Long-term peripheral stent evaluation using angioscopy.

To evaluate incorporation of peripheral artery stents into the arterial wall, we performed angioscopy on 13 patients fitted with Palmaz endoluminal stents. Of the 15 stents inspected, 5 were in the iliac artery, 9 in the femoral artery and 1 in the popliteal artery. The indications for placement were occlusion in 4 cases and high-grade stenosis in 11 cases including 3 restenosis after balloon dilatation and 1 restenosis after surgery. In 9 cases prosthesis insertion was preceded by laser treatment (Trimedyne Nd:YAG Cardiolase 4000). The decision to use a stent was based on radiologic findings in 3 cases (residual stenoses, dissections) and on angioscopic visualization in 7 cases (2 dissections, 5 flaps). In the remaining cases stent placement was performed electively. The only postoperative treatment was antiplatelet therapy (Ticlopidin). At the time of examination, the mean duration of placement was 6 months (extremes: 2 and 12 months). Inspection was made using Sopro-Meadox angioscope with a 0.75 mm probe mounted on an occlusive balloon for stents in the iliac artery and with a 2.2 mm probe with a working channel and sometimes a deflecting device for stents in the femoral or popliteal artery. Angioscopy was successful in all cases. Angiography was always performed at the same time as endoscopy. Endothelialization was observed in all cases. It appeared as a uniform and smooth whitish layer with a thickness proportional to the duration of placement. Endothelialization was most rapid in femoropopliteal arteries, total coverage being achieved within 4 months. Endothelialization took the longest on medial side of the iliac artery which may remain partially exposed after 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)

[Implantation of a pacemaker and superior vena cava anomalies: value of peroperative angiocardiography]. / Implantation de stimulateur cardiaque et anomalie cave supérieure: intérêt de l'angiocardiographie per-opératoire.

Rare abnormalities of systemic venous return may be encountered during the implantation of endocardiac pacemakers such as persistent left superior vena cava. Our patient, a 66 year old female, had, primary cardiomyopathy with sinus node dysfunction, left bundle branch block and a cardiothoracic ratio of 0,70. After left subclavian venous puncture the catheter seemed to advance down the left border of the cardiac shadow and a false route was suggested? Angiocardiography was performed immediately and showed a double superior caval system and allowed identification of the right ventricular apex. The electrode was positioned via a left SVC, coronary sinus, right atrium, right ventricle trajectory. Control angiocardiography was performed 1 year later and showed both the left SVC and coronary sinus to be still patent. The follow-up period is now 20 months. There have been 13 other reports of implantation using the left SVC; they include 4 short term failures, one late failure at 23 months, and one fatality after 2 months due to massive thrombosis of the coronary sinus. Seven good results were confirmed with follow-up of 3 to 16 months. The use of "tined" ventricular electrodes reduces the risk of secondary electrode displacement.

[False subaortic aneurysm after surgery of calcified aortic stenosis. Apropos of a case treated successfully]. / Faux anévrysme sous-aortique après chirurgie d'un rétrécissement aortique calcifié.

The authors report a case of false aneurysm of the posterior subaortic region of the left ventricle after a technically difficult surgical decalcification in a case of aortic stenosis. At reoperation, the surgeon used the femoral artery and both vena cavae for canulation. A direct approach of this "vascular" tumour, which was exterior to the great vessels, confirmed the diagnosis and enabled the localisation of the internal orifice inside the left ventricle. This was closed simply by suturing. No previous cases of this kind were found in the literature. This report underlines the necessity of taking the greatest care when decalcifying this region in order to avoid this type of serious complication.

[Azygography in pre-operative investigation of cancer of the esophagus : a report on 24 cases (author's transl)]. / L'azygographie : sa place dans le bilan pré-opératoire du cancer de l'oesophage. A propos de 24 cas.

The value of azygography for detecting extension of cancer of the middle third of the esophagus was assessed in 24 patients. The examination was conducted using the retrograde approach, and results were compared with those obtained by the esophagogram and on tracheobronchial fibroscopy. Compression of the azygos vein is a good indicator of the size of the tumor, which can also be evaluated from esophageal transit examinations. The vein can be invaded or even thrombosed due to severe regional spread but this does not mean that excision of the tumor is impossible. The results of azygography alone, therefore, are not a valid reason for contra-indicating esophagectomy. In case of doubt, tracheobronchial fibroscopy appears to be more suitable for deciding whether the tumor is operable, but azygography can assist in making this decision.

[Dilatation of the urethra by inflatable balloon catheter]. / Dilatation urétrale par sonde à ballonnet gonflable.

