Search

Infra-inguinal endarterectomy and by-pass (PSI) are the oldest and more frequently done restorative arterial operations. Here are described the evolution of patients, limbs and PSI and the factors that could interfere with them from the facts gathered since 30 years in literature. Prognosis is serious.

The authors report a typical case of rupture of the sub-clavian artery in closed trauma of the shoulder and review the world literature. The pathology of this lesion is described and its mechanism studied, it seems to be due to an acute encounter between the artery and the scalenus anterior.

This study attempts to measure inter-observer variability in reading 14 carotid angiograms and 8 aortograms. 24 surgeons and radiographs with training in arterial diseases participated in the study from different hospitals. The results were analysed with the Kappa statistical method which incorporate a correction for the extend of agreement expected by chance alone, in the evaluation of the reliability of diagnostic procedures. From a topographic point of view, the interpretation of the proximal arterial segments is more reliable than the distal segments, with the exception of the aorto-iliac bifurcation and the profunda femoral arteries. Inter-observer agreement is the most important for the occlusive lesions and the identification of stenosis is of poor reliability.

We related there a traumatic chylothorax due to a thoracic vertebral fracture. It has been recognized at the 13st day, after a lost of 11 liter of lymph and a down of albuminemia by lymphography. The direct ligature has been only partly successful leaving still a tiny lymph leak during a fortnight.

The authors report a new case of polycystic liver associated with polycystic kidney. The functional disorder due to distension of the cysts led to surgery. The impossibility of carrying out removal of the liver, owing to the diffuse character of these lesions, led the authors to choose the method described by Tien Yu Lin in 1968. This seems to be indicated in a few cases owing to the remarkable functional results.

Revascularization of ischaemic upper limbs by means of the patient's superficial veins in situ is a little known technique which has many advantages. Not only is the internal saphenous vein spared, but the technique is easily adaptable to all situations (e.g. length of the bypass, diameter of the arteries).

Anti-HLA-A,B and anti-B lymphocyte antibodies were screened as part of a prospective alloimmunity monitoring study in 29 renal allograft recipients using a standard microlymphocytotoxicity test. Warm-reactive and/or cold-reactive lymphocytotoxins were directed against a panel of B lymphocytes, the donor's B lymphocytes, and the recipient's own B lymphocytes. A small proportion of patients had pretransplant antibodies, whereas about one-half of the patients had post-transplant antibodies. One-year allograft survival rates were lower among the patients with warm- and cold-reactive sera than among those with nonreactive sera or pure B cold-reactive sera. The sera of 20 patients were tested against donor B lymphocytes. The presence of donor-specific antibodies correlated closely enough with graft loss to be of predictive value. Autoantibodies appeared to have an enhancing effect in this study.

Thirty patients were examined by 4 procedures, conventional angiography (C.A.), peripheric intravenous digital subtraction angiography (D.S.A.), ultrasonography and Doppler on femoral artery bifurcation. These arteries are divided into several sections on which findings were classified into three or five categories. There is an excellent correlation between conventional and digital angiograms. Various results of D.S.A. versus C.A. were obtained in 2% of these sections. More differences were noticed between C.A. and Doppler (7%), C.A. and ultrasonography (10%). There is a positive correlation of D.S.A. versus C.A. With Doppler and ultrasonography, arterial map is difficult to establish especially in case of many stenoses of the iliac arteries or thrombosis on femoral superficialis arteries.

The authors describe 26 cases of infection after vascular surgery, affecting a Dacron prosthesis in 13 cases and venous grafts in the other 13 patients. The site of infection was usually the region of Scarpa's triangle (15 cases) with the presence of enterobacterium in 40% of cases. The most frequently isolated germ was staphylococcus aureus (20 cases). Infection was revealed by hemorrhage in 17 patients and was evidence of breaking down of the anastomosis. Results of surgical treatment in the two groups were evaluated by using three criteria: --persistence or not of infection, --vital prognosis, --functional prognosis. Surgical treatment methods and possible contamination sources are discussed. When the operative zone is infected, the authors recommend ablation for the prostheses and conservative therapy for venous autografts. The prosthesis was left in place in 5 patients, and only one patient recovered, while two deaths occurred. In the 10 cases where ablation of the prosthesis was performed, however, the infection was cured, and in 4 patients there was revascularization in the infected area. Apart from these cases, conservative therapy was applied in 11 cases and healing occurred in all of them.

