[False aneurysm of the femoral artery complicating exostosis]. / Faux anévrysme de l'artère fémorale compliquant une exostose.

A case of false aneurysm of the femoral artery due to an exostosis of the distal end of the femur is reported. The clinical diagnosis was confirmed by sonography and, especially, by a digitalized arteriography. The CT-scan showed the perforation of the arterial wall by the exostosis. The surgical operation involved the resection of the exostosis, the excision of the edges of the arterial lesion along with a venous patch. This type of complication due to an exostosis is quite rare and the discussion runs about the opportunity of systematic surgery of osteochondromas sitting close to a vascular course.

[Femoro-popliteal endarterectomy using a pneumatic oscillator]. / Endartériectomie fémoro-poplitée à l'aide d'un oscillateur pneumatique.

In patients with severe ischaemia from femoro-popliteal thrombosis, but without suitable vein for bypass, a synthetic or bioprosthesis is usually installed. This is a costly method giving statistically mediocre results. An alternative method is femoro-popliteal endarterectomy performed with rings that are made to oscillate by a pneumatic motor. The procedure requires 3 arteriotomies: one at each end and one in-between to insert rings of a different caliber. Arteriography is mandatory at the end of the operation. This type of endarterectomy is feasible only when blood flow is adequate upstreams, when the femoro-popliteal axis is not calcified and when at least one artery of the leg remains patent. The method is less expensive, and its early results apparently better than those of prostheses extending beyond the knee.

Aneurysm of persistent sciatic artery: report of a case treated by endovascular occlusion and femoropopliteal bypass.

Aneurysmal degeneration is the most serious complication of persistent sciatic artery. In the literature there have been only 16 surgically treated cases. We report one additional case to present an original and safe method of treatment: balloon endovascular occlusion and femoropopliteal bypass. Diagnosis and other methods of treatment are discussed.

[Are there indications for sympatholysis using phenol?]. / La sympatholyse au phénol a-t-elle des indications?

A phenol injection of the lumbar sympathetic chain has been performed 45 times on 40 patients whose mean age was 78 years and whose poor general condition was a contra-indication to any kind of anesthesia. The results have been evaluated at one month and one year in 33 patients. Among these patients, 21 had an available distal artery seen on the arteriography and 12 no distal artery. Our results suggest that: the injection is not always easy, the rate of complications is important: 2 deaths (4.5%) and 4 serious complications (9%) mainly nervous irritations, the rate of good results is poor: 42% at one month and 27% at one year. When there is a toe gangrene without any distal artery, a good result should not be expected. The diabetes mellitus had no incidence on our results. The indications to a phenol lumbar sympathectomy have to be selected: the best results have been obtained on patients with rest pain or ischemic ulcers when at least a distal artery could be visualized on arteriography. On the other hand no good result should be expected when there is a toe gangrene or when there is no distal flow either on the arteriography or on Doppler examination.

[Severe ischemia caused by femoro-popliteal thrombosis. Endarterectomy using a pneumatic oscillator]. / Ischémie grave par thrombose fémoro-poplitée. Endartériectomie à l'aide d'un oscillateur pneumatique.

Autologous saphenous vein bypass is the best treatment for severe ischemia with femoro-popliteal thrombosis. But in over 20% of cases a vein is not available. Patency rates after prosthetic grafts are low. Therefore we have tested femoro-popliteal endarterectomy with the Hall arterial oscillator. This instrument is composed of loops (size: 5-12 mm) and of a pneumatic oscillator. All the length of the artery has to be exposed. The endarterectomy is started with a spatula and is then performed with the oscillating loops. Three arteriotomies are usually necessary to remove the total core. After the arterial vacuity has been checked, the distal intima is tacked down and the arteriotomies are closed with or without a venous patch angioplasty. Thirteen patients have been operated on. All of them were high risk patients. They were submitted to surgery for rest pain, distal gangrene or acute ischemia. During the post-operative period, one death and 4 thromboses occurred, the latter leading to major amputation with two subsequent deaths. Early results of the 8 other patients were good. Mean follow-up was ten months. Limb salvage was achieved in 7 patients out of 8,6 of them with patent artery and 1 with an occluded artery. Run off was an essential condition for patency. The best results were achieved when distal arteries were patent. But some success occurred in spite of a poor run off. This technic is an useful and money saving alternative for severe ischemia associated with femoro-popliteal thrombosis when autologous vein is not available.

[180 cases of umbilical hernia repaired in a new way (author's transl)]. / A propos de 180 cas de hernies ombilicales opérées selon un nouveau procédé de réparation.

We describe a new method for the cutaneous repair of umbilical hernias. The cut of the skin makes two flaps suppressing the navel which is generally salient. After the aponevrotic repair which is made by vertical suture with slowly resorbable material, the repair of the two cutaneous flaps builds a new navel which aspect is very close to the natural one. This method has been used once with complete satisfaction, for the repair of an omphalocel.