Young woman's digestive arterial occlusion--a case report and literature review.

The authors report the observation of a 31-year-old woman who presented with total occlusion of digestive arteries and was successfully treated pharmacologically. A review of the literature shows that digestive arteries thrombosis is a rare condition in young women. Only 15 cases have been previously reported. Prognosis was poor with a mortality rate of 71%; 93% used oral contraception and more than 50% were smokers. All these cases were curiously similar. The authors accentuate the role of iloprost in the recovery of the patient. Digestive artery occlusion should be taken into consideration in the differential diagnosis of abdominal pain, especially in young women who smoke and take estrogen-containing birth control pills.

[Coronarography by percutaneous puncture of the axillary artery. Value in arteriopathies of the lower limbs]. / Coronarographie par ponction percutanée de l'artère axillaire. Intérêt dans les artériopathies des membres inférieurs.

Coronary angiography by a percutaneous femoral approach using the Judkins-Bourassa technique with special preformed catheters is widely used. This approach is potentially dangerous or impossible in patients with severe lower limb arteriosclerosis even after operation and so the investigation has to be done by Sones' technique (denudation of the humeral artery). There is, however, another upper limb approach which does not involve arterial denudation: percutaneous right or left axillary artery catheterisation. This paper reports the experience of a multicentre study of this method in 105 patients. This study is of interest as an arterial catheter introducer was used which, does not compress the artery, prevents bleeding when the catheter has to be changed and reduced the risk of thromboses or laceration of the axillary artery. 73 of the 105 patients had lower limb arteriosclerosis 5 had aortic aneurysms and 1 patient had a previous history of femoral artery embolism. There was a primary indication for this approach in 21 cases. The left axillary artery was used in 83 cases (79%) and the right axillary artery in 22 cases (21%). The coronary catheters were those usually used with the femoral approach. The left side was chosen preferentially as it avoided the brachiocephalic trunk and facilitated the catheterisation of the coronary ostia and of aorto-coronary bypass grafts. Selective catheterisation of the left coronary artery was achieved in 21 out of 22 cases (95%) and of the right coronary artery in all 22 cases (100%) by the right axillary route. Both left and right coronary arteries were selectively catheterised in all cases by the left axillary approach.(ABSTRACT TRUNCATED AT 250 WORDS)

[Current problems posed by arterial injuries in hospital practice]. / Problèmes actuels posés par les traumatismes artériels en pratique hospitalière.

The authors analyse a series of 100 arterial lesions in respect to the localization, the time elapsed between the accident and reconstructive surgery, and the number of associated lesions (two or more). The results confirm the prognostic importance of the factor time: 83% of the good results are obtained in the first twelve hours, and only 67.5% after twelve hours. The results seen with popliteal and tibial lesions show a steady improvement from a 50% amputation rate twenty years ago to a 21.6% rate at the present time. The presence of associated lesions is equally important in the outcome: isolated arterial lesions (or accompanied by no more than two other anomalies) are successfully treated in 91% of the patients, opposed to 50% when loco-regional lesions are found (bone, skin, veins, nerves, muscles). The optional treatment of these complex traumatisms should be by means of a multidisciplinary approach.

[Aortic sarcomas with peripheral emboli: apropos of 2 cases]. / Sarcomes aortiques avec embolies périphériques: à propos de deux cas.

The authors report two cases of aortic angiosarcomas. These cases were similar and characterized by a typical pejorative clinical course, with peripheric emboli and many osteolytic metastasis. Immunohistochemical study was in favour of an endothelial origin, electronic microscopy indicated a mixed tumor with myofibroblasts and poorly differentiated endothelial cells. Differential diagnosis between angiosarcoma, leiomyosarcoma and intimal sarcoma are reviewed.

[Plea for the terminal anastomosis of aortic prostheses. Theoretical and practical impact]. / Plaidoyer pour l'anastomose terminale des prothèses sur l'aorte. Incidences théoriques et pratiques.

