[Floating thrombus in an aberrant right subclavian artery: a rare cause of peripheral arterial embolic events]. / Thrombus flottant d'une artère sous-clavière droite aberrante (arteria lusoria): une cause rare d'embolies artérielles périphériques.

INTRODUCTION: Floating thrombus in an aberrant right subclavian artery is a rare cause of peripheral arterial embolic events. CASE REPORT: We report a 45-year-old woman who presented with an ischemia of the right superior limb from embolic event. The diagnosis of mobile thrombus in an aberrant right subclavian artery was obtained with transoesophageal echocardiography and computed tomography. After three weeks of oral anticoagulant therapy, there was no significant resolution of the thrombus, and a surgical treatment was performed to prevent further embolization. The surgical procedure consisted of thrombectomy and reimplantation of the aberrant right subclavian artery to the right carotid artery. Postoperative recovery was uneventful. CONCLUSION: This case report illustrates that transoesophageal echography and computed tomography are useful to detect mobile thrombus of the thoracic aorta and is warranted in any embolic event in young patients.

[Vascular manifestations of Behçet's syndrome associated with solitary ulcerations and resolved with immunosuppressants]. / Manifestations vasculaires de type angio-Behçet associées à une aphtose monopolaire isolée et résolutives sous immunosuppresseurs.

INTRODUCTION: Behçet's disease is a systemic inflammatory disorder characterized by vasculitis. Its typical features are recurrent oral and genital ulcerations with uveitis. Although vascular lesions are not listed among the criteria for diagnosis of Behçet's disease, up to 25-35% of the patients develop complications in arterial and venous large vessels. EXEGESIS: We describe the case of a 45-year-old French man with Behçet-type vasculopathy. Though only one sign of Behçet's disease, i.e., oral ulcerations, was present, the patient had to undergo emergency surgery three times. The postoperative treatment combined corticosteroids, azathioprine, and oral anticoagulants. Three years later no therapy failure was observed. CONCLUSION: On the basis of 1) recurrent aortic aneurysms, 2) large arterial and venous occlusive lesions, 3) superficial phlebitis, and 4) ulcerations of the aorta in macro- and microscopic examination of resected aortic walls, we concluded that the patient's life threatening vasculopathy was of the Behçet's type, even if several of the diagnostic features of Behçet's disease were lacking. Variations in clinical features of Behçet's disease are observed that might be due to hereditary traits, particularly to the genetic expression of an incomplete phenotype that would lead to the lack of typical clinical features.

[Mechanical system of left ventricle cannulation: control of tightness by experimental left ventricular assistance]. / Système mécanique de canulation ventriculaire apicale: contrôle de l'étanchéité par assistance ventriculaire gauche expérimentale.

We have designed a mechanical device for left ventricular apex cannulation (SCAV). It will be used to implant a ventricular connection for a skeletal muscle ventricle placed in apicoaortic configuration without cardio-pulmonary bypass. The aim of this study was to assess the tightness of the ventricular connection at 48 hours. We used a left ventricular assist device (Biomedicus centrifugal pump) placed between the apex of the left ventricle and the descending thoracic aorta on 10 female sheep. The ventricular connection between the apex of the left ventricle and the Biomedicus was carried out with the SCAV and without cardio-pulmonary bypass. The intra-operative mortality was 10% (1 sheep) due to ventricular fibrillation. Three sheep died early in the run of the ventricular assistance due to technical assistance problems not related to the SCAV. The full ventricular assistance could be managed in 6 sheep through 32 h 30 (range from 15 to 46 h). No death occurred in these 9 sheep due to cardiac hemorrage or tamponade. The average apical bleeding in the pericardial drain was 157 ml (range from 20 to 270 ml). The tightness of the ventricular connection was proved by this study. The SCAV may be suitable for apical implantation of a skeletal muscle ventricle in sheep.

[Hospital procedures and surgical management of patients with stab wounds to the heart]. / Prise en charge hospitalière et conduite chirurgicale dans les plaies du coeur par arme blanche.

