[Incidence of myocardial lesions after vascular surgery: diagnosis by troponin Ic]. / Incidence des lésions myocardiques après chirurgie vasculaire: diagnostic par la troponine Ic.

OBJECTIVE: To compare the incidence of myocardial damages diagnosed following vascular surgery using the cardiac troponin I measurement technique and conventional methods. STUDY DESIGN: Prospective epidemiological study. PATIENTS: Fifty-four patients who underwent surgery for either aneurysmal disease in 28 cases or occlusive aortic disease in 26 cases. METHODS: Plasma concentration of cardiac troponin I (significant at a concentration > 1.5 ng.mL-1) was measured by immunoenzymofluorimetry on the second and fifth postoperative days. Conventional monitoring methods included daily electrocardiogram (ECG), enzymatic assay of total-PCK, and measurement of plasma levels of the MB isoenzyme of phosphokinase creatine (MB-PCK) (significant at > 1 ng.mL-1 and RI > 1.5). RESULTS: The cardiac troponin I measurement technique allowed the diagnosis of minor myocardial damages during the postoperative period in five patients, whereas with the conventional methods (clinical signs. ECG, and MB-PCK) only three myocardial lesions were diagnosed. CONCLUSION: The cardiac troponin I measurement technique allows diagnosis of minor myocardial damages following vascular surgery. Conventional methods underestimate the incidence of these damages.

[Improvement of the tolerance of prolonged catheterization of radial artery]. / Amélioration de la tolérance du cathétérisme prolongé de l'artère radiale.

The incidence of thrombosis of the radial artery after long-term cannulation was evaluated in 84 patients randomly divided into two matched groups: polyethylene catheters were used in group A for a mean period of 9 +/- 1 days, and teflon catheters were used in group B for a mean period of 11 +/- 1 days. Thrombosis was diagnosed by bedside arteriography. Its incidence was 79% in group A and 9% only in group B. (p less than 0.001). It is concluded that the safety of radial artery cannulation is increased by using short teflon catheters.

[Prolonged catheterization of the radial artery. Prospective evaluation of the thrombogenic and infectious risk]. / Le cathétérisme prolongé de l'artère radiale. Evaluation prospective du risque thrombogène et infectieux.

The rates of thrombosis and infection were studied in 102 patients who underwent 107 radial artery cannulations. A Leader cath, ORX cannula (Vygon) was placed using Seldinger's method. It was continuously perfused with an heparinized 5% dextrose solution via an Intraflo fixed upon an arterial catheter. The cannulae were used for arterial pressure monitoring and measuring arterial blood gases. Before removing the catheter, a forearm arteriography was realized with 20 ml Hexabrix. Bacterial examination and culture were carried out on the cannula tips. 70 men and 32 women (mean age: 50 +/- 17 years) were studied. Mean duration of cannulation was 9 +/- 7 days (range: 1-34 days). Complete or partial radial artery thrombosis occurred in 85%. Complete thrombosis occurred more frequently in women (84%) than in men (54%) (p less than 0.05). There was no correlation between thrombosis and duration of cannulation (9.9 +/- days for thrombosis and 7.9 +/- 4.3 days without thrombosis). Bacterial cultures of cannula tips were positive in 24% of cannulations. Pathogenic bacilli grew in only 9%. Infected cannulas were in situ for 9.9 +/- 7 days against 8.9 +/- 6.7 days for the non-infected cannulas (NS). There was no correlation between infection and radial artery thrombosis. The use of another material (silicone, Teflon) must be studied in order to decrease the occurrence of thrombosis.