Transient periprosthetic thickening after covered-stent implantation in the iliac artery.M R Sapoval, J C Gaux, A L Long, M Azencot, O Hoffman, R Shoenfeld and A RaynaudAudio Available | Share

Acute femoro-popliteal occlusions (native arteries or bypass grafts) were treated by medical and surgical treatment. Despite improvement in surgical technique, patient mortality was high and limb loss remained frequent. Percutaneous endoluminal treatment of such lesions is feasible using in situ fibrinolysis and/or thromboaspiration singly or in association with balloon angioplasty. Those techniques are effective and are currently the first intention treatment of many of those acute femoro-popliteal occlusion. The advantages and disadvantages of those techniques are discussed, as well as their respective indications, and particularly their place compared to surgical techniques. New devices such as mechanical thrombectomy may increase effectivity and indications of endovascular treatment however such devices need to be better evaluated.

A patient was treated by PTA for a tight excentric stenosis in the external iliac artery. Following angioplasty, appropriate placement of a Palmaz stent over the lesion was impossible because of arterial curves and irregular aspect of the residual stenosis. To overcome this problem, the stent was grasped and pulled over the lesion using a snare loop device by contralateral approach.

Acute femoro-popliteal occlusions (native arteries or bypass grafts) were treated by medical and surgical treatment. Despite improvement in surgical technique, patient mortality was high and limb loss remained frequent. Percutaneous endoluminal treatment of such lesions is feasible using in situ fibrinolysis and/or thromboaspiration singly or in association with balloon angioplasty. Those techniques are effective and are currently the first intention treatment of many of those acute femoro-popliteal occlusion. The advantages and disadvantages of those techniques are discussed, as well as their respective indications, and particularly their place compared to surgical techniques. New devices such as mechanical thrombectomy may increase effectivity and indications of endovascular treatment however such devices need to be better evaluated.

Two cases of isolated calcified lesions of the aorta are reported. The first observation is that of a 25 years old man suffering from mild intermittent claudication predominant in the left leg. Radiological examination showed a calcified isolated lesion of the infra renal abdominal aorta. The patient underwent surgical treatment (thromboendarteriectomy) and was asymptomatic after 6 months. The second observation concerns a 30 years old man treated for benign thrombocytemia in whom a severe arterial hypertension associated with a thoracic bruit was discovered incidentally. Radiological workup demonstrated a solitary calcified lesion of the descending thoracic aorta. Endarteriectomy was performed and the patient was still asymtomatic at 12 months. A review of the literature as well as physiopathological hypothesis and diagnostic and therapeutic management of these uncommon lesions is proposed.

Two cases of isolated calcified lesions of the aorta are reported. The first observation is that of a 25 years old man suffering from mild intermittent claudication predominant in the left leg. Radiological examination showed a calcified isolated lesion of the infra renal abdominal aorta. The patient underwent surgical treatment (thromboendarteriectomy) and was asymptomatic after 6 months. The second observation concerns a 30 years old man treated for benign thrombocytemia in whom a severe arterial hypertension associated with a thoracic bruit was discovered incidentally. Radiological workup demonstrated a solitary calcified lesion of the descending thoracic aorta. Endarteriectomy was performed and the patient was still asymtomatic at 12 months. A revue of the literature as well as physiopathological hypothesis and diagnostic and therapeutic management of these uncommon lesions is proposed.

