[False aneurysms in prostheses of the aortic bifurcation. Apropos of 34 case reports]. / Les faux anévrysmes sur prothèses du carrefour aortique. A propos de 34 observations.

Thrombosis, infection, false aneurysm and hemorrhage are all complications occurring following reconstructive arterial surgery. The authors study what is certainly the most unusual of these complications, i. e. development of false aneurysms of prostheses of the aortic bifurcation. They describe the various etiological factors responsible for their onset and also new diagnostic features and the principles of re-operation as well as results. This study is based upon a series of 34 cases of false aneurysm of prostheses of the aortic bifurcation inserted over a ten year period from 1974 to 1984. During this period, 1,400 prostheses of aortic bifurcation were inserted, essentially for two indications: chronic obliterative arterial disease of the lower limbs and aneurysmal disease. The mean latent period of onset of the complication was four and a half years. Removal followed by insertion of a new prosthetic graft is the basic treatment, overall mortality being 4% and morbidity being 30%, dominated by secondary thrombosis in 19% of cases, local infection in 8% of cases and recurrence of aneurysm in the same percentage of individuals. The overall figure of very good results was 70%. Whilst discussion is dominated by the role of different etiological factors, it nevertheless remains important to note that only progress in prosthetic and suture materials can allow a future decrease in the percentage of such false aneurysms, the factor inherent in the vascular surgeon, i. e. operative technique itself, being much easier to deal with on principle. This complication nevertheless remains very serious, best dealt with by surgery since the natural history of this false aneurysm is completely different from that of a classical femoral or popliteal aneurysm.

[So-called "primary" infected aneurysms of the sub-renal abdominal aorta. Five observations]. / Les anévrismes infectieux dits "primitifs" de l'aorte abdominale sous-rénale. A propos de cinq observations.

The authors describe 5 cases of mycotic aneurysms of the infrarenal abdominal aorta. These relatively rare lesions raise problems which are not so much diagnostic but above all therapeutic and etiopathogenic. They are rare lesions, with a striking clinical picture and often very spectacular radiological appearances, in particular by CT scan and angiography. Indications for surgery as well as the technique used thus comply with rigorous norms. However, despite everything, and in particular despite increasingly early positive diagnosis, rapid surgical management and advances in vascular surgery techniques, the mortality associated with such lesions remains very high, even in the context of cold aneurysm surgery, when compared with ordinary atherosclerotic aneurysms, dealt with under the same conditions.

[Portal and superior mesenteric venous thrombosis secondary to oral contraceptive treatment. Two cases (author's transl)]. / Thromboses veineuses portale et mésentérique supérieure, secondaires a un traitement contraceptif oral. A propos de deux cas.

Two new cases of superior mesenteric, portal and pulmonary venous thrombosis enable the authors to stress the close link between this pathology and the ingestion of oral contraceptives. The resultant vessel wall changes and laboratory changes are described. Whilst complete normalisation at the end of treatment is confirmed, preventive treatment will soon be possible by virtue of the development of new natural substances already perfected in the United States and the Scandinavian countries and recently marketed in our own country.

PIP: About 28% of women aged 15-44 use oral contraceptives (OCs) in France. The 2 cases presented here, of superior mesenteric portal and pulmonary venous thrombosis in patients on uninterrupted OCs for 8 years, reconfirm the association between OCs and embolic pathology. Similar cases have been often described in the published literature. 3 main factors influence the induction of such thromboses; 1) modification of blood coagulation, 2) modification of the vessels' walls, and, 3) immunologic role of OCs. Blood coagulation is apparently modified by synthetic estrogens only, and not be progestin agents. The vessels' walls undergo a gradual thickening, together with a proliferation of the smooth muscular cells. On the immunologic plan, it is possible that OCs may cause the procreation of antiethinyl-estradiol antibodies which appear as circulating immune complexes. Thromboembolic risk disappears spontaneously after termination of OC treatment.

[The indications for lumbar sympathectomy as a function of clinical findings and of the results of the angiographic test]. / Les indications de la sympathectomie lombaire en fonction de la clinique et du résultat de l'examen angiographique.

Indications for lumbar sympathectomy are presented as a function of the clinical findings and results of angiography, voluntarily ignoring data from non-invasive vascular function tests, in an attempt to answer two questions. Firstly, can the decision to perform lumbar sympathectomy depend on clinical findings only in 1983? Secondly, is angiography essential in all cases before sympathectomy? The positive response to both questions is based on a study of approximately 2,300 case reports.

[Thrombectomy in secondary and/or late thrombosis of branches of the aortic bifurcation prosthesis]. / Thrombectomie pour thrombose secondaire et/ou tardive des branches de prothèse du carrefour aortique.

Between 1974 and 1984, 1,100 prostheses of the aortic bifurcation, aorto-bi-femoral or aorto-bi-iliac, were inserted for atherosclerotic lesions: aneurysms were excluded from this analysis. The most frequently used prosthesis material was of double velvet Dacron. Global percent thrombosis development was 5.5%. Possible causes of the thrombosis are the operative techniques, the distal arterial bed and the presence or absence of associated anticoagulant therapy. Techniques used and results obtained with thrombectomy on one or more thrombosed prosthesis branches are compared with other reconstructive procedures for similar indications, particularly atypical axillo-femoral or inter-femoral by-pass operations. Results of this comparison may appear surprising but are nevertheless perfectly logical.