An inflatable balloon catheter of the Gruntzig type was used to dilate the urethra of 25 patients. The procedure involves atraumatic catheterization by a vascular catheter under televised urethroscopy, followed by introduction on a flexible guide of the balloon catheter which is then inflated. The stenosis is visible on the balloon and the rapidity with which it "yields" can readily be appreciated. Control of dilatation is effected by voiding urethrography. This method entails much less discomfort than conventional urethral dilatation. No complication was observed in this series. Stenosis recurred in 3 patients who subsequently underwent a second balloon dilatation.

[X-ray computed tomography in congenital and acquired anomalies of the inferior vena cava]. / Etude tomodensitométrique des anomalies congénitales et acquises de la veine cave inférieure.

The inferior vena cava (IVC) is a retroperitoneal key organ whose location and integrity must be checked in every scan. Computerized tomography (CT) of IVC provides interesting diagnostic elements which are complementary to the angiographic study: congenital abnormalities, even if they scarcely occur, are nevertheless important to detect, in order to prevent any mistake in the interpretation of the scan. Acquired abnormalities, are frequent. Today CT seems to be the most accurate method of exploration of neoplastic involvement in primary IVC tumors or external compression by retroperitoneal fibrosis. It is a non traumatic method allowing the visualization of the head of a caval thrombus inprecisely defined by phlebo-cavography. To summarize, a good scanning knowledge of the IVC and its abnormalities appears necessary, either to prevent any mistaken interpretation or to specify a pathological element with regard to a vascular exploration.

[Treatment of urethral stenoses by dilatation with the Olbert catheter. A propos of 50 cases]. / Traitement des sténoses urétrales par dilatation à la sonde d'Olbert. A propos de cinquante observations.

The method of treating urethral strictures described in this article is inspired from the technique for percutaneous angioplasty, using an inflatable catheter. It provides good immediate results in 80% of cases, regardless of the localization of the stricture and the previous treatment.

[Uncommon complication of the use of implantable chambers in oncology]. / Complication inhabituelle de l'utilisation des chambers implantables en oncologie.

The catheter of an implantable chamber migrated into the pulmonary infundibulum in a patient given chemotherapy for bronchogenic cancer. Current management of such cases is to remove the catheter under pulmonary angiography control using a basket system.

Exploration of cervico-encephalic vessels using trans-brachial approach on outpatients.

Among the several methods used for the exploration of supra-aortic vessels, none is perfect. The intra-arterial digital subtraction angiography is a secure method. The transbrachial approach for this purpose is a safe and efficient technique. The possible risks at the level of humeral artery can be reduced by applying the method described in the text. We present our experience among 200 patients, using mostly the right brachial artery. The quality of image was good in 3/4 of cases. Humeral artery thrombosis occurred only once. Failure was almost nil. We also suggest preliminary heparinization to reduce the rate of hematoma formation.

Comparative study of electrophysiological and Holter monitoring data in estimating sinoatrial function. Significance of intrinsic heart rate in disclosing autonomic sinus node dysfunction.

To study the diagnostic possibilities and mechanisms involved in sinus node dysfunction (SND), 26 patients with sick sinus syndrome were evaluated by basic electrophysiological tests before and after autonomic blockade, and by Holter monitoring. Based on intrinsic heart rate (IHR), two groups, a normal and a pathologic one, were separated. With Holter recordings, significant differences were manifested in minimal heart rate during sleeping and also in sinus cycles averaged for 24 h between the two groups. In patients with pathological IHR (n = 9) abnormal intrinsic rhythmicity were verified by electrophysiological means, while we found positive ECGs referring to sinoatrial dysfunction during the first 24 h of rhythm recording. The group of normal IHR (n = 17) covers patients with intrinsic SND (intrinsic SA block, 3/17 patients) and patients (14/17) where the electrophysiologic properties of the pacemaker cells were normal: normal intrinsic recovery time, gradual return to the stable intrinsic sinus cycle length in the postpacing secondary cycles, biphasic postextrasystolic patterns with a well-estimated intrinsic sinoatrial conduction time. Repeated Holter recording (total 26 X 24 h) revealed severe bradycardia (2 cases), SA block (4 cases), SA arrest (2 cases), tachybradyarrhythmia (1 case). Electrophysiological studies have a low diagnostic value in autonomic SND; repeated rhythm monitoring is obviously the best complementary method for appreciating the role and significance of autonomic tone in sick sinus syndrome.

[Pheochromocytoma of Zuckerkandl's organ. Value of angiographic study. Apropos of a case]. / Phéochromocytome de l'organe de Zuckerkandl. Intérêt de l'exploration angiographique. A propos d'un cas.

The authors report a case of pheochromocytoma of Zuckerkandl's organ revealed by permanent hypertension. Angiography, combined with the clinical and biological data suggesting a catecholamine secreting tumor, made the diagnosis of pheochromocytoma of Zuckerkandl's organ prior therapy.

