Spontaneous dissection of the celiac artery.

We describe a case of intestinal angina caused by spontaneous dissection of the celiac artery and thrombosis of the superior mesenteric artery. Spontaneous dissection of a visceral artery is an uncommon occurrence that is usually diagnosed after fatal hemorrhage or ischemia. The underlying mechanism is unclear but the frequent association with multiple arterial lesions suggests general arterial disease. In symptomatic forms, surgical reconstruction is mandatory, to treat the lesion and allow definitive histological diagnosis.

Arterial pressure and neurologic morbidity during carotid surgery under peridural anesthesia.

In 163 carotid reconstructions under peridural anesthesia performed from 1988 to 1991, we routinely measured residual systemic and carotid artery pressure during clamping. Seventy-nine patients (48.5%) were asymptomatic and 84 (51.5%) had a history of neurologic manifestations in the form of transient ischemic attacks (28%) or stroke (13.5%). None of the patients died perioperatvely. Eight patients (4.9%) had strokes, with complete recovery in five. A shunt was placed in 22 patients (13.5%) because of neurologic evidence that carotid clamping was poorly tolerated. This study showed a distinct association between residual pressure in the internal carotid artery and systemic arterial pressure and intraoperative neurologic morbidity. Using a cutoff value of 35 mm Hg for residual pressure, the sensitivity was 77% and specificity 81%. Using a cutoff of 80 mm Hg, the sensitivity was 60% and specificity 86%. There was no correlation between mean systemic arterial pressure and residual carotid artery pressure. The use of a shunt was the only factor with predictive value for postoperative neurologic complications. These findings suggest that measurement of systemic arterial pressure and residual carotid artery pressure is useful during carotid surgery, but further study is needed before this information can be extrapolated to carotid surgery under general anesthesia.

[Gritti's amputation in vascular surgery]. / L'amputation de Gritti en chirurgie vasculaire.

Gritti's amputation was performed in 35 patients, mean age 71 years, with vascular disease of leg. There was no immediate postoperative mortality. Of twenty patients fitted with an appliance using a specific technique, only one had a poor functional result. The results obtained in this preliminary series were compared with those after amputations and knee disarticulations. They showed that Gritti's amputation should be considered for patients with arteritis when a functional knee is impossible to conserve.

[Ehlers-Danlos syndrome type IV, revealed by a primary dissecting aneurysm of the left subclavian artery]. / Syndrome d'Ehlers-Danlos de type IV, révélé par un anévrysme disséquant primitif de l'artère sous-clavière gauche.

The authors report an unusual dissecting aneurysm of the left subclavian artery occurring in a patient suffering from the Ehlers-Danlos syndrome. Clinical history and skin biopsy permitted this diagnosis. Surgical treatment associated resection of the aneurysm, ligation of the proximal part of the subclavian artery and a prosthetic bypass between carotid and subclavian artery. Spontaneous dissecting aneurysm is a rare disease and one must think before surgery to arterial dysplasia. Technical features of the surgical treatment are discussed.

[Results of 81 supra-articular femoro-popliteal bypasses using PTFE]. / Résultats de 81 pontages prothétiques fémoro-poplités sus-articulaires en P.T.F.E.

The indications for supra-articular prosthetic bypass is still a controversial subject in cases where the internal saphenous vein can be used, or in stage II cases. These bypasses cannot be performed unless they are as permeable as venous bypasses and do not greatly increase the risk of exaggerating the symptomatology in case of thrombosis. In order to evaluate the outcome of these bypasses, we evaluated retrospectively our series of 81 surpa-articular femoro-popliteal prosthetic bypasses performed between 1987 and 1989. The man age of the patients was 64 years and 38% of them had coronary artery disease. Forty-six bypasses (57%) were performed in advanced stage II patients, 20 in stage III patients (25%) and 15 in stage IV (18%). Mean follow-up is 42 months. At 36 months, primary overall permeability was 65%. This level of permeability is in agreement with the data in the literature and is independent of the initial clinical stage, the downstream arterial network and the size of the prosthesis. The outcomes observed in our series would favour use of P.T.F.E. in the first intention operation to save the vein for possible subsequent use at stages III and IV. Inversely, for stage II, prospective randomized studies should be conducted in order to compare endovascular techniques and medical treatments.

Behçet's disease revealed by double peripheral arterial involvement.

We report the case of a 62-year-old man with Behçet's disease revealed by double aneurysmal involvement of the posterior tibial and popliteal arteries. The diagnosis was suggested because of repeated phlebitis, buccal aphthous ulcerations, and results of human leukocyte antigen gene typing. The different arguments leading to the diagnosis of Behçet's disease and appropriate treatment are presented.