Hydronephrosis after aortofemoral bypass graft. A prospective study.

This prospective study was designed to determine the frequency and natural history of hydroureteronephrosis (HUN) after placement of an aortobifemoral vascular graft. A total of 30 patients were evaluated by the study protocol, which included: pre and postoperative biological kidney function tests, preoperative and early postoperative (14th day) intravenous pyelograms and a late (mean 18th month) urologic examination by renal ultrasonic tomography. Four asymptomatic, early cases of HUN were observed in the 57 ureters examined (7%); all four complications regressed in less than 30 days. No cases of symptomatic early or late HUN were observed in this series. Asymptomatic early HUN was a frequent complication in our series (7%) but its benign course does not justify systematic screening. These asymptomatic complications contrast with the symptomatic cases of early or late HUN reported in the literature which necessitated urologic and vascular investigations.

Carotid endarterectomy plaques: correlations of clinical and anatomic findings.

To establish possible relationships between the structure of carotid plaque and neurologic symptoms, 187 consecutive endarterectomy specimens were studied prospectively. Each specimen was examined for gross and histopathological features. Intraplaque hemorrhage, although found infrequently, was closely correlated with the presence of symptoms. Plaque ulcerations were encountered more often when lesions were symptomatic. Calcifications were more frequently associated with asymptomatic lesions. Consistency of plaque was related to its morphological features (stenosis or ulceration) and symptoms. Soft plaques with predominant atheromatous grumous material and hemorrhage were associated more often with tightly stenotic, ulcerated, and symptomatic lesions. Consistency of atherosclerotic carotid plaques should be assessed and considered as an important element in the therapeutic decision.

[Value of axillofemoral bypass in the elderly]. / Intérêt du pontage axillo-fémoral chez le sujet âgé.

The aim of this retrospective study was to assess the merits of axillofemoral bypass in elderly patients. 69 axillofemoral grafts were laid from 1981 to 1985 in 56 patients, all older than 70. They always were aimed at limb salvage due to aortoiliac obliterating lesions (the indications of sepsis of aorto-bifemoral prostheses have been excluded). 13 patients have had an axillo-bifemoral graft and 43 an unilateral axillofemoral graft. The lower anastomosis involved the common femoral artery in 30 cases, the deep femoral artery in 39. The patients were followed up for 1 to 74 months, with an average of 24 months. The operative mortality was of 10 cases (17%). During the first postoperative month, 3 major amputations were required. The cumulated survival rate at 60 months was of 18%, with the primary and secondary patency rates at 60 months being of 46% and 71%, respectively. We conclude that axillofemoral bypass is perfectly adapted to this population of elderly subjects, in whom a direct aortic approach is counterindicated.

[Behçet's disease with multiple arterial lesions and voluminous hemangioma of the brain]. / Maladie de Behçet avec atteinte artérielle multiple et volumineux angiome intracérébral.

A case of a 43-years-old patient with a 9-year history of Behçet's disease is reported. The diagnosis was based on the past of bilateral hypopion iritis, oral aphthous ulceration and venous thrombosis. A right lower limb monoparesia occurred. CT scan and angiography showed a voluminous intracerebral angiodysplasia and an aneurysm of the left anterior communicating artery. Careful angiographic examination of visceral and peripheral arteries showed bilateral thrombosis of subclavian arteries, thrombosis of superior and inferior mesenteric arteries and an aneurysm of the coeliac trunk. Large arterial involvement is an unusual complication of Behçet's disease. A through review of the literature showed only 2 reported cases of intracranial arterial aneurysms. This case report was the first case of Behçet's disease with an intracerebral angiodysplasia.

[Prognosis of acute ischemia of the lower limbs in patients over 80 years of age. A prospective study]. / Pronostic des ischémies aiguës des membres inférieurs chez les sujets de plus de 80 ans. Etude prospective.

To demonstrate the importance of age in the prognosis of acute lower limb ischemia, a prospective study was performed in 137 patients over 24 months. Group I contained 75 patients aged under 80 years and group II 62 patients aged over 80 years. Risk factors and previous history were equally distributed in the two groups. The level of arterial blockage and the treatment were comparable in the two groups. Mortality was higher in group II than in group I (p less than 0.01). In both groups deaths were principally due to cardiac causes and a revascularisation syndrome. Amputation at thigh level was more common in group II (p less than 0.01). Mortality was higher in group II for combined thigh level amputation and cardiac or coronary insufficiency (p less than 0.05). This study demonstrated that, in terms of prognosis of acute lower limb ischemia, the critical threshold is 80 years.

Neurologic complications of axillary and brachial catheter arteriography in atherosclerotic patients: predictive factors.

