Femoropopliteal In-stent Restenosis Repair: Midterm Outcomes After Paclitaxel Eluting Balloon Use (PLAISIR Trial).

OBJECTIVE: The aim was to assess 18 month outcomes of the paclitaxel eluting balloon (PEB) in patients with femoropopliteal (FP) in-stent restenosis (ISR). METHODS: In a national prospective and multicentre cohort study, symptomatic patients with femoropopliteal in-stent restenosis were included from January 2012 to June 2013. Patients were treated by paclitaxel eluting balloon angioplasty (In Pact Admiral, Medtronic, Santa Rosa, CA, USA). Clinical and duplex scan follow-up evaluations were performed at 1, 3, 6, 9, 12, and 18 months. The primary endpoint was freedom from target lesion revascularisation (TLR) at 12 months. Secondary endpoints were major adverse cardiovascular events (MACE), Target extremity revascularisation (TER), primary and secondary sustained clinical improvement, recurrent restenosis rate, primary and secondary patency, quality of life assessed by EQ-5D questionnaire, technical success, clinical success, and length of stay RESULTS: A total of 53 patients were enrolled. After a blinded review, 10 patients were defined as protocol violation because restenosis occurred more than 2 years after stent implantation. Procedures were performed in 55 limbs, 48 (87%) for claudication and 7 (13%) for critical limb ischaemia. The mean diameter and length of PEB were 6 ± 0.57 mm and 86 mm ± 32 mm, follow-up was 17 months (range 1-19). At 1 year, the survival rate was 96 ± 2.7% and freedom from TLR and TER were 90.2 ± 4.2% and 85 ± 5%, respectively. Sustained primary and secondary clinical improvements were 78.6 ± 5.7% and 92.0 ± 3.8%, respectively. At 1 year, the primary patency rate was 83.7 ± 5.0%. Prior to the procedure, the mean EQ-5D score was 66 ± 14 and 74 ± 16 at 1 year (p = .10). Two patients died during follow-up; one patient died 33 days after the procedure because of limb ischaemia. CONCLUSION: PEB for the treatment of FP ISR is associated with a low rate of re-interventions and restenosis. Clinical improvement is maintained at 18 months.

An oyster-associated hepatitis A outbreak in France in 2007.

Following the notification of nine hepatitis A cases clustered in the Cotes d Armor district in northwestern France, epidemiological, environmental and microbiological investigations were set up in order to identify the source and vehicle of contamination and implement control measures. In total, 111 cases were identified in the outbreak, all of whom lived or had stayed as tourists in the Cotes d Armor district. Of the cases, 87% had eaten raw shellfish, and 81% specifically oysters. Traceback investigations carried out on raw shellfish consumed by the cases showed that the raw shellfish originated from a single shellfish farm. The shellfish were probably contaminated either in the submersible tanks or in a depuration land-based tank where they were stored. The source of contamination was not identified but shellfish could have been tainted by sewage overflows or by wastewater releases from a polluted storm sewer close to the shellfish farm or from on-site sanitation facilities. To prevent future hepatitis A outbreaks due to shellfish consumption from this area, hazards specific to each farm should be analysed. Timely information on sewage overflows should also be part of communities efforts regarding sewage collection and treatment.

[Current indications for cardiac CT]. / Les indications actuelles du scanner cardiaque.

There is a need to define the current indications for coronary CT angiography (CCTA) even as technology continuously evolves. CCTA using 64 MDCT units has shown to be highly accurate for diagnosis of stenoses >or=50% on selected populations. It is currently used for its negative predictive value (96-98%). Stenosis quantification remains inferior to conventional coronary angiography with tendency to overestimate stenoses <70%. For diagnosis of coronary artery disease, CCTA is considered based on clinical findings (pre-test probability of coronary artery disease) and presence of myocardial ischemia on other functional studies. The main appropriate indications include: In the setting of acute coronary syndrome, CCTA excludes coronary artery disease with excellent NPV and good negative likelihood ratio (0.05) when ECG is non-contributory, 2 consecutive troponin levels at 6 hours are negative in a patient with low risk of coronary artery disease. In the setting of stable angina or atypical precordial chest pain, CCTA is indicated in patient with low to medium risk when functional test are non-contributory or unavailable, or ECG is non-interpretable. CCTA is a complement to coronary angiography for morphological evaluation of some lesions prior to angioplasty and stent placement (long segment occlusion, proximal lesions involving LAD and circumflex arteries). In selected patients, CCTA may replace coronary angiography prior to valvular surgery.

