[Evaluation of the neurological risk of asymptomatic carotid stenosis and discussion of the value of carotid surgery in stage 0. Apropos of a study of 123 obliterative lesions]. / Evaluation du risque neurologique d'une sténose carotidienne asymptomatique et discussion de l'intérêt de la chirurgie carotidienne au stade 0. A propos de l'étude de 123 lésions oblitérantes.

The authors analyzed neurological risk on the basis of the study of 123 asymptomatic obstructive carotid lesions. Patients were divided into two groups: Group A (54 patients undergoing prophylactic endarterectomy). Group B (69 patients not undergoing surgery). Definition of the carotid lesion was based upon a combination of Doppler, sonography and arteriography results. Assessment of comparative neurological risk, on the basis of a hemodynamic definition of the stenosis, in the two patient groups, led to definition of appropriate management of an asymptomatic carotid stenosis. In group A, operative mortality was nil and there was one transient ischemic accident. In group B, there were 12 accidents, 9 transient and 3 permanent. In this latter group there was one neurological death, i. e. mortality of neurological origin of 1.5%. Evaluation of risk initially requires definition of the stenosis. The presence of a carotid bruit alone is inadequate. Doppler and sonography, followed where necessary by arteriography, define the degree of stenosis which is the primordial prognostic feature. The difference of risk between a population undergoing surgery or not is statistically significant, in particular in hemodynamically tight stenosis. Finally, the degree of stenosis influences the severity of any subsequent accident, although this has not been proved statistically. In the majority of cases, the initial accident would appear to be regressive. In total, 4 concepts have been defined: the risk of carotid surgery at stage 0 is low, being of the order of 0. Overall neurological risk is less in the long term in asymptomatic patients who have undergone surgery than in those who have not been operated upon.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of sonography. What more does it contribute than the Doppler test in the search for supra-aortic trunk lesions in the assessment of a patient presenting with a lower-limb arteriopathy?]. / Place de l'échographie. Qu'apporte-t-elle de plus que l'examen Doppler dans la recherche de lésions des troncs supra-aortiques au cours du bilan d'un patient présentant une artériopathie des membres inférieurs?

Supra-aortic trunk lesions were present in 40% of patients with constricted stage II, and stages III and IV of lower limb arteriopathy, while 17.5% presented hemodynamically significant stenotic lesions. It appears essential, therefore, to perform Doppler tests during routine investigations, particularly since most of these patients will improve after surgery. The Doppler ultrasound and echotomographic examinations are complementary and indissociable. The former studies hemodynamics and the latter the arterial condition of the tissue and its pathologic variations (regular hyperechogenic plaque, intraluminal irregular, only slightly echogenic plaque, aneurysm). The Doppler ultrasound test is an important and sufficient investigation, particularly for hemodynamic lesions: thrombosis, prethrombotic states and stenosis greater than 70%, whereas the ultrasonographic examination is confirmatory in non-hemodynamically significant cases. Combining these two exploratory procedures can optimize management, indications for arteriography and the choice of therapy in these patients with multiple arterial lesions.

[Our experience with surgery of chronic obstructive lesions of the subclavian artery. Apropos of 94 procedures. Critical analysis of our results]. / Notre expérience dans la chirurgie des lésions obstructives chroniques de l'artère sous-clavière. A propos de 94 interventions. Analyse critique de nos résultats.

Patient characteristics, types of lesion, routes of approach and techniques employed are discussed in relation to 94 cases of surgical treatment for chronic obstruction of the subclavian artery. The most frequently (60% of cases) used procedure was an extrathoracic by-pass operation, thrombo-endarterectomy being performed in 25%, réimplantations in 10%, and aortic by-pass implants in 6% of cases. Immediate and 30-day follow-up results are presented, and failures critically analyzed with regard to their relation to vascular or neurological complications, and those linked to the approach route. Conclusions to be drawn from these unsuccessful cases are exposed, as well as current tendencies in respect of indications for surgery in these lesions.

[Echographic study in the exploration of supra-aortic trunks. Comparative study with doppler velocimetry and their respective roles in functional vascular explorations]. / Examen échographique dans l'exploration des troncs supra-aortiques. Etude comparée à l'examen vélocimétrique doppler et leur place respective dans les explorations fonctionnelles vasculaires.

Over the last six months, 1,311 doppler examinations of the supra-aortic trunks have been performed with confrontation doppler, ultrasound, arteriography and intra-operative examination according to the cases. We studied these cases with the following questions in mind: Does real time ultrasound of the supra-aortic trunks give more valuable information than the classical doppler examination? Is the diagnosis simplified? Is the therapeutic management altered? We are able to conclude: 1. In the case of a mildly stenotic plaque (less than 50%), the doppler examination gives an acoustic and graphic representation which is rich and not differentiated for stenoses of between 10% and 50%, which corresponds to an ultrasound plaque of 1 mm to 4-5 mm: the ultrasound supports the diagnosis. 2. However, in stenoses greater than 50%, there is good correlation between the doppler examination, ultrasound and arteriography. Ultrasound enables the exact extent of the plaque to be visualised in sagittal and transverse planes. It can diagnose aneurysmal lesions and suggest ulcerated lesions. 3. Finally, the doppler examination seems to be indispensable in cases of pre-thrombosis or fresh thrombosis of the carotid. Ultrasound can be negative at this early stage.