Stab wounds of the heart are frequent: one case every two and a half months in our service. In our series of 9 cases, only three were alive at arrival to the emergency ward, but in all of these three, treatment was simple requiring only simple wound suture without extra-corporeal circulation. Based on our experience and the data in the literature, we propose cooperation between three teams for managing these patients: anaesthesists, echocardiographists and cardiothoracic surgeons. The patients are admitted directly to the cardiothoracic operating theatre where the echocardiographist and the surgery team take charge. The surgical procedure depends on the general situation and especially on whether or not the echocardiologist can confirm haemopericardium immediately. Every patient with possible wound to the heart or major vessels should be managed directly by the cardiothoracic surgery team before of formal diagnosis has been established.

[Brachiocephalic trunk erosion by a tracheotomy cannula]. / Ulcération du tronc brachio-céphalique par une canule de trachéotomie.

We report the case of a 27-year-old severe head trauma patient who developed an erosion of the brachiocephalic artery, 19 days after the insertion of a tracheal cannula. Emergency treatment included overinflation of the tracheostomy cuff and surgery via sternotomy, with occlusion of the tracheostomy and the tracheo-arterial fistula and reimplantation of the brachiocephalic artery via a vascular prosthesis. This life-threatening complication is due to close anatomic relationships between the trachea and the brachiocephalic artery. In our case, the tip of the cannula eroded the anterior trachea wall resulting in a tracheo-arterial fistula with massive haemorrhage. Warning symptoms such as pulsations of the cannula and aspiration of blood must be recognised without delay and followed by an adequate pre-established management.

[Vascular complications of lumbar disk surgery. Report of two cases and review of the literature on 122 cases]. / Complications vasculaires de la chirurgie discale lombaire. A propos de deux cas et d'une revue de littérature de 122 cas.

We report two cases of right lumbar common iliac arteriovenous injury after an operation on the L4-L5 disk. One case was an arteriovenous fistula disclosed 5 years after the operation and in the other case, a postoperative acute haemorrhage. A retrospective study is carried out in the literature aiming at establishing the frequency of vascular injury in lumbar disk surgery, their nosologic definition, and the provided treatment. One hundred and twenty two observations were taken into account. The frequency cannot be determined. 78 of these observations (63.9%) reported an arteriovenous fistula between two elements of the aortic-cava intersection, with acute revelation (6.4%), sub-acute (19%) or late as a right cardiac failure (64%). Thirty one cases of acute haemorrhages through isolated arterial wound (25.4%), 3 cases of arterial or venous thrombosis (2.5%) and 10 cases of false aneurysms (8.2%) were found. The treatment was always surgical, sometimes in high emergency. In the case of haemorrhage the death rate was 21% and in the event of fistula 1.3%. Morbidity was 11.5%, mostly due to a post-phlebitic syndrome. These results reduce the mildness reputation of lumbar disk surgery all the more as recording of the complications is under estimated and most of them are found far from the initial act.

[Retroperitoneal lymphocele: a rarely reported complication of abdominal aortic surgery. Apropos of a case]. / Lymphocèle rétropéritonéale: complication rarement décrite de la chirurgie aortique abdominale. A propos d'un cas.

The authors present a case of a retroperitoneal lymphocele following prosthetic reconstruction of the abdominal aorta followed by a discussion about the principal differential diagnosis of a retroperitoneal collection following surgery on abdominal aorta. To date, only ten cases have been reported in this post-operative; it is probably a more frequent complication; the radiologist must play a major role both in the detection and the treatment of such collections.

[Hypertrophic arteriovenous fistula for hemodialysis. Reduction by means of a constrictive perivenous mesh]. / Fistules artério-veineuses hypertrophiques d'hémodialyse. Réduction à l'aide d'un filet péri-veineux constrictif.