End-to-end anastomosis of an aortic prosthesis was used during reconstructive surgery in 100 patients. The advantages of this method are analyzed and compared with those of end-to-side implantation, the former procedure providing improved hemodynamic and long-term results: absence of anastomotic dilatation, regularity of aortic blood flow distribution, lack of competitive or superfluous flow, a guaranteed pelvic circulation and simplicity of later repeat surgery following thrombosis. Tactical indications for this method of anastomosis are defined and depend mainly upon the type of lesions at the iliac bifurcation. The greater complexity of this method would appear to be acceptable in view of the possible improved long-term permeability when compared with the conventional procedure.

[Should one operate on all asymptomatic carotid lesions?]. / Faut-il opérer toutes les lésions carotidiennes asymptomatiques?

Two subgroups in Natali and Thevenet's stage 0 class of asymptomatic diseases are defined. True asymptomatic affections occur in patients with neurologically asymptomatic carotid lesions. The natural history of these diseases when compared with results after surgery is in favor of preventive operative therapy. False asymptomatic affections are seen in patients who, after previous operations for symptomatic carotid lesions, present a lesion on the controlateral carotid which until then had been neurologically silent. The natural history of this group shows that immediate definitive cerebral accidents are rare and that life expectancy is low. In contrast, the course after repeat surgery, the present data being the first to be published, appears to be rather unfavorable. Careful selection of patients in this subgroup is therefore necessary when considering surgical treatment.

[Uretero-arterial fistulas: report of 2 cases and review of the literature]. / Fistules urétéro-artérielles: à propos de 2 cas et revue de la littérature.

Uretero-arterial fistulas are rare. The authors report two new cases complicating iliac vascular surgery. These fistulas occurred in a particular context: aorto-iliac disease, neoplasm and pelvic radiotherapy. Prolonged ureteric catheterisation is a risk factor found in 65% of cases. The clinical diagnosis is difficult and must be suggested in the presence of episodes of haematuria, sometimes minimal and intermittent, but often cataclysmic. The clinical context is highly suggestive of the diagnosis. The most useful complementary investigations are arteriography and retrograde ureteropyelography. Surgical treatment is complex, as it is performed in an emergency context in patients with a poor general state and it must treat both the vascular and the urological problem. Embolization can be proposed in some cases. The prognosis remains serious due to the frequency and severity of postoperative complications, which is why this disease must be investigated in all patients at risk.

Atherosclerotic lesions of the aorta and renal arteries: results of simultaneous surgical treatment.

Between 1975 and 1985, 43 patients underwent simultaneous aortic and renal artery reconstruction. Twenty-two patients had infrarenal abdominal aortic aneurysms and 21 had aortoiliac occlusive disease. In addition, 40 patients had severe lesions of one or both renal arteries and three patients had a lesion in an accessory renal artery. Hypertension was present in 29 patients, 15 of whom had impaired renal function. Four patients had chronic renal insufficiency without hypertension. Ten patients underwent prophylactic renal artery reconstruction. Infrarenal aortic repair was carried out simultaneously with thromboendarterectomy of one or both renal arteries, or reimplantation of a renal artery into the aorta, in two cases with contralateral nephrectomy. In one patient, the celiac and superior mesenteric arteries were also bypassed. Three patients (7%) died in the immediate postoperative period, two of these from myocardial infarction. Long-term survival was studied in 37 patients. Sixty-seven percent of patients with preoperative hypertension and less than 50% of those with preoperative renal insufficiency had good results.

[Practical reflections on Linton's operation. Apropos of 110 operations]. / Réflexions pratiques sur l'opération de Linton. A propos de 110 interventions.

Appropriate surgery on venous ulcers (Linton's operation) is an efficient therapeutic method. In 110 of these operations, rapid healing of the ulcer was achieved in 90% of cases, with 10% affected by necrosis and infection of the cutaneous incision. The result held without relapse for three years for 85% of the 52 patients who were able to be reviewed after this length of time. The operative technique has to adhere to two imperatives: a long incision up to the ulcer, and very exact skin closure. Ulcerous relapse, and ulcers failing to respond to routine treatment are the prime indications of surgery; indications can be extended to certain pre-ulcerous conditions.

Occlusive disease of the renal arteries and chronic renal failure: the limits of reconstructive surgery.

