi tivity of the regional perfusion index was similar to that of TcPO2. The sensitivity of TcPO2 increased with respect to the Leriche stage and the number of lesions but was always lower than that of ABI. There was a weak correlation between TcPO2 and ABI after exercise, but no correlation was noted between maximal walking distance, ABI, and TcPO2. Conclusion: TcPO 2 is not required in patients with Leriche stage II intermittent clau dication but might be useful either in severely affected patients (Leriche stage III or IV) or in selected patients.

The authors report the use of Ethibloc in the treatment of cystic lymphangiomas and venous angiomas in 19 children. This embolizing product is injected by puncture in situ. Ten cystic lymphangiomas were treated, including 7 of the cervico-facial region. Of these ten, 8 were embolized initially using Ethibloc, and 2 after surgery. The diagnosis was always confirmed by echography and in some cases also by scanner. Six were completely cured and 2 had partial but satisfactory results requiring further injections. The final 2 cases when Ethibloc was administered after surgery, gave very disappointing results as the residual lesion was microcystic and thus difficult to access for the Ethibloc injection. The 9 venous angiomas involved various regions, including 5 facial lesions. These angiomas required a more extensive blood-clotting and radiologic assessment: standard radiography to detect the clot, Doppler echography and M.R.I. precisely clarifying the exact extension in depth. For 6 patients the cure was complete, for 2 others the results were good. Finally, in 1 case Ethibloc embolization was carried out prior to surgery, allowing definitive cure. In all, this technique resulted in a complete cure in 2/3 of the cases and its simplicity makes it a seemingly interesting alternative to surgery.

The authors report the case of a young man operated for tetralogy of Fallot and in whom surgical treatment of severe stenosis of the origins of the right and left pulmonary arteries had failed. Correction of these stenoses was obtained by implanting percutaneously an endoprosthesis in the right pulmonary artery with a good result: control angiography showed that the stenosis had disappeared and an increase in the right pulmonary artery diameter from: 5 to 11 mm, and the left pulmonary artery diameter from 7 to 14 mm. Perfusion pulmonary scintigraphy showed equal flow in the two lungs.

Between April 1988 and October 1992, 15 consecutive infants aged less than 3 months (average 17 days) with critical valvular stenosis underwent balloon dilatation. Thirteen were less than 1 month old and all had low output syndromes. The diagnosis and follow-up assessments were made by Doppler echocardiography. Before valvuloplasty the maximum instantaneous gradient was 75 +/- 34 mmHg. The average diameter of the aortic ring was 6.8 +/- 1.3 mm. Seven patients had aortic rings with diameters of less than 7 mm. Ten infants had a right-to-left shunt via a patent ductus arteriosus and pulmonary hypertension. Dilatation was performed after surgical denudation of the left carotid artery: a balloon catheter with a diameter 0.85 times that of the aortic ring was used. After dilatation, the gradient was 26 +/- 18 mmHg (p0.001). Grade I aortic regurgitation was observed in 4 cases and Grade II in 2 cases. Eight patients died 1 to 100 days after dilatation (seven of low output and one sudden death). Of these patients, 6 had aortic rings7 mm diameter. The average follow-up was 20.6 +/- 15.5 months (range 2 to 48 months). None of the patients had a precordial or carotid diastolic murmur. The gradient increased with improvement in left ventricular function. Two patients had a stable Grade I aortic regurgitation. Carotid Doppler echocardiographic control examinations performed in 4 patients were normal. Poor prognostic factors were: aortic ring diameter7 mm (p0.025) and a low gradient after dilatation (p0.012).(ABSTRACT TRUNCATED AT 250 WORDS)