[Treatment of stenoses of the urethra. 2]. / Traitement des sténoses de l'urètre. Deuxième partie.

This is a comparative study in 183 patients of the treatment of urethral stenoses by two-stage urethroplasty, internal endoscopic urethrotomy and urethrotomy via the Olbert catheter. Urethroplasty (39 patients) was preferentially carried out in patients with moniliform stenosis greater than 2 cm long in the penile and penoscrotal urethra. There was no significant difference in the indications for the two forms of urethrotomy. Good results were obtained for the 3 techniques in about 80% of cases but there was significantly higher complication rate with surgical urethroplasty. The failure rate of the 3 techniques did not differ significantly. The cost of treatment, on the other hand, greatly differed depending on the technique. Surgical urethroplasty was 2.8 times more costly than internal endoscopic urethrotomy and 10.4 times more costly than Olbert catheter urethrotomy. Olbert catheter urethrothomy was 3.7 times cheaper than internal endoscopic urethrotomy.

[Percutaneous renal angioplasty]. / L'angioplastie rénale percutanée.

Renal angioplasty was performed in twenty hypertensive patients, and good immediate results were obtained in 18 cases. One unsuccessful result was due to insufficient dilatation of a stenosed renal artery, and another from an accident during dissection of the aortic wall in contact with the renal ostium. Repeated dilatation was necessary in two cases following recurrence of stenosis. A high percentage improvement in the hypertension was obtained: 12 cases recovered and there was marked improvement in 4 other patients, treatment being effective, therefore, in 16 of the 20 patients operated upon. The published literature is reviewed, and emphasis placed on the need for treatment by surgeons experienced in angiography examinations, in close collaboration with the medical and surgical team, the later being ready to intervene if the slightest complication of a surgical nature develops.

[Contribution of computed tomography in the staging of abdominal malignant lymphomas (author's transl)]. / Bilan d'extension sous-diaphragmatique des lymphomes malins par scanographie.

The authors present their experience of Computed Tomography in the staging of abdominal sub-diaphragmatic extension in 144 cases of malignant lymphoma of the lymph nodes (76 cases of Hodgkin's disease and 68 non-Hodgkin lymphomas). The method provides accurate information on sub-mesocolic lymph node involvement, particularly when hypertrophy is pronounced. It may also be used to assess supra-mesocolic extension of the disease, which is inaccessible to lymphography, and to study the size and, mainly, the structure of the liver and spleen tissues. Easy to perform reliable and non-invasive, the scanner constitutes a new and important means of assessing the extension, course and response to treatment of malignant lymphomas.

[Iatrogenic ergotism. Responsibility of an ergotamine tartrate-erythromycine propionate association (author's transl)]. / Ergotisme iatrogène: rôle de l'association tartrate d'erogtamine- propionate d'érythromycine.

Acute ischemia of the lower limbs was seen in a patient given ergotamine tartrate with erythromycine propionate. The authors recall the danger of such associations in patients with hepatic failure, the value of early diagnosis, and the possible use of nitroglycerin for suppressing the vascular spasm.

Long-term results with the Palmaz stent in the superficial femoral artery.

PURPOSE: Femoral stenting has demonstrated inconsistent and often disappointing long-term results. To compare out experience, we retrospectively analyzed a series of patients who had Palmaz balloon-expandable stents placed exclusively for superficial femoral artery (SFA) lesions. METHODS: From January 1990 to November 1993, 39 patients were evaluated for claudication (79%) or critical ischemia in 42 limbs. The culprit lesions were confined to the SFA: 24 (57%) occlusions and 18 (43%) stenoses, including 3 restenotic lesions. Stenting was elective in 12 (29%) cases: the 3 restenoses and 9 chronic, calcified occlusions. The remaining stents were applied for postangioplasty residual stenosis or angioscopic findings of thrombogenic luminal irregularities. A total of 55 prostheses were successfully implanted. All patients were maintained on ticlopidine and followed by routine duplex scanning. Follow-up angiography was performed in 28 (72%) patients between 4 and 45 months. RESULTS: In the postprocedural period, two acute thromboses (4.8%) occurred within 48 hours in patients who had long occlusions and poor runoff; no other major complications were encountered, for a clinical success rate of 95%. Follow-up evaluation ranged from 4 months to 4 years with a mean of 25 months. The restenosis rate was 19% (34% in occlusions; 10% in stenotic lesions, p = NS). At 24 months, cumulative primary patency was 77% and secondary patency 89%. CONCLUSIONS: Palmaz stents performed will in the SFA, demonstrating a low acute thrombosis rate and good long-term patency. The incidence of restenosis is likely to be greater in occlusions than in stenoses.