Treatments of neoplastic diseases often involve radiotherapy. One of its side effects is arterial damage. 1Piedbois P Becquemin JP Blanc I et al.Arterial occlusive disease after radiotherapy: a report of fourteen cases.Radiother Oncol. 1990; 17: 133-140Abstract Full Text PDF PubMed Scopus (40) Google Scholar Lesions in the aorta and iliac, mesenteric, pelvic, coronary, carotid, intracerebral, subclavian, and axillary arteries have been reported. These lesions mimick atherosclerosis, and there is no specific histologic hallmark of radiation-damaged arteries. The only diagnostic criteria of radiation-induced arterial injury is the occurrence of arterial lesions in a previously irradiated area with otherwise healthy arteries. Most of the cases reported occlusive lesions or stenoses, sometimes aneurysmal dilation or arterial rupture. 2McReady RA Hyde GL Bivins BA Mattingly SS Griffen GO Radiation-induced arterial injury.Surgery. 1983; 93: 306-312PubMed Google Scholar One publication reported distal embolism arising from a postradiation lesion. 3Bressler EL Vogelzang RL Atlas SW Neiman HL Radiation injury to the axillary artery presenting as distal thromboembolism.Am J Roentgenol. 1984; 143: 1079-1080Crossref PubMed Scopus (5) Google Scholar Three women, 65, 68, and 76 years old, were referred for the recent acute onset of permanent coldness and pain in the right hand, with ischemic or necrotic fingers. They had undergone radiotherapy after a right mastectomy for breast cancer 12, 14, and 19 years ago, respectively. At the time of referral, they were considered to be in complete remission. Angiography showed an inhomogeneous short, tight stenosis of the axillary artery, with loss of several digital arteries. The stenoses were considered to be postradiation lesions responsible for distal embolisms in the digital arteries. Percutaneous transluminal angioplasty (PTA) was performed via the humeral retrograde route with a 6F or 7F sheath. Because of additional spasm of the humeral artery, it was possible to leave the side port open during catheterization of the stenosis and during balloon inflation and deflation. The postprocedure angiography showed a good result with no residual stenosis or dissection in all three cases. The clinical follow-up (without ischemic complications) is 18 to 48 months. Surgical treatment of symptomatic radiation-induced arterial lesions is difficult because of hazards of anastomosis leakage and poor healing of the irradiated skin. Surgeons recommend bypass grafting with anastomosis in healthy (nonirradiated) cutaneous and arterial areas. 4Rosenfeld JC Savarese RP De Laurentis DA Management of extremity ischemia secondary to radiation therapy.J Cardiovasc Surg. 1987; 28: 266-269PubMed Google Scholar PTA of iliac, renal, and brachial radiation-damaged arteries has been reported as an alternative to surgery in the treatment of radioinduced arterial stenosis. 5Milutinovic J Darcy M Thompson KA Radiation-induced renovascular hypertension successfully treated with transluminal angioplasty: case report.Cardiovasc Intervent Radiol. 1990; 13: 29-31Crossref PubMed Scopus (16) Google Scholar However, PTA is rarely Fig. 1Angiograms of 76-year-old woman with acute ischemia of second finger and ischemic ulceration. A, Selective angiogram of right axillary artery shows hemodynamically significant ulcerated stenosis (arrow). B, Control angiogram after PTA shows reopening of artery and slight parietal damage (arrow).View Large Image Figure ViewerDownload (PPT)erformed on arterial lesions causing embolism because of a fear of distal embolism occurring during or after PTA. Our experience shows a good result of PTA on these emboligenic radiation-induced arterial stenosis, with a prolonged relief of ischemic symptoms.

In a series of 50 patients (22 females, 28 males); 52 ostial renal artery stenoses were treated by transluminal balloon angioplasty. The mean age of patients was 66 years (range 36-81); mean arterial pressures were 181 mmHg for the systolic pressure and 87 mmHg for the diastolic pressure. The mean level of serum creatinine was 179 mu mol/l +/- 128. An immediate success was obtained in 86,5 % (residual stenosis of 26 %). There were 7.6 % of immediate failures and 13.5 % of residual stenosis above 50 %. Mortality within 1 month was observed in 2 patients. - Morbidity included one aortic dissection and 5 cholesterol embolisms. After a mean follow-up of 10 months, 78 % of the series were controlled : 66,6 % exhibited a residual stenosis below 50 %, 25.9 % had restenosis and 7.4 % had an occlusion of the renal artery. Since patients with ostial renal artery stenosis constitute a high surgical risk group, transluminal balloon angioplasty might be considered as an acceptable and safe alternative treatment.

The aim of this study was to determine the frequency, significance and prognosis of small, abnormal, strand-like echos observed by early transoesophageal echocardiography after mitral mechanical valve replacement with hemi-disc prostheses. One hundred and twenty nine consecutive patients operated between October 1988 and June 1992 underwent transoesophageal echocardiography on average 15 +/- 7 days after surgery. A second transoesophageal echocardiography was performed in 52 patients on average 8 months after the first postoperative examination. The frequency of small strand-like echos and of non-obstructive thromboses of the valve at the initial transoesophageal examination was 43% and 8.5% respectively. A multivariate analysis showed that the only independent predictive factor for prosthetic valve strands was spontaneous intra-atrial contrast (p < 0.01). The presence of strands was significantly related to the prevalence of early thrombo-embolic events (confirmed non-obstructive valve thrombosis and systemic embolism). Strands were observed in 80% of cases with early thromboembolic complications compared with only 38% of cases with no early thromboembolic events (p < 0.04). Univariate analysis showed that the protamine/heparin ratio at the end of cardiopulmonary bypass and the percentage of ineffective postoperative heparinisation were higher in patients with these small, abnormal echos (p < 0.05 and p < 0.001, respectively). These appearances disappear at long-term transoesophageal echocardiographic control examinations in about half the cases. The authors conclude that the majority of these small, abnormal echos are thrombotic in nature and are associated with a higher thromboembolic risk, justifying effective anticoagulation in the first postoperative hours whenever possible, considering the risk of bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