In order to assess the therapeutic outcome of percutaneous transluminal angioplasty for subclavian stenosis, 50 patients were followed up clinically as well as with a velocimetric Doppler after attempted angioplasty. A minimal clinical follow-up of 9 months was expected. Subclavian stenoses were due to atheroma in 49 patients and to Takayasu's disease in 1 case. Indication of angioplasty was curative in 34 (68%) symptomatic patients (posterior fossa ischemia and/or upper limb ischemia) and preventive in 16 (32%) asymptomatic patients (severe difference of blood pressure between the 2 arms and/or association with carotid stenosis or axillo-femoral bypass). Angioplasty was successful in 45 patients (primary success rate = 90%). Three (6%) thrombosis occurred due to the percutaneous approach, one of the axillary and one of the brachial artery without any significant sequelae, and one of the aorta requiring an aorto-bifemoral bypass. A complication occurred in 2 unsuccessful angioplasties (4%): an ischemic stroke occurred in 1 case and a thrombosis of the dilated site requiring a surgical bypass. Clinical follow-up over a period of 9-101 months (mean = 41) was performed in 43 out of the 45 patients who had undergone angioplasty successfully. Two patients had a follow-up shorter than 9 months: one died after 5 months, the other was lost to follow-up. By the end of the clinical follow-up, 37 (84%) out of the 44 followed-up patients had benefitted from the procedure. Doppler study performed in 35 out of the 44 followed-up patients (80%) over a period of 2-90 months (mean = 39) showed 5 restenosis (14%). This study demonstrates the good long-term results of angioplasty in case of subclavian artery stenosis. Though there are complications, angioplasty could be proposed as a first choice treatment for subclavian stenosis as compared to surgery. Indications in asymptomatic patients should be carefully weighed as complications may occur.

The authors report the immediate and mid-term results of a retrospective study concerning 30 attempted angioplasties in 30 patients with tight stenosis of the subclavian artery. The cohort consisted of 23 men with a mean age of 57.5 and 7 women with a mean age of 57.7. Twenty three patients had symptoms and 7 were asymptomatic. There were 2 technical failures related to impossibility of passage through the stenosis. There were two complications during the immediate postoperative period in the form of obstruction at the arterial puncture site with no long term functional consequences. Clinical evaluation after a mean follow-up of 32.5 months showed that 25 (89.2%) of 28 patients with a good primary result were improved from a clinical and/or blood pressure after a mean follow-up of 34.5 months in 19 (82.6%) of the 23 patients undergoing this investigation. This study confirms the satisfactory efficacy of subclavian angioplasty with a low complication rate. It would seem legitimate to suggest angioplasty as first line treatment of stenosis of the subclavian artery and to reserve surgery for failures or contraindications to the technique.

In a prospective study, 174 patients (118 women and 56 men, average age 44 years, range 14 to 82) with proximal extensive thrombosis received streptokinase (100,000 U/hour) for an average of 2.8 days (range 0.5 to 7) through the catheter of a temporary caval filter. Twenty-seven of 45 (60%) patients with nonocclusive clots were completely free of clots at the second phlebography versus 17 of 116 (14%) with occlusive clots (p less than 0.001). Among nonocclusive clots, proximal ones (caval, iliac and femoral) were more easily lysed than popliteal clots (88 of 116 [76%] vs 26 of 58 [45%]; p less than 0.001). In 41 of 132 (31%) patients, a daily injection of contrast medium through the filter-carrying catheter enabled the observation of a clot in the filter, which was lysed by streptokinase. Seventy patients with follow-up greater than 2 years (median 34 months) were examined clinically. Nineteen of 22 (86%) patients with venograms free of clots at discharge were free of clinical sequelae versus 16 of 48 (33%) without normal venograms (p less than 0.001). It is concluded that: (1) in the case of occlusive clots, only a few patients were normalized after streptokinase; (2) proximal nonocclusive clots were most effectively lysed; (3) when venograms were free of clots at discharge, the majority of patients did not have venous sequelae at follow-up; and (4) embolic migration seems to occur frequently with streptokinase.

Marfan's syndrome only very rarely presents as a peripheral arterial complication. In the case described, dissection of the left iliac artery in a 52-year-old man presented as intermittent claudication of sudden onset and enabled the diagnosis of previously unrecognised Marfan's syndrome on the basis of great height, a dorsal kyphoscoliosis, a positive family history and aortic abnormalities. Treatment based upon vasodilators and platelet antiaggregation enabled a favourable outcome with frequent monitoring.

The authors propose a therapeutic strategy enabling diagnosis, treatment and prevention in the same clinical procedure based on a series of 8 patients presenting with signs of massive pulmonary embolism (acute cardiorespiratory distress, shock, loss of consciousness, and/or cardiac arrest). A removable vena cava filter is rapidly introduced percutaneously via a brachial, femoral or jugular vein, and opened in the inferior vena cava. Using the same catheter and without a second venous puncture, pulmonary angiography and cavography are performed by digitised angiography using a small quantity of contrast medium (40 ml, 12 ml/sec). The diagnosis of massive pulmonary embolism (index of pulmonary obstruction 70 to 90%) was confirmed in 6 out of the 8 cases. In 2 patients, the contrast medium passed from the right atrium into the left atrium and one of the patients developed hemiplegia. Thrombolytic drugs (rt-PA followed by Streptokinase) were injected via the same filter catheter. The dosage of rt-PA was 20 to 50 mg as a bolus followed by 50 mg in 2 hours. Streptokinase was then infused at a dose of 100,000 U/hour for an average of 36 hours (24-48 hours), followed by intravenous heparin and oral vitamin K antagonists. Two patients required blood transfusion for haemorrhage during the relay with heparin. The temporary caval filter was removed in all cases but 3 patients required a definitive filter because of the persistence of life-threatening venous thrombosis. Seven of the 8 patients survived their pulmonary embolism. This approach is rapid, saves time, and spares the patients from more invasive procedures.