[Why Coronary CTA will affect the diagnosis and management of stable coronary artery disease?]. / Pourquoi l'angioscanner va transformer les habitudes dans le diagnostic et la prise en charge de la maladie coronaire stable?

Until recently, the optimal work-up of patients with stable coronary artery disease (CAD) was based on non-invasive functional tests. Coronary CTA (CCTA) now challenges this standard work-up due to its efficacy to exclude significant coronary artery disease. Current indications for CCTA include symptomatic patients with intermediate pre-test probability of CAD with altered ECG (LBBB, repolarization abnormalities) rendering stress tests useless or patients unable to achieve sustained stress effort, and patients with indeterminate or uninterpretable results on ischemic work-up. A more agressive position is to consider CCTA as the cornerstone of patient management because the limitations and pitfalls of non-invasive techniques open the door to an alternative diagnostic imaging technique, either alone, or in combination with other Imaging techniques after reorganizing the sequence of imaging work-up. Without dismissing the dogma of initial détection of CAD along with prognostic stratification using functional tests, the recent availability of a minimally invasive anatomical test in the management of patients with stress angina, given the known limitations of traditional tests, changes the standard work-up algorithms. This suggests that the diagnostic work-up of patients with CAD is likely to be modified to increase the rôle of CCTA.

Effects of bradykinin on coronary blood flow and vasomotion in transplant patients.

OBJECTIVES: To evaluate the effects of exogenous bradykinin on coronary epicardial and microcirculatory tone in transplant patients (HTXs), and to compare them with the effects of acetylcholine. BACKGROUND: Coronary endothelial dysfunction has been reported to occur early after heart transplantation, most notably when acetylcholine was the endothelium-function marker used. The effects of bradykinin on coronary vasomotion are unknown in HTXs. METHODS: Sixteen HTXs were compared 3.6 +/- 1.7 months after transplantation to seven control subjects. Coronary flow velocity was measured using guide-wire Doppler. Diameters (D) of three segments of the left coronary artery and coronary blood flow (CBF) were assessed at baseline, after 3-min infusions of increasing bradykinin doses (50, 150 and 250 ng/min) then of increasing acetylcholine doses (estimated blood concentrations of 10(-8), 10(-7) and 10(-6) M). RESULTS: Bradykinin induced similar dose-dependent increases in D and CBF in both groups: D was 11 +/- 12%, 19 +/- 14% and 22 +/- 16% (all p < 0.0001), and CBF was 50 +/- 40%, 130 +/- 68% and 186 +/- 77% (all p < 0.0001). Acetylcholine induced significant epicardial vasodilation in control subjects and vasoconstriction in HTX, as well as a marked increase in CBF in both groups. Acute allograft rejection, present in 8 of the 16 HTXs, did not modify responses to bradykinin, but was associated with a smaller CBF increase in response to acetylcholine (p < 0.05). CONCLUSIONS: The coronary vasodilating effects of bradykinin are preserved early after heart transplantation, even in the presence of acute allograft rejection. Although there is an abnormal vasoconstricting response to acetylcholine reflecting endothelium dysfunction, the endothelium remains a functionally active organ in heart transplant recipients.

[A case review: About a STEMI in the very elderly]. / Un cas, une revue: un SCA ST+ chez le sujet très âgé.

Because of the demographic growth of our societies and the increasing prevalence of coronary artery disease with age, we will be increasingly faced with the treatment of myocardial ST+ very elderly patients (>90 years?). If evidence-based medicine does not exist within this framework, there are many registries that can guide us in their care. First, age should not in itself be an indication against reperfusion conventional techniques. In fact recommendations put no upper age limit. The primary angioplasty technical success, which is identical to the younger populations, is the treatment of choice and should be performed preferably by radial arterial access. The thrombolytic alternative, validated for octogenarians, has not been studied for older. Bleeding, neurological, ischemic complications and hospital mortality are more common than in younger populations, especially as the initial hemodynamic alteration is important, but the survivors have the same life-threatening or even better than that of a same reference population ages. Which in itself even justifies maximum adhesion to the therapeutic recommendations taking into account the co-morbidities and possible visceral shortcomings.

Infrapopliteal arterial recanalization: A true advance for limb salvage in diabetics.

