[Percutaneous transluminal endarterectomy of femoro-popliteal atheromatous lesions. Technique. Indications. Results after 6 months]. / Athérectomie transluminale percutanée des lésions athéromateuses fémoro-poplitéees. Technique. Indications. Résultats à 6 mois.

Percutaneous atherectomy was performed in 25 patients with 30 symptomatic femoro-popliteal stenosis. INITIAL RESULTS: 23 patients were successfully treated with disappearance of claudication and a mean 0.35 increase in the ankle-arm-index. Two early thrombosis occurred. Angiographic analysis: residual stenosis lower than 30% in 25 lesions; no dissection or embolization; effective treatment of eccentered and calcified lesions; no significant dissection after additional angioplasty. RESULTS AT 6 MONTHS FOLLOW-UP: (17 patients, 19 lesions): stable improvement in 14 patients; 2 restenosis; 1 new disease. Atherectomy restores a large lumen with minimal wall trauma, thus perhaps decreasing the restenosis rate.

[Adverse effects of contrast media: results of a 6 months study]. / Effets indésirables des produits de contraste: bilan de 6 mois de suivi.

The use of iodinated contrast agents is associated with adverse drug reactions (ADRs) (mainly allergic). Data from the literature suggest a frequency of ADRs ranging from 5 to 8 per cent for the whole group of iodinated contrast agents. The present systematic prospective study performed over a period of six months investigated ADRs in a Radiology Department of the University Hospital in Toulouse. After 1480 injections of iodinated contrast agents, only five ADRs (i.e. 0.34 per cent) were observed. However, the frequency remained higher in patients with a history of allergy (1.5 per cent). The low frequency of ADRs can be explained both by the use of mainly low osmolality contrast agents (75 per cent) and by systematic preventive management of risk (detailed questionnaire, choice of the contrast agent according to risk).

[The "3-in-1" block: myth or reality?]. / Le bloc "trois-en-un": mythe ou réalité?

The technique described by Winnie in 1973 is supposed to provide a regional block of the femoral, femoral cutaneous, and obturator nerves by a single injection within the femoral nerve sheath. This study aimed to assess the diffusion spaces for the local anaesthetic solution used in this technique. The anatomical study included the dissection of 2 adult and 1 foetal cadavers. It was associated with a radiographic study in adult volunteers. About 20 to 60 ml of an isotonic radiographic contrast (iopamidol 150) were injected into the femoral nerve sheath located with the help of a nerve stimulator. Standard pelvic radiographs and computerised tomographic scans were carried out at the time of injection, and 30 min later. Two different unpredictable distributions were found; which were independent of the injected volume. One type consisted in an internal diffusion towards the psoas major muscle, the liquid thus reaching the three nerves. The other type was an external diffusion, in front of the iliacus muscle, the liquid never reaching the internal side of the psoas major muscle, and therefore the obturator nerve. The "3 in 1" block would therefore seem to be useful for those surgical acts requiring only a block of the femoral and femoral cutaneous nerves, i.e. those involving the anterior aspect of the thigh and knee, the femoral shaft, and the patella. On the other hand, its usefulness for surgery of the hip (dislocation, fractured neck of femur) is rather uncertain.

[Percutaneous transluminal atherectomy of the femoropopliteal arteries. Technic, indications, results after 6 months]. / Athérectomie transluminale percutanée des artères fémoro-poplitées. Technique, indications, résultats à six mois.

Percutaneous atherectomy was performed in 25 patients with 30 symptomatic femoro-popliteal stenoses. Twenty-three patients were successfully treated with resolution of claudication and a mean 0.35 increase in the ankle-arm-index. Two early thromboses occurred. Residual stenosis was less-than 30% in 25 lesions, with no dissection, and no embolization. Atherectomy seems to be an effective treatment for eccentric and calcified lesions. At 6 months follow-up (17 patients, 19 lesions) clinical and Doppler improvement remained stable in 14 patients; 2 restenosis and 1 new disease occurred. Atherectomy restores a large lumen with minimal wall trauma, thereby possibly decreasing the restenosis rate.

Osteoid osteoma: percutaneous resection with CT guidance.

In 24 patients with presumed osteoid osteoma in the appendicular skeleton (n = 23) and lumbar spine (n = 1), percutaneous resection with a drill system and computed tomographic (CT) guidance was performed. In the procedure, a 7-mm-diameter toothed drill inserted over a guide wire is used to remove the nidus. Twenty-three patients were successfully treated. Histologic confirmation of osteoid osteoma was obtained in 19 cases. In one patient, open surgery with bone grafting and osteosynthesis was necessary because of inadvertent extensive bone resection resulting from damage to the drill. All patients have remained free of pain and recurrence for 3-24 months. Although the procedure was effective in all patients, the 7-mm diameter of the toothed drill may cause difficulty in small bones or even danger in areas such as the posterior vertebral arch. In locations such as the tubular bones of the lower extremity and the femoral neck, however, this technique is feasible and may become the treatment of choice for osteoid osteoma.

Osteoid osteoma: CT-guided percutaneous resection and follow-up in 38 patients.

PURPOSE: To reevaluate at medium term the results of computed tomography (CT)-guided percutaneous resection of osteoid osteomas. MATERIALS AND METHODS: Thirty-eight patients who had undergone treatment by means of this technique were reexamined with a mean follow-up of 3.7 years. The short- and medium-term clinical course and histologic features of the resection specimens were analyzed. RESULTS: The bone fragment could be analyzed in all cases, and the diagnosis of osteoid osteoma was confirmed in 28 patients (74%). A different diagnosis was made in six patients: mucoid cyst, subchondral arthritic geode, fibrous dysplastic lesion, focal osteochondritis, or focal chronic osteomyelitis. Cure was obtained in 32 patients (84%), whatever the cause. Complications, generally minor and transient, were observed in nine patients (24%). The most severe complications were two femoral fractures and one focal chronic osteomyelitis due to Staphylococcus aureus infection. CONCLUSION: The results of this study confirm the efficacy of percutaneous resection of osteoid osteomas and the possibility of using this method for successful treatment of other small bone lesions.

Transjugular intrahepatic portosystemic shunts using the Wallstent prosthesis: a follow-up study.

PURPOSE: The aim of the present study was to assess the efficacy of transjugular intrahepatic portosystemic shunts (TIPS) in 45 patients with cirrhosis during a mean follow-up of 7 months. METHODS: Forty-five consecutive patients treated by TIPS and who had been followed for at least 6 months after TIPS or until death, were included. Mean follow-up was 7.2 +/- 5.0 months. Shunt patency was assessed at 1 week and 1 month, then every 3 months after the procedure by Doppler US and angiography whenever needed. RESULTS: Thirty-six patients had been stented for refractory bleeding from ruptured esophagogastric varices. Of these, 8 patients (22%) rebled, 7 of whom were treated by a second shunt. Nine patients were treated for refractory ascites. Three patients had recurrent ascites due to shunt obstruction. All were treated by a second shunt which occluded in 2 patients. As a whole, 14 (31.1%) patients developed shunt obstruction within a mean of 120 +/- 136 days, 4 of whom remained asymptomatic. Other complications were septicemia by Staphylococcus aureus in 1 patient, transient encephalopathy in 9 patients, and disseminated intravascular coagulation in 1 patient. CONCLUSIONS: TIPS appears to be a relatively safe and effective technique in treating complications of portal hypertension in patients with cirrhosis. Shunt obstruction in 31% of our patients probably represents the most important limitation of this technique.