Percutaneous endovascular treatment of peripheral aneurysms.

BACKGROUND: To evaluate the feasibility and efficacy of percutaneous endovascular treatment of peripheral aneurysms. METHODS: Forty-eight patients, M: 41, F: 7, mean age: 65.7 +/- 10.1 years (47-85 years), with 50 aneurysms were treated: 45 with covered stents (Cragg/Passager 22, Corvita 21, Wallgraft 1, Endotex 1) 4 with non-covered stents and 1 with stent graft. Twenty-six aneurysms located at the iliac artery, 12 at the femoral and 12 at the popliteal artery. Mean lesion length: 61.1 +/- 21.3 mm. Percutaneous approach used in all cases, femoral antegrade (n=24), retrograde (n=23), contralateral (n=2), popliteal (n=1). Stents used were 6-12 mm in diameter and 30-120 mm in length. Multiple stents used to cover all lesions in 20 cases. RESULTS: Immediate technical success was 96% (48/50). In 1 case of long, tortuous femoropopliteal aneurysm, it was impossible to cover the low part, due to rigidity of the device used, in 1 case of large iliac aneurysm there was incomplete immediate exclusion. No complication during the procedure. Four patients developed non-infectious fever/local pain. Eight thromboses occurred: 2 at iliac, 1 at femoral and 5 at the popliteal level. All other stents remained patent, the aneurysms completely excluded over a mean follow-up of 20.6 +/- 13.2 m, maximum 61 m. Primary patency: all lesions 82%, iliac 92%, femoropopliteal 78%. Secondary patency: all lesions 88%, iliac 96%, femoropopliteal 86%. CONCLUSION: Percutaneous endoluminal treatment of peripheral aneurysms seems safe and effective with high technical success and good long-term results, except for popliteal localization. It could be an alternative to surgery.

Endovascular treatment of internal iliac artery aneurysms.

PURPOSE: To describe a technique for percutaneous endovascular repair of internal iliac artery aneurysms. TECHNIQUE: In a patient with an isolated internal iliac artery aneurysm and combined tight stenoses at the origins of the external and internal iliac arteries, interventional treatment consisted of coil embolization of the internal iliac artery and branches using the contralateral femoral approach. Balloon dilation of the external iliac stenosis occluded the internal iliac artery, and Palmaz stents were placed in the external iliac stenosis to overcome residual luminal narrowing. CONCLUSIONS: This one-step percutaneous technique allows total exclusion of the internal iliac artery aneurysm using coil embolization. This treatment may be an alternative to surgery in isolated internal iliac artery aneurysms with small orifices.

Endovascular treatment of infrarenal abdominal aneurysms by the Stentor system: preliminary results of 79 cases. Stentor Retrospective Study Group.

PURPOSE: We report the initial French multicenter experience with the Stentor system in the endovascular treatment of AAAs. METHODS: Between May 1994 and March 1996, 79 patients with AAAs were consecutively treated with an endovascular technique using the Stentor system. There were 71 bifurcated grafts and eight straight grafts. The patients were followed-up from 1 to 18 months (mean, 5.7 months). Patient data and events were retrospectively analyzed. RESULTS: No patients was lost to follow-up. There were no surgical conversions. Four patients died after operation (4.8%). Two of them had been considered inoperable by the standard technique. Four patients (4.8%) had pulmonary complications, and three had colonic ischemia (3.7%). Forty-five patients (57%) had postoperative fever, and a transitory thrombocytopenia (10%) developed in eight patients. In 66 patients (83%) the aneurysm was immediately excluded. The exclusion was definitive in 62 (78%). In 17 patients, there were 13 initial and six delayed endoleaks. In two of these patients, the initial endoleak sealed temporarily and resumed after 1 year of follow-up, requiring an additional straight, covered stent. Over all, seven of the leaks were treated successfully by an additional endovascular graft, one leak required a lumbar artery embolization, eight leaks sealed spontaneously, and one leak was untreated. During follow-up, there was no aneurysm rupture. Two patients died of unrelated causes. CONCLUSION: The Stentor system can safely and effectively exclude AAAs in the short term. Careful follow-up is required to detect any delayed endoleak, and long-term results are awaited to confirm the efficacy of the method in preventing AAA rupture.

[Application of a new covered endoprosthesis in the treatment of occlusive and aneurysmal peripheral arterial diseases]. / Application d'une nouvelle endoprothèse couverte au traitement des artériopathies périphériques occlusives et anévrismales.