Fifty-two asymptomatic patients underwent routine computed tomographic evaluation of aortobifemoral bypass grafts implanted end-to-side on the aorta five to 10 years after operation. Anteroposterior diameters were measured at the level of the stem and the limbs of the graft, the aortoprosthetic anastomosis, and the infraanastomotic aorta. The stems of the prostheses were found to be dilated between 30 and 110% (mean 58%) of initial values. The limbs of the graft were dilated between 15 and 150% of initial values, the mean being 52%. The anteroposterior diameter of the aortoprosthetic anastomosis measured between 27 and 48 mm with a mean of 32 mm. Eight patients (15%) had an anastomotic false aneurysm. The aorta distal to the prosthetic anastomosis was completely occluded in 48 cases (92%). A mural thrombus was encountered at the level of the aortoprosthetic anastomosis in 21 (40%) patients. These findings raise questions as to the possible role of side-to-end aortoprosthetic anastomoses in the genesis of anastomotic dilatations, false aneurysms, intraprosthetic thrombosis, and thrombosis of the branches of aortofemoral bifurcation prosthetic grafts.

The authors present a removable vena cava filter that may be introduced percutaneously, is atraumatic to the venous wall, and permits the simultaneous use of thrombolytk therapy. Sixty-five patients were studied: 42 cases of pulmonary embolism with threatening venous thrombosis; 23 cases of phlebitis associated with an ilio-caval thrombus without pulmonary embolism. The filter was introduced 38 timesfemor ally and 27 times by a jugular approach. In 16 cases (24-6%) clots broke loose, were effectively caught by the filter, and were progressively dissolved during thrombolytic therapy. The filter remained in place on average 4-5 ± 1-2 days. The filter was removed in all cases without provoking the recurrence of pulmonary embolism. Two deaths, not related to pulmonary embolism, occurred during hospitalization. Phlebography, performed in all cases before and after treatment, showed a significant decrease of the phlebographic score (10.88±0.82 vs 6.77±0.86, P

This is a report of successful dilation of stenosis of the common trunk in a case of total anomalous pulmonary vein return into the left superior vena cava in a 3 month old infant. Percutaneous angioplasty was performed with a 6 mm diameter balloon catheter. Right ventricular systolic pressure decreased from 96 to 60 mm Hg, mean pulmonary vein pressure decreased from 26 to 14 mm Hg and left ventricular systolic pressure increased from 70 to 90 mm Hg.

The authors describe 6 cases of unilateral obstruction to pulmonary venous return: two cases of Halasz syndrome and postoperative obstruction of the reimplanted collector vein, one patient with Halasz syndrome and spontaneous obstruction of the vein in the form of a scimitar, one case of neoplastic invasion of the atrium-vein junction, one with unilateral absence of the right intra- and extraparenchymatous regions of the pulmonary veins, and lastly, a case of juxta-auricular interruption in the right pulmonary veins. The anatomy and physiopathology of the collateral venous pathways are briefly described, together with the relations between systemic arterial hypervascularization and pulmonary venous obstruction. The authors then review the radiological, clinical, and angiohemodynamic features of the unilateral venous obstruction syndrome, and conclude that precise diagnosis of venous occlusion, its location, and its tolerance are essential for deciding the therapeutic measures required.

The so-called left "tracheal" bronchus is usually found to be a transposition of the segmental apicoposterior bronchus of the upper left lobe onto the terminal portion of the main trunk. This systematisation abnormality is less common on the left than on the right. In our experience, based on 1,500 bronchographs carried out on adults and children, we have discovered seven left "tracheal" bronchi four of them associated with an obstructive emphysema in the same area. Although this malformation is rarely encountered in the etiologies of interlobular or poly-segmental emphysemas in children, it does however appear that an upper left emphysema has two etiologies which are peculiar to it: segmental bronchial atresia and left "tracheal" bronchi. Why the left "tracheal" bronchi is more often pathogenetic in comparison with the right is open to speculation. As in many other examples of tracheo-bronchial compression for vascular reasons, the close contact between the hyperarterial ectopic bronchi and the left pulmonary artery seems, logically, to be the culprit.