The world is facing an epidemic of diabetes; consequently in the next years, critical limb ischemia (CLI) due to diabetic arterial disease, characterized by multiple and long occlusions of below-the-knee (BTK) vessels, will become a major issue for vascular operators. Revascularization is a key therapy in these patients as restoring adequate blood supply to the wound is essential for healing, thus avoiding major amputations. Endoluminal therapy for BTK arteries is now a key part of the vascular specialist armamentarium. Tibial artery endovascular approaches have been shown to achieve high limb salvage rates with low morbidity and mortality and endovascular interventions one should now consider to be the first line treatment in the majority of CLI patients, especially in those with associated medical comorbidities. To do so, the vascular specialist requires detailed knowledge of the BTK endovascular techniques and devices. The first step decision in tibial endovascular therapy is access. In this context, the anterograde ipsilateral approach is generally preferred. The next critical decision is the choice of the vessel(s) to be approached in order to achieve successful limb salvage. Obtaining pulsatile flow to the correct portion of the foot is the paramount for ulcer healing. As such, a good understanding of the current angiosome model should enhance clinical results. The devices used should be carefully selected and optimal choice of guide wire is also extremely important and should be based on the characteristics of the lesion (location, length, and stenosis/occlusion) together with the characteristics of the guide wire itself (tip load, stiffness, hydrophilic/hydrophobic coating, flexibility, torque transmission, trackability, and pushability). Passing through chronic total occlusions can be quite challenging. The vascular interventional radiologist needs therefore to master the techniques that have been recently described: anterograde approaches, including the drilling technique, the penetrating technique, the subintimal technique and the parallel technique; subintimal arterial flossing with anterograde-retrograde procedures (Safari); the pedal-plantar loop technique and revascularization through collateral fibular artery vessels.

Management of acute chest pain: A major role for coronary CT angiography.

Most patients presenting with acute chest pain (ACP) at the emergency unit do not have any marked electrocardiogram abnormalities or known history of heart disease. Identifying the few patients who have, or will actually develop acute coronary syndrome in this group that is considered to be at low risk, is an actual clinical challenge for emergency department physicians. In these patients, the goal of complementary non-invasive morphological or functional imaging tests is to exclude heart disease. The diagnostic values of coronary CT angiography include a sensitivity of 96% and a negative likelihood ratio of 0.09, which are highly contributory to the diagnosis, and the integration of this imaging test into a decision tree algorithm appears to be the least expensive strategy with the best cost/effective ratio. Coronary CT angiography is indicated in the presence of ACP associated with an inconclusive electrocardiogram, in the absence of any other obvious diagnoses, when the ultrasensitive troponin assay is negative or the dynamic changes are modest, slow and/or inconclusive. Ideally, coronary CT angiography should be performed within 3 to 48hours after the initial consultation.

Feasibility, safety, cost-effectiveness and 1 year follow-up of coronary stenting without predilation: a matched comparison with the standard approach.

BACKGROUND: We evaluated the feasibility, safety, procedural cost-effectiveness, radiation dose and time and 1-year target vessel revascularization rate of direct unprotected mounted stenting without previous balloon dilatation (DS) in native coronary artery lesions. METHODS: DS was attempted in 119 patients; 39 had a recent myocardial infarction, 62 had unstable angina, and 18 had stable angina. The clinical follow-up was obtained at 14+/-5 months (range 6 to 24 months). These results were compared with those for a consecutive group of 160 patients matched for type and length of lesions and who had a stent only if the post-balloon residual stenosis was >30%. RESULTS: The feasibility of DS was 112/119 (94%). The number of inflations, the length of the stent/length of the lesion ratio, the time and the dose of radiation were dramatically lower in the DS group (P<0.001). DS conferred a slight reduction in procedure-related cost [$820+/-157 for DS vs. 894+/-427 for standard dilatation (SD) per patient]. The 1-year target vessel revascularization rate was similar in both groups [nine (8%) for DS vs. 17 (11%) patients for SD, ns]. CONCLUSIONS: DS is feasible and safe in selected coronary lesions. This method provides a low rate of repeat revascularization and reduces the time and the dose of radiation compared with the standard approach.

Validation of a digital videodensitometric program analysis for measurement of left ventricular ejection fraction.