[Superior vena cava syndrome and Riedel's thyroiditis. Report of a case: review of the literature]. / Syndrome cave supérieur et thyroidite de Riedel. A propos d'un cas: revue de la littérature.

The authors present the case of a 42-year-old female patient, initially admitted to hospital for the etiological diagnosis--which remained negative--and the treatment of a superior vena cava syndrome. This patient was seen again two years later as the superior vena cava syndrome recurred, while a thyroid syndrome appeared at the same time. Exeresis followed by a clinicopathological study demonstrated Riedel's chronic fibrous thyroiditis. The authors study the causal relationships between both conditions and their integration into multifocal fibroses. To their knowledge, this is the first case in which the superior vena caval syndrome is the site of occurrence of fibrosis, precedes the thyroid involvement. The new radiological technique at our disposal--CT, MRI--should allow more easily searching for the various sites of the fibrosing disease (biliary ducts, pancreas, duodenum, retroperitoneum, mediastinum, orbits), and immunological studies will make it possible to better classify them and define their pathogenesis.

[Vascular complications of cervical ribs. Apropos of 15 cases]. / Les complications vasculaires des côtes cervicales. A propos de 15 observations.

Anatomical, etiopathogenic, clinical, and paraclinical aspects of vascular complication of cervical rib are discussed based on findings in 15 cases. Emphasis is placed on the value of newly available non-invasive functional tests, such as computerized angiography and particularly ultrasonography, which can modify surgical conduct. Operative technique is described, and indications for surgery and short- and long-term results obtained presented. Evaluation of results reported in the literature shows that they were excellent in 75 to 93% of cases, recent studies indicating an even higher rate of improvement.

[Our experience with surgery of chronic obstructive lesions of the subclavian artery. Apropos of 94 procedures. Critical analysis of our results]. / Notre expérience dans la chirurgie des lésions obstructives chroniques de l'artère sous-clavière. A propos de 94 interventions. Analyse critique de nos résultats.

Patient characteristics, types of lesion, routes of approach and techniques employed are discussed in relation to 94 cases of surgical treatment for chronic obstruction of the subclavian artery. The most frequently (60% of cases) used procedure was an extrathoracic by-pass operation, thrombo-endarterectomy being performed in 25%, réimplantations in 10%, and aortic by-pass implants in 6% of cases. Immediate and 30-day follow-up results are presented, and failures critically analyzed with regard to their relation to vascular or neurological complications, and those linked to the approach route. Conclusions to be drawn from these unsuccessful cases are exposed, as well as current tendencies in respect of indications for surgery in these lesions.

[Echographic study in the exploration of supra-aortic trunks. Comparative study with doppler velocimetry and their respective roles in functional vascular explorations]. / Examen échographique dans l'exploration des troncs supra-aortiques. Etude comparée à l'examen vélocimétrique doppler et leur place respective dans les explorations fonctionnelles vasculaires.

Over the last six months, 1,311 doppler examinations of the supra-aortic trunks have been performed with confrontation doppler, ultrasound, arteriography and intra-operative examination according to the cases. We studied these cases with the following questions in mind: Does real time ultrasound of the supra-aortic trunks give more valuable information than the classical doppler examination? Is the diagnosis simplified? Is the therapeutic management altered? We are able to conclude: 1. In the case of a mildly stenotic plaque (less than 50%), the doppler examination gives an acoustic and graphic representation which is rich and not differentiated for stenoses of between 10% and 50%, which corresponds to an ultrasound plaque of 1 mm to 4-5 mm: the ultrasound supports the diagnosis. 2. However, in stenoses greater than 50%, there is good correlation between the doppler examination, ultrasound and arteriography. Ultrasound enables the exact extent of the plaque to be visualised in sagittal and transverse planes. It can diagnose aneurysmal lesions and suggest ulcerated lesions. 3. Finally, the doppler examination seems to be indispensable in cases of pre-thrombosis or fresh thrombosis of the carotid. Ultrasound can be negative at this early stage.

[Spontaneous rupture of the esophagus or Boerhaave syndrome. Report of 3 cases and review of the literature]. / La rupture spontanée de l'oesophage ou syndrome de Boerhaave. A propos de trois cas et revue de la littérature.

A triad of signs constitutes Boerhaave syndrome: forceful vomiting, chest pain and subcutaneous emphysema. The syndrome results from spontaneous rupture of the oesophageal wall leading to an oeso-pleural or oeso-mediastinal fistula. Positive diagnosis is established with a water-soluble swallow, sometimes coupled with computed tomography of the thorax. Boerhaave syndrome is a surgical emergency. We report three cases of spontaneous rupture of the oesophagus and analyze the importance of emergency surgery as well as emergency treatment of the sepsis, an important prognosis factor.