The authors report the case of a young patient, 24 years old, hospitalized for a phlebitis of the right inferior member. The cause determined by venous angiography, echography and computed tomography, was a congenital agenesis of the inferior vena cava. This case allows to remember the embryology of the congenital anomalous inferior vena cava, which are rare and often unknown.

In 2 patients with malignant hypertension and acute renal failure due to renal artery stenosis in a solitary functioning kidney, percutaneous transluminal angioplasty was used to dilate the stenotic renal artery. In both cases, hypertension resolved and renal function significantly improved. Follow-up angiographies revealed the continued patency of the dilated vascular segments.

Fifty-six percutaneous transluminal balloon valvuloplasty procedures were performed in 51 patients suffering from congenital pulmonary valve stenosis. The patients ranged in age from 1 day to 60 years (mean 6.9 years); 21 were infants less than 1 year of age, including 8 neonates. The peak systolic pressure gradient was greater than 50 mm Hg (mean 81.5) in 47 cases, and less than 50 mm Hg (mean 34.6) in 9. Valvuloplasty enabled a reduction in the mean right ventricular peak systolic pressure from 93.1 to 51.6 mm Hg (p less than 0.001), the mean transvalvular gradient from 73.4 to 27.0 mm Hg (p less than 0.001) and the mean right ventricular pressure expressed as a percent of systemic pressure from 99.5 to 52.0% (p less than 0.001). In infants and neonates, the mean right ventricular pressure expressed as a percent of systemic pressure decreased from 117.3 to 64.4% (p less than 0.001). In 23 patients, follow-up cardiac catheterization at 1 to 17 months revealed a significant change in the right ventricular systolic pressure, which decreased from 54.0 to 46.7 mm Hg (p less than 0.05), and in the peak systolic pressure gradient, which decreased from 27.3 to 22.6 mm Hg (p less than 0.05). Valvuloplasty is an effective procedure in relieving pulmonary stenosis in patients of all ages, including neonates.

We report our first 20 cases of peripheral laser angioplasty using an optic fibre with contact sapphire tip. The equipment included a teflon catheter on which was screwed a round sapphire 2.2 mm in diameter. A 600 microns optic fibre connected to a Nd-Yag laser instrument was introduced into the catheter and placed in contact with the sapphire. Twenty patients underwent recanalization of femoral or popliteal arteries occluded on a length of 5 to 45 cm. The sapphire-tipped catheter was introduced by the Seldinger technique up to the site of occlusion. The 15 watt laser emission was set at intervals of one second. Sixteen out of the 20 occluded arteries were recanalized. Among the 4 failures, 3 were due to perforation and 1 to intraparietal progression. Angioplasty was performed with laser alone in 3 cases and with laser completed by balloon catheter in 13 cases. The minimum diameter of the laser-induced channel was 2 mm and was significantly increased (3.8 mm) by complementary balloon dilatation. In the 3 patients who underwent laser angioplasty alone, no noticeable improvement in distal blood flow was demonstrated by doppler velocimetry, and reocclusion occurred either soon afterwards (n = 2) or later (n = 1). Midterm results were much better in patients who had had additional balloon dilatation: early (3rd day) or late (2 months) reocclusion took place in only 3 patients. In the remaining 10 patients, followed up for periods of 1 week to 18 months (mean: 6 months), clinical improvement and recanalization were maintained.

In order to evaluate the long-term results of renal angioplasty with a follow-up of at least 3 years, we reviewed the first 50 patients who were treated by this technique for renovascular hypertension. The 42 patients (85 p. 100) in whom the angioplasty was technically successful were followed up both clinically and radiologically, using intravenous digital angiography. The clinical follow-up lasted 52 months on average (range: 8 to 96 months) and reached 3 years or more in 37 patients (4 patients died and 1 was lost sight of). The hypertension returned in 19 of the 42 patients (45 p. 100), the relapse occurring after 24 months in 8 cases. Thirteen of these patients accepted a control angiography which showed restenosis in 11 cases. At the end of the follow-up period, and after a second dilatation in some cases, 30 (60 p. 100) of the 50 patients were found to have benefited from the angioplasty (20 p. 100 were cured and 40 p. 100 were improved). 80 p. 100 of the patients whose renal artery stenosis was due to fibromuscular dysplasia (n = 10) were cured or improved, as were 66 p. 100 of the patients with "localized atheroma" (n = 12), but patients with severe and diffuse atheromatous lesions (n = 28) did not respond so well (7 p. 100 cured, 43 p. 100 improved), and all the major complications of the procedure occurred in this group. The radiological follow-up was performed in 36 patients over a mean period of 31 months (range: 1 to 96 months).(ABSTRACT TRUNCATED AT 250 WORDS)