In order to investigate the value of renal revascularization in patients with chronic renal failure and associated occlusive lesions of the renal arteries, the long-term results of 48 revascularizations in 43 patients operated upon between January 1980 and May 1988 were analyzed. There were 36 men and 7 women whose mean age was 61.8 years (range 36 to 79 years). The diagnosis of kidney failure was based on serum creatinine levels greater than 120 micromoles/L on two consecutive determinations. Patients were divided into four groups: Group I (23 patients) had a creatininemia between 120 and 200 mumoles/L, Group II (16 patients) between 200 and 350 mumoles/L, Group III (2 patients) between 350 and 800 mumoles/L and Group IV (2 patients) who had chronic renal failure requiring hemodialysis. Hypertension was found in 37 patients. Renal artery restoration was unilateral in 38 patients, 12 of whom had a solitary kidney. Restoration was bilateral in five patients. In 24 patients, renal artery surgery was associated with reconstruction of the infrarenal aorta. Three patients undergoing associated aortic procedures (7%) died after surgery. Thirty-nine patients were followed for a mean of 35.1 months; one patient was lost to follow-up. Improvement or stabilization of renal function was noted in 24 patients (62%). Deterioration was found in 15 patients (38%), six of whom presently required chronic hemodialysis. In Groups I and II, 69.5% of patients stabilized or improved their kidney function. Renal function worsened in all patients in Groups III and IV. We conclude that restorative renal surgery can improve renal function in patients whose preoperative serum creatinine levels are less than 350 mumoles/L. In this population of patients, associated aortic restoration should be performed only when absolutely necessary.

Fibromuscular disease of the renal artery: a new histopathologic classification.

To evaluate the relationship between clinical, radiologic, and histopathologic features in various types of renal artery fibromuscular disease, the records of 37 patients operated upon for a total of 44 lesions of the renal artery (30 unilateral and seven bilateral) were retrospectively reviewed. Of these, 36 had hypertension associated with stenosis or aneurysm of the trunk or branches of the renal artery; one had aneurysm of the renal artery without hypertension. The histopathologic study included 38 arterial segments retrieved from 33 patients and underscored the difficulties in using topographic criteria to classify lesions. While all arterial aneurysms were associated with involvement of the media, more than one layer of the artery was involved in 65.7% of cases. Topographic forms, such as the perimedial type, were difficult to classify. Based on the study results, it appears essential to distinguish patients with fibrosis and smooth muscular hyperplasia (type I: 19 patients, 23 arteries) from patients with isolated fibrosis (type II: 14 patients, 15 arteries). In group II, preoperative hypertension was more long-standing (p less than 0.04), more lesions were extended distally (p less than 0.05), and the probability of recovery from hypertension at 52 months follow-up was lower. We have distinguished two different evolutive stages of fibromuscular disease of the renal artery, one characterized by fibrosis with smooth muscle hyperplasia and the second, associated with more severe prognosis, characterized by isolated fibrosis.

Coxiella burnetii infection of aneurysms or vascular grafts: report of seven cases and review.

The most frequent clinical presentation of chronic Q fever is endocarditis, although infections of aneurysms and vascular prostheses have also been described. We report seven new cases of Coxiella burnetii infection of aneurysms or vascular grafts. We also review the literature and compare our cases with the six previously reported cases. This study demonstrated the lack of specific symptoms associated with this disease. Moreover, prospectively, in an attempt to reevaluate the incidence of Q fever-associated vascular infection, we systematically searched for C. burnetii infections in 163 patients with aortic aneurysms or vascular grafts who underwent vascular surgery. Microbiological testing included standard culture, Q fever serology, cell culture, and polymerase chain reaction amplification of C. burnetii DNA from biopsy specimens of aneurysms or vascular grafts. A microorganism was isolated from 25 patients, including C. burnetii in two cases; both of these patients had serological titers consistent with chronic Q fever. Both patients had nonspecific clinical features, and thus their infections would have probably remained undiagnosed without our systematic testing. Therefore, since the incidence of C. burnetii vascular infection is probably underestimated, we suggest that C. burnetii serology be routinely carried out in cases of unexplained febrile illness, pain, or weight loss in patients with a history of underlying vascular disease.