In a series of 50 patients (22 females, 28 males); 52 ostial renal artery stenoses were treated by transluminal balloon angioplasty. The mean age of patients was 66 years (range 36-81); mean arterial pressures were 181 mmHg for the systolic pressure and 87 mmHg for the diastolic pressure. The mean level of serum creatinine was 179 mumol/l +/- 128. An immediate success was obtained in 86.5% (residual stenosis of 26%). There were 7.6% of immediate failures and 13.5% of residual stenosis above 50%. Mortality within 1 month was observed in 2 patients. Morbidity included one aortic dissection and 5 cholesterol embolisms. After a mean follow-up of 10 months, 78% of the series were controlled: 66.6% exhibited a residual stenosis below 50%, 25.9% had restenosis and 7.4% had an occlusion of the renal artery. Since patients with ostial renal artery stenosis constitute a high surgical risk group, transluminal balloon angioplasty might be considered as an acceptable and safe alternative treatment.

The aim of this study was to evaluate the early postoperative angiographic features of arterial coronary bypass grafts in 83 asymptomatic patients referred consecutively from the surgical unit. The patients aged 33 to 78 years (average 62 years) were operated between August 1989 and March 1992 and received only arterial coronary bypass grafts: 209 arteries bypassed (121 internal mammary including 10 sequential grafts, 46 radial, 36 epigastric including 4 sequential grafts and 6 gastroepiploic arterial grafts), an average of 2.4 bypass grafts per patient. Selective angiography of the arterial grafts was performed systematically between the 7th and 15th postoperative days in patients with uncomplicated recoveries. The native coronary arterial network was opacified only when a graft was "non-functional": haemodynamic (> 70%) stenosis or occlusion. 3.8% of pediculated mammary grafts were occluded. On the other hand, 16.6% of free internal mammary grafts were occluded. None of the radial artery grafts were occluded, but 8% were stenotic. Finally, 30% of epigastric and 50% of the gastroepiploic grafts were occluded. These results confirm the good function of in situ mammary artery grafts by suggest that systematic multiple arterial grafts should be used with caution. Radial artery grafts give very encouraging results which require long-term evaluation. Early postoperative evaluation of coronary arterial grafts provides important information and should be considered a routine procedure.

Blood pressure (BP) variability depends on external and internal factors. Among these, arterial baroreflex play an important role. The matter of this study is to assess the relationship between these two parameters in borderline hypertension (BL). Twenty six BL male hypertensive were recruited for the study, all gave informed consent. Age: 21 +/- 2 years, height: 177 +/- 8 cm, weight: 77 +/- 14 kg. An ambulatory BP monitoring was performed in each one using a Diasys (Novacor) recorder. Measurements were obtained each 15 minutes for 24 hours. Mean, standard deviation and variation coefficient (VC) of BP and heart rate (HR) were computed for 24 hours, daytime (9a.m.-7 p.m.), nighttime (11 p.m.-7 a.m.). Baroreflex sensitivity (BRS) was determined as the ratio of HR variation on systolic BP variation recorded with a Finapres device from the fourth phase of a Valsalva manoeuvre. Mean systolic and diastolic BP values for 24 hours, daytime and nighttime are: 129 +/- 11/73 +/- 13, 137 +/- 14/76 +/- 15, 114 +/- 11/69 +/- 12 mmHg. VC are: 12 +/- 3/15 +/- 3, 9 +/- 3/13 +/- 3, 10 +/- 3/13 +/- 4%. HR values are: 73 +/- 10, 84 +/- 14, 58 +/- 7 b/min, VC are: 24 +/- 5, 17 +/- 4, 17 +/- 7%. Index for BRS = 1.76 +/- 0.65%. There is no correlation between BRS and systolic BP or HR. BRS is correlated to the inverse of systolic daytime BP VC: r = -0.556, p = 0.003. There is no correlation with other parameters. This study provides evidence for a link between BRS and daytime BP variability in borderline hypertension.