Arterial endofibrosis in endurance athletes: angiographic features and classification.

PURPOSE: To describe the spectrum of angiographic features of arterial endofibrosis and to assess the patterns of associated lesions. MATERIALS AND METHODS: This retrospective study was compliant with the declaration of Helsinki principles. Files of patients who underwent surgery between January 1998 and December 2009 were retrospectively searched for histologic analysis-proven arterial endofibrosis. Preoperative angiograms were read in consensus by two radiologists. Abnormalities of the common iliac (CIA), external iliac (EIA), and femoral arteries were classified into five types, known as the CEF classification. RESULTS: This study assessed 180 patients (161 men, 19 women) with 195 symptomatic limbs (136 left-side limbs; P < .001). Angiography depicted 28 abnormalities in the CIA (27 stenoses, one dissection), 185 in the EIA (17 thromboses, 167 stenoses, one dissection), one in the common femoral artery (dissection), and 14 in the deep femoral artery (one thrombosis, 13 stenoses). CIA and EIA stenoses predominantly involved the distal and proximal third of the artery respectively. They were mild (CIA and EIA mean severity, 19% ± 7 and 26% ± 11, respectively) and long (45% ± 26 and 51% ± 26 of the artery, respectively). EIA stenoses were significantly longer in women (P < .003). Upon hip flexion, 23 CIA and 116 EIA stenoses showed kinking (mean amplitude, 76° ± 23 and 76° ± 30, respectively). All deep femoral artery stenoses were diaphragm-like and involved the lateral circumflex femoral artery. CIA, EIA, and femoral lesions were not randomly associated (P < .001). ConCLUSION: Arterial endofibrosis mainly affects the central part of the iliac artery and the lateral circumflex femoral artery. The CIA, EIA, and femoral lesion classification may help to distinguish patterns of associated lesions.

Treatment of popliteal aneurysms by femoral artery transposition: long-term evaluation.

A multicentric retrospective study was carried out on 29 operations (28 patients) to evaluate the long-term results of the treatment of popliteal artery aneurysms by transposition of the superficial femoral artery (SFA). This treatment consisted in proximal and distal ligation and bypass grafting or endoaneurysmorrhaphy followed by reconstruction of the popliteal artery. This surgery was always performed when the homolateral SFA could be used. After surgery, every patient was prescribed a long-term antiplatelet treatment. Mean follow-up was 39.2+/-28 months. Actuarial primary patency was 100% at 1 year and 92% at 3 years. No patients presented with either aneurysmal evolution of arterial graft or septic complication of prosthetic bypass. SFA can be used to treat isolated popliteal aneurysms with satisfying long-term results. This technique is an alternative to the use of autologous saphenous vein.

Effect of abdominal aortic grafts on aortic stiffness and central hemodynamics.

Graft-prosthesis and stentgraft placements are effective modalities for treating abdominal aortic aneurysm, but related changes in arterial stiffness are not well established. The present study sought to assess aortic stiffness after aneurism repair by measuring pulse wave velocity (PWV). The graft-related variation of carotid-femoral PWV was compared with that of carotid-radial PWV, the latter being unaffected by vascular treatment. The secondary objective was to evaluate potential differences between graft-prosthesis and stentgraft in terms of aortic stiffness and augmentation index, a composite indicator integrating wave reflexion. Fifty patients were included (39 had a graft-prosthesis and 11 had a stentgraft). In the whole group and after a median postoperative follow-up of 47 days, carotid-femoral PWV increased by +1.0 m/s [-12.3, +10.3], while carotid-radial PWV slightly decreased by -0.3 m/s [-4.4; +3.5] (P = 0.001). The effect of the type of prosthesis on the PWV was not significant. Nevertheless, the augmentation index increased after stentgraft implantation (+4% [-10; +17]) and decreased after graft-prosthesis placement (-8.5% [-47; +17]) (P < 0.01). This difference was not explained by a heart rate or a treatment effect and was likely attributable to the prosthesis per se. This study demonstrates the impact of aortic grafts on aortic stiffness. Besides, it suggests that stentgraft increases reflected waves more than graft-prostheses. These changes of vascular properties may influence the outcomes after surgery.

Past, present and future of arterial endofibrosis in athletes: a point of view.