Continuous EEG monitoring during 110 carotid endarterectomies showed transient or permanent abnormalities in 35 cases. In 13 cases, these abnormalities occurred during carotid clamping and led the surgeon to place a shunt in 8 cases. In 22 cases, electrical abnormalities of various types appeared outside the clamping period. Continuous EEG monitoring demonstrated that cerebral disturbances can occur at any time during the operative period. Thus, intra-operative EEG monitoring allows a better understanding of clinical signs which may be seen postoperatively.

Dealing with lower limbs arteriopathies with combined aorto iliac and superficial femoral occlusive diease and when ischemia leads to operation should an extension bypass to the popliteal or tibial artery be associated every time it is possible? The authors have investigated the results of revascularizing operation above the profunda femoris on 35 limbs (27 patients). On 19 limbs only, has the revascularization been sufficient to cure the distal ischemia. On the other 16 limbs, a second operation was necessary 7 times an extension bypass to the popliteal or tibial artery, once an above knee amputation, twic a below knee amputation. From the comparison of these results with the degree of ischemia and the arteriographic aspect of the profunda femoris, the author's conclusion is that revascularization must extent below the profunda femoris unless the profunda is in good condition and there is no rest ischemia.

A "suspended" popliteal artery (S.P.A.) constitutes one of the most pejorative anatomical forms for atheromatous lesions of the lower limbs, as obliteration of the superficial femoral artery is often associated with atheromatous lesions in the tibial arteries, making them inaccessible to arterial reconstruction. Operations have been conducted on 5 cases (14 patients) over a period of 3 years. The average age of the patients was 71.6 years and the average follow-up period was 13 months. In each case operation was required to avoid amputation. Venous material was used for the shunt in 10 cases, while 5 had composite (n = 3) or prosthetic (n = 2) material. Postoperative mortality was nul, but 28% died by the end of the first year. Thrombosis occurred in 3 cases, at the 2nd, 7th, and 9th month respectively (actuarial permeability rate after 1 year: 72%), and 4 patients had high amputations (leg: 3, thigh: 1) in spite of permeability of the shunt is two cases (actuarial conservation rate of the limbs after 1 year: 67.5%). An analysis of the results of these 15 cases and those rare series reported in the published literature, enables definition of the indications for revascularization of an S.P.A.

On the basis of a new case of sub-adventitial cystic degeneration of the popliteal artery, the authors review the characteristics of this condition. The diagnosis may be suspected on the basis of clinical and arteriographic findings in an individual in whom the arterial system is otherwise normal. The various aetiological hypotheses are recalled. Treatment in the majority of cases consists of simple excision of the cyst. Intimal changes or segmental obstruction impose the need for resection with restoration of continuity by bypass.

Endoaortic calcified proliferation, also known as coral reef atherosclerosis represents a rare form of atherosclerosis characterized by a gross appearance and location in the thoracic and celiac aorta. We report two new cases of calcified obstruction of the aorta. In the first case, clinical examination revealed hypertension, abdominal angina associated with abdominal bruit, and diminished femoral pulses. The second case was diagnosed postoperatively when intractable hypertension and renal failure ensued following reconstruction of an abdominal aortic aneurysm. Accurate evaluation of lesions was possible through Doppler sonography, CT scan, and aortography. Because of hypertension and visceral ischemia, surgical treatment was required. Hypertension and intestinal angina were completely relieved in the first case, while hypertension and renal failure improved greatly in the second.

Drummond's marginal artery was revascularized by anastomosis with the left renal artery in two patients with visceral ischemia due to occlusion of the celiac and superior mesenteric arteries. In this manner, the authors avoided entering an infected abdominal cavity, interposition bypass and aortic clamping. In both cases, visceral arterial supply was improved. In one case, a left renal steal syndrome was observed. Because of possible renal involvement, indications for this technique should be carefully chosen.