Left ventricular (LV) function was studied in 30 patients using digital subtraction angiography by the intravenous approach. Each ventriculogram was processed with a specific videodensitometric analysis to determine LV ejection fraction. The program was verified in an experimental set-up consisting of nine latex balloons filled with contrast medium. Its validation has been established by comparing videodensitometric results with classical results supplied by geometric methods. A good correlation was obtained (r = 0.9449) and, furthermore, with experimental models, videodensitometric analysis seemed to be more accurate than geometric analysis. Digital videodensitometry appears to be a valuable and accurate method for quantifying LV function, and a promising technique for determination of the real volumes.

Transient relief of abdominal angina by Wallstent placement into an occluded superior mesenteric artery.

A 56-year-old man presented with complete occlusion of the superior and inferior mesenteric arteries resulting in chronic mesenteric ischemia. After a minimal angioplasty a Wallstent was inserted across the superior mesenteric artery occlusion. This produced immediate clinical relief, with a successful angiographic result. Eight months later, an intrastent occlusion with acute bowel infarction was treated in emergency by saphenous vein bypass graft. Despite the death of the patient a few days later from a multivisceral failure syndrome, this method seemed to us feasible in treating a chronically occluded SMA in patients with high operative risk.

Peripheral artery thrombolysis with urokinase-lys-plasminogen. A disappointing experience.

Thirty-five patients with peripheral arterial occlusion were treated by intra-arterial infusion of low dose urokinase associated with bolus of lys-plasminogen. Systemic fibrinolysis was moderate, thrombolysis was achieved in 26 patients (74%). Only one patient required blood transfusion, five patients (14%) had distal emboli. Infection at the catheter entry site occurred in 2 patients, 3 patients experienced proximal embolism. Six patients required leg amputation, 4 died, in 2 of them deaths were related to arterial catheterization. Local thrombolysis with limited systemic fibrinolysis is associated to a high rate of catheter-related complications.

[Femoro-popliteal emboli: treatment by manual thrombo-aspiration]. / Embolies fémoro-poplitées: traitement par thrombo-aspiration manuelle.

Acute arterial thrombo-embolic pathology constitutes a common pathology in the elderly population, principally in cases of cardiac arrhythmia. Out study allowed analysis of the results of percutaneous manual thrombo-aspiration as a primary procedure in a series of 25 patients (average age: 73.3 +/- 11.3 years) presenting with a picture of acute femoro-popliteal ischaemia, of supposed cardiac origin. Most of the patients had an arrhythmia with atrial fibrillation (68%), and 88% had grade II ischaemia. The site of proximal occlusion most frequently found was the popliteal axis (22 patients). Thrombo-aspiration was performed in all cases via the common femoral route homo-lateral with the ischaemia, by anterograde approach, after having obtained a diagnostic angiograph of the opposite side. The procedure, with an average duration of 39 minutes, allowed restoration of good quality flow in at least 2 axes subjacent to the occlusion in 23 patients (92%). Besides two failures, two complications (8%) were counted (one Scarpa haematoma and one early re-thrombosis). This good result was sustained long term, with 94% of patients reviewed on average 3 years after the procedure remaining asymptomatic. Manual thrombo-aspiration thus constitutes a technique of choice in the framework of the management of acute infra-inguinal emboli due to its angiographic and functional results on the one hand, and its low morbidity on the other, in a population particularly exposed to the risk of spontaneous and post-operative vascular complications.

[Localized dilatation of the bronchi. A misunderstood etiology of coronaro-bronchial fistula]. / Dilatation des bronches localisée. Etiologie méconnue de fistule coronaro-bronchique.

The authors report the case of a coronary to bronchial artery anastomosis secondary to focal bronchiectasis. The diagnosis was made after finding large retroatrial vessels on coronary arteriography. A pulmonary steal syndrome, frequently reported in this condition in the literature, was not present in that particular case. The diagnosis of a coronary to bronchial artery anastomosis should alert the physician to possible underlying cardiac disease (Tetralogy of Fallot, supravalvular aortic stenosis, severe coronary artery disease). A bronchopulmonary etiology (chronic obstructive airways disease, multiple bullae, bronchiectasis) is less commonly found as the presentation is often atypical.

[Quantification of left ventricular function by subtraction intravenous angiography]. / Quantification de la fonction du ventricule gauche par angiographie numérique par voie veineuse.