Exercise-induced arterial endofibrosis (EIAE) is now a 20-year-old concept. Initially observed in highly trained cyclists, it has been found in many other male and female endurance athletes. Most stenoses are located on the first centimetres of the external iliac artery but other localisation may be found. The disease is defined by specific histological findings showing fibrosis of the intimal and medial wall of the artery. Ankle pressure measurement plays a key role in the diagnosis of EIAE provided that the exercise tests reproduce symptoms and are performed with the subject being highly trained, and that pressure measurements are performed early following exercise. Various cut-off values have been proposed in the literature. Magnetic resonance imaging or arteriography or ultrasound imaging should be performed by trained operators only. Surgical 'endofibrosectomy' is preferable in young cyclists generally associated with a saphenous enlargement patch. We do not recommend angioplasty. Athletes are generally allowed to return to competition within 3-4 months following surgery. Many unanswered questions remain, specifically about the pathophysiology of this disease. Mechanical and pressure strain play a central role in the development of EIEA, but nutritional and haemorrheological factors, hormonal changes and a genetic predisposition are likely to contribute. New techniques could facilitate the diagnosis of EIAE.

Endovascular treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta: long-term outcome.

The purpose of this multicenter study was to assess the long-term outcome of endovascular treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta on the basis of clinical and ultrasound examination. Clinical, ultrasound, and angiographic findings from 36 women and 50 men (mean age, 53.2 years) treated for atherosclerotic stenosis of the infrarenal abdominal aorta were reviewed. Patients had claudication in 74 cases and rest pain in 4. Seven patients presented trophic manifestations and one had blue toe syndrome. Mean preoperative systolic index was 0.71. Mean diameter reduction was 77%. Circumferential calcification was partial in 36 cases (41%) and complete in 30 cases (35%). Percutaneous transluminal angioplasty was performed using the single-balloon technique in 60 cases and double-balloon technique in 26 cases. A stent was placed in 76 cases (88%) by necessity in 34% of cases (22 residual stenoses, 4 dissections). Completion angiographic findings were considered good in 82 cases (95%). The remaining four patients had residual stenosis with a diameter reduction >30%. One patient died during the immediate postoperative period from septicemia unrelated to treatment (early mortality, 1.2%). Aortic angioplasty was complicated by stent detachment from the angioplasty balloon in two patients, retroperitoneal hematoma in one, peripheral embolism in two, puncture-site hematoma in three, myocardial infarction in one, and thrombophlebitis of deep femoral artery in one patient (early morbidity, 9.3%). All patients underwent follow-up with clinical and hemodynamic evaluation (mean follow-up, 31 months). Actuarial survival at 3 years was 91%. Primary actuarial patency was 94% at 1 year, 89% at 3 years, and 77% at 5 years. Aortic restenosis occurred in seven patients and was treated by angioplasty in two, aortobifemoral bypass in four, and surveillance in one. Mean systolic index was 0.89. Statistical analysis of patency demonstrated no factor predictive of long-term complication. From the long-term follow-up findings in this study, we conclude that aortic angioplasty is a reliable minimally invasive technique for treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta.

Arterioesophageal fistula: a rare complication of retroesophageal subclavian arteries.

Formation of a fistula between a retroesophageal subclavian artery and the esophagus is a rare cause of hematemesis that is usually fatal. Several etiologies have been described. The purpose of this report is to describe a case involving successful surgical repair of an arterioesophageal fistula induced by prolonged nasogastric intubation. A preoperative CT scan under emergency conditions allowed tentative diagnosis. Arteriography in the operating room confirmed the presence of a fistula and also allowed temporary hemostasis by tamponade. On the basis of a review of the literature, this case demonstrates the importance of screening patients requiring prolonged nasogastric intubation to rule out the possibility of an aberrant aortic arch system.

Force-velocity relationship on a cycle ergometer and knee-extensor strength indices.

Maximal anaerobic power (Pmax) is often measured on a friction loaded cycle ergometer by means of an all-out exercise against a single braking force or from the force-velocity relationship. The relationship between braking force (F) and peak velocity (V) in cycling is linear: V = V0(1-F/F0) where V0 and F0 correspond to the intercepts with the velocity axis and force axis, respectively. The aim of the present paper was to test the hypothesis that parameter F0 expresses strength ability. The first study (12 male volleyball players) showed significant correlations between F0 and maximal isometric voluntary force (MVF) or maximal isometric rate of force development (MRFD) during isometric knee extension with data expressed either in absolute units (0.66 < r < 0.81, P < 0.01) or related to quadriceps muscle mass kgQ or kgQ2/3 (0.58 < r < 0.82, 0.05 < P < 0.001). In the second study (24 male athletes), F0 was significantly correlated with the peak torques in isokinetic Biodex knee extension at four angular velocities (0, 1.57, 3.14 and 4.19 rad.s-1) with the values expressed in absolute units (0.49 < r < 0.83, 0.05 < P < 0.001). When the results were related to kgQ or kgQ2/3 the correlation coefficients increased with velocity (0.22 < r < 0.69) and were significant (0.05 < P < 0.001) except at 0 rad.s-1. Nevertheless, the interest of the determination of F0 in addition to Pmax is questionable because similar coefficients of correlation were obtained between Pmax and strength performances.