Aneurysmal arteriovenous fistulae (AVF) for haemodialysis often need surgical closure. We present a technique which consists of inserting the AVF into a constrictive perivenous mesh tube, thereby bringing the caliber of the AVF down to its normal size and restoring the normal shape of the forearm. Nine patients underwent AVF constriction without postoperative events. All AVFs were patent at 4 months. This technique also has the advantage of saving veins which, of course, is worthwhile in patients under haemodialysis.

[Revascularization of coronary arteries. Reimplantation of the right internal mammary artery into the left in situ mammary artery]. / Revascularisation des artères coronaires. Ré-implantation en y de l'artère mammaire interne droite dans l'artère mammaire interne gauche.

The distal latero-circumflex arteries and the posterior descending artery are located so far from the mammary arteries that they cannot be revascularized by the conventional procedure. Reimplantation of the right internal mammary artery (RIMA) used as a free graft into the left internal mammary artery (LIMA) in situ doubles the length of the RIMA, thus enabling the distal coronary arteries (lower lateral or posterior interventricular arteries) to be bypassed. The Y-shaped reimplantation anastomosis technique is described, and the immediate results obtained in 25 patients are reported. Seven angiographic controls were performed after 6 months to 1 year, and 6 anastomoses were perfectly patent. One RIMA is occluded (major competitive flow).

[Late spontaneous revascularization of an internal mammary graft onto the anterior interventricular artery]. / Reperméabilisation tardive spontanée d'un pontage mammaire interne sur l'artère interventriculaire antérieure (IVA).

The authors report a case of internal mammary artery graft anastomosed to the left anterior descending coronary artery (LADC) which was found to be non functional in the early post-operative period (one month) but second catheterization at one year revealed the graft to be patent with thrombosis of the LADC. This case shows the flow adjustment possibilities of internal mammary artery graft.

[Double and sequential mammary artery bypass grafts. Apropos of 184 patients]. / Doubles greffons mammaires et pontages mammaires séquentiels. A propos de 184 patients.

In this series of 184 patients (pts), 312 internal mammary arteries were used to graft 430 coronary arteries. Two mammary arteries were used in 104 pts and sequential anastomoses were performed in 118 pts. The operative mortality was 1.6% and the peri-operative myocardial infarction was 4.1%. 9% of patients had post-operative complications: 1% of bilateral phrenic paralysis, 2.1% of post-operative hemorrhage leading to reoperation, 1.6% of sternal infection, 0.5% of true mediastinal infection, 1.6% of sternal dehiscence and 2.7% of reversible psychiatric illness. A 3 month follow-up was available in 160 pts. 95% of patients became angina free, the thallium scan shown a normal uptake of thallium at maximal stress in the myocardial grafted area in 92% of the patients.

Constrictive perivenous mesh prosthesis for preservation of vein integrity. Experimental results and application for coronary bypass grafting.

Saphenous veins undergo dramatic morphologic changes when used as coronary bypass grafts, and careful preparation of the graft alone is inadequate in preventing these changes. In this study, the use of a constrictive mesh for vein graft was evaluated. Fourteen sheep were subjected to a 5 cm resection of the carotid artery. Six sheep (Group A) received a jugular vein interposition graft, and the other eight sheep (Group B) received a jugular vein graft on which the constrictive mesh had been applied. The diameter of grafts in Group A was 14 +/- 1 mm compared with 7 +/- 0.5 mm for Group B (p = 0.05). The animals were put to death 4 months later. Scanning electron microscopy showed a disruption of the endothelial lining in Group A and a normal endothelium in Group B. Microscopy showed a statistical difference between Groups A and B regarding regularity and thickness of the intimal hyperplasia. Group B showed a moderate and regular intimal thickening and increased vasa vasorum. This indicates that distention and subsequent damage of the vein graft may be minimized by use of a constrictive mesh. Saphenous grafts surrounded by this constrictive mesh were inserted in four patients. Vein diameters were, respectively, 5, 4.3, 3.5, and 3.5 mm before meshing. After insertion in the mesh, vein diameters were 4.3, 3.5, 2.8, and 2.5 mm, respectively. Angiography performed 2 months later showed patent grafts of regular caliber.