Digitised intravenous angiography (Diva), initially applied to the study of the aorta and great vessels, has benefited from technical advances, especially the possibility of recording 25 frames per second, which now allows studies of the heart itself. 22 subjects underwent angiography with digitised subtraction after injection of 50 ml of sodium diatrizoate and meglumine in the right atrium and selective left ventriculography in the same catheter session. The end diastolic and systolic indices and global ejection fractions were measured independently for each technique by Chapman's method by two observers. The model of digitised angiography used was a CGR Divas prototype functioning in the pulsed graphic mode at 25 images per second. The results showed that the Diva method gave reproducible values of the end diastolic index (101 +/- 29.8 and 104.5 +/- 30.7: r = 0.98), of the end systolic index (43.2 +/- 32.9 and 44.6 +/- 32.5; r = 0.98), and of the ejection fraction (62.5 +/- 17.16 p. 100 and 62.17 +/- 15.7 p. 100; r = 0.96). There was a close correlation between the results of Diva and selective ventriculography (end diastolic index: 97.8 +/- 21.1 and 101.6 +/- 10.3; r = 0.87; end systolic index: 38.82 +/- 24.8 and 43.9 +/- 21.17; r = 0.95; ejection fraction: 62.12 +/- 16.27 and 57.29 +/- 15.53; r = 0.95). There was a significant underestimation of the end systolic index using Diva (0.01 less than p less than 0.02). The originality of the pulsed graphic method is the totally digitised character of the data.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of numeric intravenous angiography in the study of coarctations of the thoracic aorta]. / Intérêt de l'angiographie numérique par voie veineuse pour l'exploration des coarctations de l'aorte thoracique.

The investigation of isthmic coarctation of the aorta comprises radiological opacification usually by a retrograde arterial approach. Digitised intravenous angiography (DIVA) is a new way of carrying out this task by a relatively simple and non-invasive technique. We investigated 32 patients with this method and now present our results: the investigation was performed for suspected coarctation in 22 cases and for postoperative assessment in 10 cases. The equipment used was characterised by a variable rate of acquisition from 1 to 3 images per second with a 512 X 512 matrix. The investigation consisted in an intravenous injection of 50 to 100 ml of contrast, usually via a peripheral vein (87.5 p. 100). Overall, DIVA demonstrated the coarctation or the appearances of the site of operation in 97 p. 100 of cases. This high success rate was related to the study population: young cooperative patients capable of maintaining apnoea and remaining still during the procedure. In the 21 patients referred for suspected coarctation (excluding the only failure of the series), the diagnosis was confirmed and the site of coarctation accurately located. The degree of stenosis was assessed subjectively: appearances of the site of coarctation, importance of the collateral circulation. In addition, a videodensitometric study, i.e. a study of the variations of the patterns of grey with respect to time, was carried out in 4 patients; in severe coarctation, a delay of about 4 seconds in the opacification of the zone distal to the stenosis was observed. This analysis is still at the experimental stage, but it may eventually allow reliable quantification of the degree of stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Percutaneous suture of femoral artery after diagnostic coronary angiography]. / Suture percutanée du point de ponction artériel fémoral après coronarographie diagnostique.

UNLABELLED: Complete local haemostasis after femoral artery catheterization can be performed using percutaneous suture devices. To evaluate efficacy and safety of these systems after diagnostic coronary angiography, we performed a randomized study where patients were treated either with a manual compression (group C) or a percutaneous suture (group T). Fifty patients were included in each group. Patients in group C had to rest at bed during 24 hours while patients in group T had to stand up and walk immediately after complete haemostasis was obtained. All angiographies were performed using a 6 F sheath. All patients had a clinical evaluation and an echography 24 hours after the procedure and all were reached by phone call at 15 days. Both groups were similar in term of age, sex ratio, diabetes, height and weight. Complete haemostasis was obtained in 20 +/- 6 mn in group C and in 6 +/- 10 mn in group T (p < 0.001). Device technical success rate in group T was 90%; 70% of patients walked immediately down the X ray table and 90% before the 4 hours. Ambulation delay was 24 +/- 5 hours in group C and 5 +/- 9 hours in group T (p < 0.0001). Clinical and echographic complications rate were similar in both groups (8%). There was no post procedure complication in group T (especially after ambulation) nor at the phone call. CONCLUSION: Femoral artery percutaneous suture after diagnostic coronary angiography is as safe and working than manual compression. It allows an immediate mobilization and ambulation, far earlier than compression.