The aim of this study was to report the authors' experience of a new auto-expandable nitinol stent covered by a thin layer of polyester, the Cragg Endopro System 1, for percutaneous internal revascularisation. One hundred and forty-two patients (120 men, 22 women; average age: 63.5 +/- 10 (38-88) received a total of 204 stents (58 iliac, 75 femoral, 9 politeal). The lesions were stenosis in 61 cases, occlusions in 61 cases and aneurysms in 20 cases. The mean length at the femoro-popliteal level was 14.2 +/- 2.4 cm (4-30), at iliac level 9.4 +/- 0.9 (3-15). Implantation was successful in 140/142 cases, a technical success in 136/142 cases (96%). There were 4 acute thromboses requiring surgery and 4 others treated successfully by thrombolysis. There were 18 secondary thromboses. Twenty-nine patients had pyrexia and pain in the treated limb for several days. Over a 27 months follow-up all the iliac stents remained patent; there were 8 restenoses unrelated to the stent, 7 of which were treated by a repeat angioplasty. The primary (PI) and secondary (PII) patency rates at 27 months were: iliac, PI = 97%, PII = 100%; global femoral, PI = 64%, PII = 76% (stenosis PI = 59%, PII = 81%; occlusions, PI = 65%, PII = 74%); lesions of less than 15 cm, PI = 68%, PII = 93%; lesions over 15 cm, PI = 54%, PII: 76%; aneurysms, PI and PII = 88%). The authors conclude that the Cragg Endopro System 1 stent is safe and effective in the treatment of long lesions and aneurysms with encouraging medium term results suggesting that it may be a real alternative to surgery.

Occlusive and aneurysmal peripheral arterial disease: assessment of a stent-graft system.

PURPOSE: To assess the use of a recently developed stent-graft system for treatment of occlusive lesions and aneurysms in the iliac and femoropopliteal arteries. MATERIALS AND METHODS: The stent-graft consisted of a nitinol stent framework covered by a thin-walled polyester fabric. The device was used in 105 patients with symptomatic peripheral vascular disease. Implant locations were iliac artery (n = 38), femoral artery (n = 62), and popliteal artery (n = 5). RESULTS: Initial technical success was achieved in all patients except one with occlusive disease and one with aneurysmal disease. Residual stenosis after stent-graft implantation was 0.5% +/- 3. Mean ankle-brachial index increased from 0.53 to 0.98. Complications were hematoma (n = 3), pseudoaneurysm (n = 2), puncture site thrombosis (n = 1), early graft thrombosis (n = 8), graft misplacement (n = 1), distal embolization (n = 2), delayed thrombosis (n = 14), pain and fever (n = 27). At the iliac level, primary patency was 97% and secondary patency was 100%. At the femoral level, primary patency was 59% and secondary patency was 81%. CONCLUSION: Endoluminal bypass with a percutaneously delivered stent-graft is feasible. Technical results are good, and the number of complications is few at the iliac level. At the femoropopliteal level, patency is not as good and the number of complications is higher.

Palmaz stent placement in iliac and femoropopliteal arteries: primary and secondary patency in 310 patients with 2-4-year follow-up.

PURPOSE: To define the long-term outcome of stent placement in iliac and femoropopliteal arteries. MATERIALS AND METHODS: Three hundred ten patients received 418 balloon-expandable Palmaz stents. Two hundred thirty stents were implanted in iliac arteries of 184 patients, and 188 stents were implanted in femoropopliteal arteries in 126 patients. Restenosis rates were based on results of angiography performed 4-6 months after stent placement. Long-term patency rates were determined with duplex ultrasound. RESULTS: Immediate procedural success was achieved in 309 patients. Acute thrombosis ( < 24 hours) occurred in five patients, and immediate clinical success in 288. The 30-day mortality and morbidity rates were 0% and 8%, respectively. Angiography performed at 6 months in 299 patients revealed restenosis rates of 0.5% in iliac lesions, 11% in superficial femoral artery (SFA) lesions, and 20% in popliteal lesions. Survival analysis revealed 4-year primary patency rates of 86% +/- 4.1 for iliac artery lesions, 65% +/- 7.5 for SFA lesions, and 50% +/- 17.7 for popliteal artery lesions. Most restenotic lesions were successfully treated with repeat angioplasty. CONCLUSION: Implantation of Palmaz stents in iliac arteries allows long-term primary patency to be maintained in most patients.

[Endovascular treatment of aneurysms of the subrenal aorta using the Stentor endoprosthesis. Preliminary series]. / Traitement endovasculaire des anévrismes de l'aorte sous-rénale par l'endoprothèse Stentor. Série préliminaire.

The Stentor is a thermal memory Nitinol frame covered by an external permeable polyester fabric. The Mialhe Stentor bifurcation which is matted into the infra renal aorta is designed for the treatment of AAA extended to the bifurcation and the iliac arteries. The bifurcated device is comprised of two separately introduced segments: --the aortic part with a fixed iliac limb loaded into a 18 F delivery system is introduced into the common femoral artery by a cut down approach, --the contralateral iliac leg loaded into a 10 F introducer is inserted percutaneously. This preliminary series involves 84 Stentor procedures: 14 straight, 2 tapered, 21 single bifurcated and 50 bifurcated and extended devices. The per and post operative surgical complications are reported: 4 peripheral emboli, 1 partial left colon ischemia, 2 hematomas and 1 local infection at the access site. Post operative angio and CT scan are necessary to identify the remaining leakages and their origin. In this series two AAA remain injected because of a proximal leakage by mismatch which has to be treated by implanting a cuff. These preliminary results demonstrate the accuracy of the proximal positioning, the adaptability of the device according to the anatomical situation and its ability to be extended. A long term follow-up study is necessary to prove the long term effectiveness of the endovascular exclusion of AAA and to improve the selection criteria.

