Treatment of renal graft artery stenosis. Comparison between surgical bypass and percutaneous transluminal angioplasty.

In order to compare saphenous bypass (SB) and percutaneous transluminal angioplasty (PTA) as treatment of renal graft artery stenosis (GAS), we have reviewed the results of both procedures in 33 patients treated consecutively by either SB (n = 16) or PTA (n = 17). All patients had become hypertensive within the first year after transplantation despite triple hypotensive drug therapy. SB was performed 17 (range 3-55) and PTA 19 (range 2-96) months after transplantation. SB failed in only 1 patient as a result of vascular thrombosis with graft loss. PTA was technically unsuccessful in 3 patients and was complicated by vascular branch thrombosis in 1 patient. Blood pressure decrease was similar in both groups: from 179/114 before SB to 147/90 (n = 15, P less than .001) at 6 months and 150/93 (n = 14, P less than .005) at 12 months after SB and from 177/110 before PTA to 149/93 (n = 13, P less than .01) at 6 months and 150/95 (n = 10, P less than .02) at 12 months. At 1 year, control of BP was improved in 85% of SB group patients and 74% of PTA group patients. Recurrent stenosis was documented in 3 PTA group patients: subsequently 1 had a successful SB and the 2 others a repeated PTA--successful in 1, unsuccessful in the other. We conclude that both methods are equally effective for BP control but that PTA entails a higher rate of initial failure and a significant rate of restenosis. However, because of technical ease and better tolerance, PTA emerges as the first-choice treatment of GAS, SB remaining indicated when PTA is not feasible or has failed.

Dissecting aneurysm of the ascending aorta with aorto-caval fistula. Fiberoptic oximetric findings and surgical management.

A patient presented the rare complication of a dissecting aneurysm of the ascending aorta ruptured into the superior vena cava producing a left-right fistula. Continuous oximetric measurements by a fiberoptic pulmonary artery floated catheter was used to localize the site of the shunt. Emergency surgical repair was successfully performed.

Reversible renal artery stenosis in renal transplantation.

Spontaneous regression of an arterial stenosis in a renal transplant recipient is documented. Implications of this observation and possible pathogenic mechanisms are discussed.

Revascularization of the superior mesenteric artery.

From 1965 to 1973, 7 patients with severe chronic mesenteric vascular insufficiency have been successfully operated upon. Abdominal pain, weight loss and epigastric murmur were the most significant symptoms and signs in these diffusely atheromatous patients. Aortography with exposure in the lateral projection was essential for diagnosis and operative planning. Although two and often all three main splanchnic arteries were involved, revasculariztion of only the superior mesenteric artery restored normal hemodynamics. There was no operative mortality. Weight gain was dramatic and post-prandial pain disappeared in all patients. One patient diedone year and one half after the operation from an acute cerebro-vascular accidnet. Our surgical experience in this field, although small, is very gratifying and rewarding.

[Role of catheterization and pneumoangiography in moderately severe pulmonary embolism]. / Place du cathétérisme et de l'angiopneumographie dans les embolies pulmonaires de gravité moyenne.

In patients with moderate pulmonary embolic disease, angiography is regarded as the most reliable procedure for establishing the diagnosis. Digital subtraction angiography (DSA) is easier to perform than conventional pneumoangiography (presently carried out in some selected cases only) and has become the diagnostic procedure of choice for pulmonary embolism. DSA achieves satisfactory results and is still more accurate when it is performed after perfusion/ventilation lung scans. In patients with acute embolus, usually hospitalized in the intensive care unit. Swan-Ganz catheterization provides the clinician with a great degree of haematologic information that enables him to select the appropriate therapeutic choice, which most often has to be determined in emergency.

[Hemodynamics and massive pulmonary embolism]. / Hémodynamique et embolie pulmonaire massive.

In massive pulmonary embolism, the hemodynamic evaluation means a Swan-Ganz catheter and echocardiography, may be indicated as a hemodynamic assessment in correlation to the degree of obstruction and as a therapeutic guideline. Some figures demonstrate the importance of some hemodynamic parameters in order to choice the adequate therapy. Inconvenience and precautions of the method are shortly mentioned.

[Pulmonary embolectomy. Clinical experience]. / L'embolectomie pulmonaire. Expérience clinique.

Between 1969 and 1984, twenty-three patients underwent an emergency pulmonary embolectomy under extracorporeal circulation in the Catholic University of Louvain (UCL), Department of Cardiovascular and Thoracic Surgery. The aim of this paper is to delineate the indications of this procedure. Patients were 23 to 70 years old. Diagnosis of Pulmonary Embolism was made according to clinical signs, ECG and Chest X Ray with Swan-Ganz catheter insertion into the pulmonary artery and the help of pulmonary angiogram if time permitted. The surgical technique is briefly described. Four patients died during the immediate postoperative period and three died later. The sixteen survivors all enjoy a normal life.

[Coarctation of the aortic isthmus in the adult]. / La coarctation de l'isthme aortique chez l'adulte.

Forty four patients over the age of eighteen operated upon for coarctation of the aorta from 1962 to 1983 at our institution were followed for one to 21 years (mean 13 years 3 months). Hypertension was found in 86% of the patients and 82% were preoperatively symptomatic. There were three late deaths. During the follow-up period, drug resistant hypertension persists in 31% of the patients at rest and/or exertion and 18% have functional symptoms. These data emphasize the importance of early diagnosis and treatment for patients with coarctation of the aorta.

[Rupture of the renal artery following blunt trauma. Interest of angiography and therapeutic possibilities (author's transl)]. / Rupture traumatique de l'artère rénale. Intérêt de l'angiographie immédiate et possibilités thérapeutiques.

Isolated rupture and thrombosis of the renal artery is a rare form of traumatic injury : two cases are added by the authors to the seventy reports found in the English and French literature. Clinical signs calling for the diagnosis like hematuria or high blood pressure may be absent. To make an early diagnosis, every patient suffering from acute blunt trauma of the abdomen should be submitted immediately to intravenous urography. Angiography should follow immediately when no secretion is produced on one or both sides. If a lesion of the renal artery is discovered, surgical repair can be attempted when the delay does not exceed 12 to 24 hours from the time of the accident. The best technical modalities include segmental resection with thrombectomy, aortorenal by-pass or eventually renal autotransplantation.

Hepatic heterogeneity on CT in Budd-Chiari syndrome: correlation with regional disturbances in portal flow.

A comparative study of the imaging findings of computed tomography (CT), selective arteriography, CT arteriography, and/or CT portography is presented in 4 patients with Budd-Chiari syndrome. Hepatic differences in attenuation and morphologic changes were generally found to be closely related with regional disturbances in portal flow. Areas with complete hepatic vein obstruction were hypodense on pre- and postcontrast scans, probably due to portal flow inversion. In 2 of 4 cases, these were subsequently atrophied, while areas receiving the remaining venous outflow appeared hypertrophied. They were markedly enhanced on postcontrast scans. Enhancement may be patchy due to portal and sinusoidal stasis.

Nontumorous attenuation differences on computed tomographic portography.

Nineteen patients with suspected hepatic neoplasms underwent dynamic computed tomography (CT) and computed tomographic porotography (CTP) in a preoperative setting. Nontumorous attenuation differences in the liver were observed in 8 patients (42%) with CTP and in 2 patients (10.5%) with dynamic CT (p less than 0.05). Although nontumorous attenuation differences are significantly more frequent with CTP than with dynamic CT, they are seldom a diagnostic problem because of their geographic pattern.