[Chylothorax from closed thoracic injuries. Apropos of a case. Review of the literature]. / Chylothorax traumatique à thorax fermé. A propos d'une observation. Revue de la littérature.

Chylothorax of traumatic origin represents 60% of cases reported. A patient presented with a chylothorax from a closed chest injury, these representing only 10% of total cases seen with injury to the thoracic duct. Direct lesions, of either accidental or perioperative origin are the most frequent lesions. Various elements relating to the circumstances of onset, diagnostic factors and different therapeutic procedures are discussed. The course of these lesions after treatment is usually very favorable, as a result of the essential close cooperation between surgeons and intensive care physicians.

[Ruptured bronchial artery aneurysm simulating dissection of the aorta in a patient with bronchopulmonary sequestration (author's transl)]. / Rupture d'anévrysme d'une artère bronchique, sur séquestration pulmonaire, simulant une dissection aortique.

A patient with bronchopulmonary sequestration presented a clinical picture of dissection of the aorta following rupture of a bronchial artery aneurysm. Because of the rare nature of this type of lesion comments are limited to a description of the clinical history, angiographic images, surgical procedures, and operative findings in this case, these raising questions that cannot always be answered.

[Malignant venous tumors of the limbs. Apropos of 6 cases]. / Les tumeurs veineuses malignes des membres. A propos de 6 observations.

The authors report six personal cases of malignant venous tumours of the limbs, tumour pathology of the inferior vena cava being excluded from this study. Diagnostic features are described together with the various therapeutic possibilities. This discussion forms the basis of a review of the worldwide literature, but stresses two problems which determine the prognosis: that of diagnosis, which in the majority of cases is very late, and that of their prognosis, which remains somber because of their tendency to metastasize by blood-borne spread and that of locoregional recurrences. Finally, the authors suggest a three stage classification, taking into account not only macroscopic pathological features but also the results of the various special investigations which have led to the diagnosis. Prognostic correlation based upon the features involved in this classification is entirely satisfactory.

[Ruptured aneurysms of the aorta. Analysis of a series of 75 cases]. / Les anévrysmes rompus de l'aorte. Analyse d'une série de 75 observations.

Rupture of an abdominal aorta aneurysm was treated in 75 patients between 1969 and 1984. Global mortality was 70%, and factors influencing mortality, and its causes, are analyzed in this series. The presence and course of hemorrhagic shock is the essential prognostic factor, as well as the type of rupture. Mortality as a function of the groups varied between 27 and 90%. Causes of early mortality were directly related to collapse and its severity, other types of fatal complication being related to the patients general condition. Prognosis is improved by early diagnosis and rapidity of operative treatment. This series represents, in fact, only 36% of the total aneurysms operated upon during the same period, and a preventive surgical attitude is the only means of improving overall prognosis.

[Indications and results of dorsal sympathectomy in vascular syndromes of the upper limb (author's transl)]. / Indications et résultats de la sympathectomie dorsale dans les syndromes vasculaires du membre supérieur.

The authors report 50 cases of dorsal sympathectomy followed up on the cardiovascular surgery unit of the Amiens University Hospital over a period of six years. The authors then formulate a number of reflexions concerning the clinical findings, the therapeutic indications, and the way of assessing the results of this operation in vascular syndromes of the upper limb. This is a plea in favour of this operation as, in most cases, no other treatment is comparable.

[Aneurysms of the superior mesenteric artery and of its branches. Report of three cases (author's transl)]. / Les anévrysmes de l'artère mésentérique supérieure et de ses branches. A propos de trois observations.

The authors report three cases of atheromatous aneurysm revealed by a complication (e.g. rupture, thrombosis, peripheral embolisation) and propose an etiological, physio-pathological, clinical and therapeutic study of aneurysms of the superior mesenteric artery. They emphasise the advantages of early diagnosis leading to arteriography, which alone permits appropriate surgical treatment.

[Our experience with interaxillary shunts. Apropos of 39 shunts. Technic, results, indications]. / Notre expérience sur les pontages inter-axillaires. A propos de 39 pontages. Technique, résultats, indications.

The technique used and the results obtained in 39 patients with chronic obstructive subclavian artery lesions treated by interaxillary shunts are described and the literature reviewed. The indications for this therapy appear to be well defined and to apply mainly to elderly patients, to those with evidence of return flow after carotid-subclavian bypass, and to those with upper limb ischemia from post-vertebral lesions. This type of shunt is effective, is simple to perform and possesses minimal morbidity.

[Iliocaval venous thrombosis. Clinical and paraclinical aspects and therapeutic approach, apropos of 58 cases]. / Les thromboses veineuses ilio-caves. Aspects cliniques, paracliniques et approche thérapeutique à propos de 58 cas.

The authors report 58 cases of ilio-femoral and ilio-caval thrombosis and emphasise the considerable contribution of two vascular function tests: Doppler and occlusion rheoplethysmography, which now compensate for clinical deficiencies. Nevertheless, phlebography remains essential in defining management which is based upon age, general condition, and the site and type of thrombosis (floating or adherent clot). An outline therapeutic approach is suggested on the basis of these data.