[Peripheral arterial angioplasty: value of the popliteal approach. Apropos of 30 cases]. / Angioplastie artérielle périphérique: intérêt de la voie poplitée. A propos de 30 cas.

The percutaneous common femoral arterial approach is usually used for endovascular management of lower limb arterial disease. This approach is sometimes impracticable because the femoral artery is the site of severe calcific atheromatous lesions which prevent arterial puncture or, when the superficial femoral lesions are ostial or proximal, make it impossible to position the introducer and advance the guide wire. The popliteal artery then becomes very useful for treating these lesions by a retrograde approach. Similarly, superficial femoral lesions which cannot be successfully dilated by the anterograde femoral approach may justify retrograde catheterisation via the popliteal artery. Between May 1988 and August 1991, the authors used the retrograde popliteal approach in 30 cases. They obtained 24 successes, 12 of which were associated with the implantation of an endoprosthesis. There was 1 complication at the puncture site a popliteal arteriovenous fistula was created but was treated successfully by surgery.

Lymphatic targeting of polymeric nanoparticles after intraperitoneal administration in rats.

Following intraperitoneal administration, the lymphatic targeting of polyacrylic nanoparticles has been evaluated in thoracic duct cannulated rats. The dosage forms administered consisted of carbon-14 polyhexylcyanoacrylate nanoparticles (PHCA) and polymethylmethacrylate (PMMA) nanoparticles. The carbon-14 concentrations were much higher in the excreted thoracic lymph than in the blood for both types of particles. The most dramatic results were found in the mediastinal nodes since the carbon-14 concentrations of rats receiving PHCA and PMMA nanoparticles by the ip route were 70- to more than 2000-fold higher than in the corresponding nodes of animals treated by the intravenous route. This potential lymphatic targeting could prove valuable in cancerology to treat tumors that metastasize in the peritoneal cavity or via lymphatic pathways such as colon carcinomas.

[Urinary tract infections during the 1st month after kidney transplantation]. / Infections urinaires du premier mois post-transplantation rénale.

The incidence and the predisposal factors of urinary tract infections (UTI) in the first month post-transplant were studied in 255 kidney transplantations (252 patients). UTI episodes were demonstrated in 73.7% of the grafts. The most common organisms were: Escherichia coli (35.8%), Staphylococcus (33.6%), Streptococcus D (11.2%), Klebsiella (5.3%). The infectious episodes were recurrent in 39% of the cases. The majority of the UTIs were asymptomatic but 7% of the infections led to septicaemia. Etiology of end-stage renal disease, pre-graft binephrectomy, asymptomatic vesicoureteral reflux into the patient's own kidneys, type of immunosuppressive treatment, acute tubular necrosis, rejection episodes, urological complications, coexistent other infections were not predisposal factors. Bacteriuria was more frequent in female than in male patients. The incidence of UTI was found to be statistically increased with history of UTI preoperatively (p = 0.039) and the use of ureteral catheter (p = 0.018). Occurrence of UTI was less common when the donor was treated by antibiotics before brain death (p-0.025). These results provide additional support for regular monitoring of urine cultures in the first month post-transplant. They should help to identify means of reduction of this infectious risk.

[Cure of complex post-irradiation uro-genital fistulae]. / Cure des fistules uro-génitales complexes post-radiques. A propos de deux cas.

The authors report two cases of complex radiation induced urogenital fistulae (vesicovaginal and combined rectovaginal), which were closed successfully at the second attempt with complete restitution of bladder function, without any urinary diversion using colpocleisis in one patient. They mention the necessity of bringing a new source of blood supply into the fistula repair area. Then, they review the different extensive procedures used to ensure this result: small bowel graft, omentopexy to reinforce the suture lines, fibroadipose tissue from the labia majora (Martius' operation). Lastly, basedow their experience and a review of the literature, they propose a therapeutic strategy based on a transperitoneovesical approach with the combined used of isolated small bowel and omental pedicle graft.

[Synechia of the labia minora as a cause of dysuria]. / Synéchie des petites lèvres cause de dysurie.

Vulvar fusion is common in children but is rarely discovered in adult woman. The authors report two cases, observed in post menopausal women, and revealed by urinary symptoms.

[The surgical treatment of pectus excavatum (author's transl)]. / La correction chirurgicale du thorax en entonnoir.

The Authors who have operated on 120 cases of pectus excavatum, describe their own method of surgical correction. It consists of: -- Sternal mobilisation by sternotomies; -- Limited chondreal resections; -- Internal fixation. The Authors emphasize the interest of a good internal fixation which must allow normal breathing during the period of cartilage's strengthening. The use of long flexibles thread pins affords a good stability and flexibility and assures at long term good cosmetic results.