A 44 year old man presented with a cerebral abscess, the location of which suggested a septicaemic origin. Although the patient was not cyanosed, a cardiological work-up was requested to exclude a right-to-left shunt. This showed a double abnormality of the systemic venous drainage: presence of an abnormal left superior vena cava draining into the coronary sinus and of a right superior vena cava draining into the left atrium. These two vena cava intercommunicated by anastomoses. Angiography in the right superior vena cava after occlusion by balloon catheter at its junction with the left atrium showed flow from the right to the left superior vena cava and to the azygos system. Simple ligature of the right superior vena cava was therefore performed to prevent recurrence of cerebral abscess. This case is rare and of interest because of the presence of two superior vena cavae, one on the right draining into the left atrium and the other on the left draining into the coronary sinus, with anastomoses between the two superior vena cavae. This double abnormality of systemic venous drainage explains the absence of cyanosis and therefore the relatively late detection of this malformation.

The author discusses Uhl's disease in a 60 year old patient as indicated by right ventricular insuficiency without troubles of the ventricular rhythm. Echocardiography revealed the distinctive symptoms of this illness (dilation of the right cavities, diastolic opening of the pulmonary valve, delayed closing of the tricuspid valve) emphasizing its diagnostic value. The contribution of tomodensitometry is considered.

A 1-month-old infant was referred for a rapidly expanding mass at the left elbow. Angiography showed contrast extra-vasation from the brachial artery in a 4 X 3 cm pseudo-aneurysm. This false aneurysm was treated surgically with good result. It is probable that accidental arterial puncture during repeated veni punctures in the neonatal period for determination of bilirubinaemia was responsible for pseudo-aneurysm of the brachial artery.

A radiological opacity of the posterior and inferior mediastinum should evoke a lesion of vascular origin. The venous nature of the mass can be easily confirmed by morphological changes apparent during the respiratory cycle and changes in position. Investigations to establish etiology of this venous ectasia arising from the azygos vein require more extensive radiological examinations, and computed tomography may be of value. Portal hypertension is one cause of increased venous blood flow in the azygos systems, and should be systematically considered.

The authors review five cases of actinomycosis with thoracic involvement, and emphasize the importance of parietal manifestations and their radiological appearance in the diagnosis of such cases. They refer particulary to the bone locations of the disease and mention rare oesophageal lesions and the development of systemico-pulmonary shunts.

Multifocal atherosclerotic lesions are frequent. It could thus be expected that multifocal angioplasties (performed in one particular patient on several [iliofemoral, renal, subclavian, mesenteric, coronary] sites) are frequent. To study multifocal angioplasty, we considered the 5344 angioplasties (PTA) (4151 coronary and 1193 peripheral PTA) which had been performed over 10 years in our institution. Eighty PTA (1.5%) were considered as multifocal angioplasty. They were performed in 30 patients who were followed up during 7 to 132 months (mean = 55). In case of primary PTA (72 PTA), the most frequent involved site was the iliofemoral site (47%) followed by renal (35%), coronary (8%), subclavian (7%) and mesenteric sites (3%). Eight PTA were performed after primary failure (3 cases) or after restenosis (5 cases). The 30 patients were divided into 2 groups according to the chronology of multifocal PTA. In group I, 20 patients had multifocal lesions on the first workup and multifocal angiopathy over a short operative period (3 months). The 10 patients of group II initially had a single procedure. They subsequently had multifocal angioplasty over a longer period (2 years) on different sites of the first PTA. Compared to group I, mean age was lower in group II (46 vs 52 year; ns), primary success rate higher (100 vs 90%; p0.05), complications less frequent (3 vs 20%, p0.05) and restenosis rate lower (7 vs 21%; p0.01). In conclusion, multifocal angioplasty is infrequent. A specific group of patients who had multifocal angioplasty spread over several months or years could be individualized.(ABSTRACT TRUNCATED AT 250 WORDS)

Une observation tres rare. Cette malformation congenitale est diagnostiquee chez un homme de 44 ans atteint d'un abces du cerveau. La veine cave superieure droite est ligaturee; les resultats sont satisfaisants