Catheter arteriography by the axillary or brachial route can be responsible for central neurologic complications. The objectives of this prospective study were to define the predictive factors of these complications and determine their incidence. This report is based on 288 consecutive arteriography sessions performed between January 1985 and June 1987. All patients had arterial atheromatous pathology. Ten central neurologic complications (3.5%) occurred, two of which (0.7%) were permanent. Four factors were significantly associated with increased incidence of central neurologic complications: antecedent transient ischemic attack (p less than 0.001); tight (greater than 80%) stenosis of at least one internal carotid artery (p less than 0.02); angina pectoris (p less than 0.05); age over 80 years old (p less than 0.001). Seldinger's or Dos Santos' techniques are preferable to axillary or brachial catheter techniques for investigation of the lower limbs and the abdominal aorta. The former obviates the need to catheterize the aortic arch and reduces the risk of embolism to the supraaortic arteries. Digital venous arteriography is an alternative to aortic arch catheterization when investigating the supraaortic arteries in the presence of risk factors.

Synchronous reconstruction for combined aortoiliac and femoropopliteal occlusive lesions. The role of proximal bypass.

Between January 1984 and December 1986, 31 patients underwent synchronous revascularization (SR) because of the serious clinical condition of a lower limb and presence of arteriographically visible lesions. Average follow-up was 30 months. Operative mortality was 10%. Two patient populations were identified: Group I (N = 13): patients who underwent ilio-femoral or aorto-femoral proximal revascularization (PR); Group II (N = 18): patients who had axillo-femoral PR. Group I patients were younger than those in Group II (64 yr versus 72 yr; p less than 0.01). An association of pre-operative risk factors (arterial hypertension; coronary, renal or respiratory insufficiency) was twice as frequent in Group II as in Group I (p less than 0.02). The rate of SR compared to PR alone was 15%. However, there was no statistically significant difference between Groups I and II. Comparison of the actuarial survival curves for patients ahd the patency rates of SR in Groups I and II failed to reveal any statistically significant differences. Axillo-femoral bypass can be used for PR when SR is necessary in high risk patients.

Femorodistal bypass using the chemically processed human umbilical vein graft: 9-year experience.

To evaluate patency, limb salvage rates and complications associated with the use of human umbilical vein as an arterial substitute, the authors carried out a retrospective review of 52 femorodistal bypasses performed over 9 years using human umbilical vein. Indications for operation included acute ischemia, rest pain and nonhealing ulceration or gangrene. There were 28 early occlusions, which resulted in a 1-month primary patency rate of 46% and a secondary patency rate of 52%. The primary and secondary patency rates at 1 year were 18% and 19% respectively. The mean limb salvage rate at 1 month was 57% and at 1 year 34%. Three aneurysms occurred (two anastomotic, one graft). Factors found to have a significant effect on patency rates were indication for operation and state of distal runoff. Infection occurred in 6% of grafts and led to amputation in every case. These disappointing results have caused the authors to discontinue use of human umbilical vein as an arterial substitute.

Traumatic fistula between the aorta and the left renal vein: case report and review of the literature.

This report of an aorto-left renal vein fistula (ALRVF) of traumatic origin is the sixth such case on record. The fistula was successfully repaired, with preservation of the kidney, by autotransfusion. Review of the English language literature revealed the differences between spontaneous and traumatic ALRVF. Spontaneous fistulas were caused by rupture of an abdominal aortic aneurysm into a retroaortic left renal vein. Hematuria was almost constant (93% of cases). The operative mortality rate was 14%. By contrast, traumatic ALRVFs were the result of a penetrating wound to the abdomen. The left renal vein was in a normal position, anterior to the aorta. Hematuria was less common (16% of cases). The diagnosis was delayed because clinical signs were less acute. There were no reports of postoperative deaths.

[Venous involvement in the thoracic outlet syndrome (apropos of 30 cases)]. / L'atteinte veineuse dans le syndrome de la traversée cervico-brachiale (à propos de 30 cas).

This paper present 30 patients with subclavian venous compression caused by a thoracic outlet syndrome. 3 stages are differentiated: intermittent compression: 15 patients; acute occlusion: 5 patients; chronic occlusion: 10 patients. Every stage corresponds with a clinic and radiologic unit: venous claudication of the upper limb; phlebitis; post-phlebitis syndrome. 8/30 patients had a bilateral compression. 22/30 patients had an associated arterial compression. The hypertrophy of the subclavian muscle is the main etiology of the venous compression. The venography dynamic of the upper limb is the basic investigation. The resection of the first rib is the basic intervention, according to the technic of Roos. A venous thrombectomy was associated in 4 cases. A previous general thrombolysis was associated in one case.