[Hypoxemia after heart surgery by a right-left shunt via a permeable unrecognized foramen ovale]. / Hypoxémie après chirurgie cardiaque par shunt droite-gauche à travers un foramen ovale perméable et méconnu.

Hypoxemia is a relatively common complication in the immediate postoperative period after cardiac surgery under cardio-pulmonary bypass, usually due to pulmonary disease. When this does not improve with oxygen therapy and in the absence of pulmonary disease, it may be due to a right-to-left shunt. We report a case with a right-to-left intracardiac shunt due to persistence of a patent foramen ovale, which became functional again under the new hemodynamic conditions after surgery under cardiopulmonary bypass and assisted ventilation. The diagnosis and physiopathological mechanism were studied by cardiac catheterisation and angiography. Contrast echocardiography should be able to detect these acquired shunts relatively easily. The diagnosis requires appropriate therapy: discontinuation of ineffective assisted ventilation as this may aggravate the situation by increasing pulmonary resistance, and anticoagulant therapy to prevent potentially disastrous paradoxical thromboembolism.

[Determination of the ejection fraction of the left ventricle by videodensitometric analysis of digital angiography. Preliminary results]. / Détermination de la fraction d'éjection du ventricule gauche par analyse vidéodensitométrique d'une angiographie numérique. Résultats préliminaires.

Digitalisation enables angiocardiography to be performed by a peripheral intravenous injection. Computer-assisted analysis of the date widens the possibilities of quantification. The authors have developed a videodensitometric method of studying the left ventricular ejection fraction. The research was performed on an experimental model and the technique validated in a series of 10 patients. The experimental model consisted of a series of balloons which, when inflated with contrast medium assumed an allipsoid shape resembling a left ventricle. The balloons were blown up in two stages with an automatic injector to simulate systole and diastole. The images were recorded in the same way as during ventriculography. Videodensitometric measurements showed 3 to 5% variations from the true values. The method was then applied to the calculation of the left ventricular ejection fraction in 10 patients: left ventricular function was also quantified by geometrical methods (Dodge) from the same angiogrammes and the 2 sets of results were then compared. The correlation coefficient between the two methods was 0.97, so validating the new technique. Videodensitometry opens up new perspectives in the study of left ventricular function. On the other hand it can be used to monitor the ejection fraction in severely ill or recently operated patients, and, on the other hand the principle of videodensitometry eliminates the geometrical approximations inherent in the classical methods of angiographic analysis and would therefore seem to be more suitable for the study of pathological left ventricules (aneurysm...). Finally, the technique of videodensitometry represents a new step towards the measurement of true volumes and flow rates.

[Percutaneous angioplasty in iliac obstructions. Immediate and long-term results]. / Angioplastie percutanée avec endoprothèse dans les occlusions iliaques: résultats immédiats et à distance.

During the last 35 months, mechanical recanalisation was obtained in 25 (19 men, 6 women, aged 39 to 92 years, average 59 years) out of 30 patients admitted for percutaneous andovascular management, associating angioplasty and endovascular stents, of iliac artery occlusion of over 5 months duration. Forty-three balloon-expandable stents (27 Palmaz, 16 Strecker) were implanted in 29 iliac arteries (15 external, 14 common iliac arteries) with occlusions 2 to 7 cms long (average: 4.6 cm) either after balloon angioplasty (22 cases) or without angioplasty (7 cases) because of a suspected fresh thrombus suggested by easy recanalisation by the guide wire and with the aim of avoiding fragmentation and embolisation of the thrombotic material. In this type of case, a Strecker stent was preferred, a choice also justified by an "obligatory" contro-lateral approach (5 cases). With the exception of these cases, the treatment of first intention was to insert one or more Palmaz stents by a homo-lateral approach. Two haematomas with no complications and 1 reocclusion at the 24th hour, revascularised by urokinase with a good 6 months result, were observed. After the insertion of one Palmaz stent in one patient, a non-occlusive thrombus, probably due to embolism, was observed straddling the homolateral superficial and profunda femoral arteries, but it was of no clinical consequence. After thromboaspiration and angioplasty by a contro-lateral approach, the arterial lumen was recanalized with a sustained result at 18 months. Clinical Doppler and angiographic (digitised intravenous angioplasty) controls were obtained every 6 months in 22 patients.(ABSTRACT TRUNCATED AT 250 WORDS)