[Medical treatment of arm embolisms]. / Traitement médical des embolies du membre supérieur.

Emboli in the upper limb occur much less often than in other territories. They usually cause subacute ischaemia due to the importance of the arterial anastomotic network. Medical treatment is thus often sufficient. An analysis of the data in the literature show that medical treatment can give results comparable to surgery. Medical management should only be proposed as a complementary treatment when acute sensitivomotor acute ischaemia threatens the upper limb since priority must be placed on immediate restoration of the arterial flow.

[Medical treatment of sclerotic arteriopathies of the lower limbs]. / Traitement médical des artériopathies scléreuses des membres inférieurs.

The medical treatment of sclerotic arterial disease in the lower limbs is only one facet in the management of generalized arterial disease. Clinical and ancillary investigations estimate not only the severity of arterial insufficiency, but also the diffusion of arterial disease and the existence of threatening lesions. Medical treatment has 2 essential aims: to limit the progression of lesions by risk factor control and antithrombotic drugs; to improve arterial insufficiency using adapted rehabilitation and, if necessary, drugs with vasodilatating or haemorrheological properties.

Fibrinolysis and elastic compression: no fibrinolytic effect of elastic compression in healthy volunteers.

The local and systemic fibrinolytic response to the placing of elastic compression in healthy volunteers was studied to determine whether this method of preventing venous thromboembolism has any profibrinolytic effect, as previously demonstrated with intermittent pneumatic compression. Variations in the major parameters of fibrinolysis (euglobulin lysis time, t-PA antigen, PAI-1 antigen, PAI-1 activity) were studied in an open randomized cross-over study in 21 healthy volunteers, in which three types of treatment were tested for periods of 24 h each (without elastic compression, elastic compression of an upper limb, elastic compression of the lower limbs). Four blood samples were taken from the upper limb during each period (at 08:00 h, 10:00 h, 18:00 h, 08:00 h on the following day). The placing of elastic compression did not cause any statistically significant change in the four parameters tested between the three types of treatment. In contrast, circadian rhythm was confirmed for all the fibrinolytic factors studied with a minimal fibrinolytic activity in the morning and a maximal activity in the evening. Elastic compression does not seem to have any profibrinolytic effect in healthy volunteers but other studies are needed in patients before a definitive conclusion can be reached.

[The effect of vascular risk factors in arteriopathy of the legs in women]. / Influence des facteurs de risque vasculaire dans l'artériopathie des membres inférieurs de la femme.

Here the analysis of the results of a multicentered prospective epidemiologic study that has counted only the new cases of chronic atherosclerosis obliterans of the lower extremities. Included have been 989 patients (659 men and 330 women). Critical analysis of data allows a comparative study between the sexes. Thus, specifics of arteriopathy among women can be drawn. It appears that they are only the consequences of the fact that men and women reflect a different level of tobacco use in the two populations.

[The role of oscillometric, oscillographic and rheographic methods in assessing arteriopathy of the legs]. / Place des méthodes oscillométriques, oscillographiques et rhéographiques dans l'exploration des artériopathies des membres inférieurs.

The oscillometric method records arterial wall oscillations during pulse wave and index pressure. Sensitivity increases with reactive hyperemia but many artefacts influence his technic. Electronic oscillography is more sensitive but has similar limits and a very high cost. This two methods detect easily arterial occlusive lesions but give only few information about the severity of arterial disease. On the opposite, Irrigraphy (impedance plethysmography) is a functional non invasive technic. Perfected by R. Sarrazin, J. F. Picard and A. Franco, it consists in recording the signal generated by electrical impedances variations related to pulse volume and heart rate. The pulse volume curve is recorded at six different positions of the leg. This method permits the evaluation of collateral vessels. Automatization of this non invasive technic increased reliability, and saves time examination.

[Laser angioplasty. Problems and perspectives]. / Angioplastie láser. Problèmes et perspectives.

Percutaneous endoluminal balloon angioplasty opened a new area in the field vascular therapeutic. Percutaneous laser angioplasty and mechanical abrasion are logical extension of this new therapeutic approach. A number of patients have been treated by these advanced technics, but their use is not yet of current practice in medical centers. Furthermore, from one center to another there are notable differences between the means used for angioplasty, what reflects the numerous problems which are to be solved: choice of the wavelength : infrared emitted by Nd-YAG lasers, visible by argon lasers or ultraviolet by excime lasers, pulsed or C.W. lasers, control of the desobstruction process, either by radiology, angioscopy, intraluminal vascular ultrasound or fluoroscopy, indications. The problem is still real. A lot of desobstruction have been performed on proximal lesions, but the future of this technics concerns perhaps more distal lesions.