Pulsed transthrombotic fibrinolysis: technique and results in the management of occluded lower limb bypass grafts.

Between March 1987 and March 1993 we used pulsed transthrombotic fibrinolysis to treat 58 symptomatic thrombotic occlusions of lower limb bypass grafts in 45 patients. There were 17 suprainguinal grafts and 28 infrainguinal grafts. Treatment consisted of pulsed infusion of fibrinolytic agents into the thrombus followed by continuous infusion using an electric pump. Minor percutaneous or surgical procedures were often associated. The mean delay to treatment was 7 days. The mean duration of treatment was 150 +/- 66 minutes. Immediate patency was achieved in 88% of cases with no significant difference between suprainguinal and infrainguinal grafts. The clinical success rate was 55%. Actuarial patency at 1 year was 54% +/- 11% for suprainguinal grafts and 26% +/- 7% for infrainguinal grafts. The probability of patency was much lower in patients whose grafts had been implanted within 3 months before occlusion and in patients in whom an adjuvant procedure had not been performed. This study demonstrates that, in cases not requiring immediate surgery, pulsed transthrombotic fibrinolysis can achieve durable patency by treating both the bypass and distal arterial network. This technique allows identification of lesions causing thrombosis and adaptation of treatment specifically to these lesions.

[Carotid and aortic lesions: two-stage surgery]. / Lésions carotidiennes et aortiques: chirurgie en deux temps.

The problem of chronology between different surgical acts is at stake when a patient suffering from carotid and aorto-iliac or femoropopliteal diseases requires surgery. The joint operation increases surgical risk and its practice penalizes the surgeon. Sequential surgery is safer. It does not increase the risk of a adverse evolution of the diseases areas which has not been operated on at time of the first operation.

[Prospective etiologic study of 128 patients with ambulatory dep vein thrombosis]. / Etude étiologique prospective de 128 patients avec une thrombose veineuse profonde survenue en ambulatoire.

Etiology of deep vein thrombosis in ambulant patients (DVTA = TVPA in text) varies: cancer, blood disease, infectious focus, dysimmunity syndrome, dysglobulinemia, extrinsic compression, metabolic disorder, anomaly of hemostasis. A prospective study was carried out between June 1988 and September 1989 by angiologists in 5 regions of France to evaluate the diagnostic rentability of an epidemiologic survey and to determine possible distinctive characters of DVTA. The survey was comprised of a questionnaire, a full clinical examination and screening tests: chest x-ray, abdominopelvic ultrasound imaging, a-uro/gynecologic examination, full blood count, serum iron, ferritin, uric acid, triglycerides, cholesterol, protein electrophoresis, antinuclear antibodies, circulating anticoagulant, hemostasis factors and liver function tests. The study included 128 patients, mean age 60 +/- 16 years with a DVTA developing without a previous immobilization. The usual predominance in the left leg was not observed. The etiology was identified in 33 cases, including 20 (15.6%) as a result of the screening tests: anomalies of hemostasis (8), blood diseases (3), dysimmunity syndromes (4), extrinsic compression (3), cancer metastasis (1) and hypertriglyceridemia in a diabetic (1). The screening procedure was of no greater value in the absence of a triggering or predisposing factor, on the contrary. An anomaly of hemostasis was detected more frequently in the presence of local or regional triggering factors in the men (4 out of 4) and in the women on the pill (4 out of 4). The number of cancers discovered following screening (2%) was smaller than that expected according to the literature (10%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative trials of fluid gelatins on hemostasis in heart surgery in adults]. / Essais comparatifs des gélatines fluides sur l'hémostase dans la chirurgie cardiaque de l'adulte.

The purpose of this study was to compare, in adult cardiac surgery, the results of two gelatin substitutes (Plasmion and Haemaccel) especially for haemostasis and coagulation factors. Patients showing before operation any perturbation of blood parameters (anaemia, coagulation troubles) as well as patients suffering from serious complications or deceased in the postoperative period have been excluded. This study was realised with 54 patients randomised in two groups: group P (Plasmion); group H (Haemaccel). Anaesthesia was a diazanalgesia. Hemodilution was used in combination with autologous peroperative blood transfusion and reinfusion of residual blood from ECC after ultrafiltration. The two groups were statistically similar. In average, patients received the same gelatins quantity. The only remarkable findings were: a lesser decrease of platelets number per-ECC: a lesser fibrinogen level in postoperative period with Haemaccel.

[Plasma hemoglobin. Comparison between 2 methods of determination]. / Hémoglobine plasmatique. Comparison entre deux méthodes de dosage.

The methods used to titrate plasmatic haemoglobin, an analysis which is of great interest to cardiac surgery, must be very accurate because the levels are much lower than those found in whole blood. This work introduces a comparison between two methods: the ammoniacal water method and Cripps's differential method. After studying various criteria (repeatability, limit of detection, accuracy, reference values, stability of the reaction), and after studying the correlation between each method and the benzidin method, used as reference method, as well as the correlation between all of them, Cripp's method turns out to be the closest to the benzidin method, as well as being simpler, more accurate, more specific, and also easier to use than the ammoniacal water method, the only problem occurring at the stage of the preparation of the standard solution.

[Serologic and clinical study of post-transfusion viral contamination after cardiac surgery. Excluding human immunodeficiency virus]. / Etude sérologique et clinique des contaminations virales post-transfusionnelles après chirurgie cardiaque. En dehors du virus d'immunodéficience humaine.

The incidence of post-transfusion viral contamination after cardiac surgery is variable but not negligible. The serological and clinical features of such contamination were determined in a series of 100 consecutive patients seen between June, 1983 and January, 1984. The ELISA technique was used for hepatitis A and B viruses and cytomegalovirus on three samples of blood taken before (S1), and 15 days (S2) and 2 to 3 months (S3) after surgery. In case of hepatitis further investigations were performed for heterophilic infectious mononucleosis antibodies and for hepatitis B virus DNA. The transient appearance at S2 of anti-cytomegalovirus antibodies brought by transfusion was observed in 40% of the cases; seroconversion occurred in 4% (cytomegalovirus 3, hepatitis B virus 1), and 5% of the patients developed clinical and biochemical hepatitis without serological markers.

[Activated thromboplastin time, plasma heparin and plasma fibrinogen using the Fibrintimer 10]. / Temps de céphaline activé, héparinémie et fibrinogène plasmatique sur Fibrintimer 10.

After a thorough study, and having chosen the machine that is to equip an average sized haemostasis laboratory, the installation then requires certain steps (the reorganisation of work, better adapted reagents, a change of normality, a fine tuning of the technics, the time to get used to the machine). In this perspective, this work describes the regulation of the technic to determine the heparin activity on the Fibrintimer 10 (F 10) by chronometry (thrombin clotting time with variable concentration), a study of the repeatability and reproducibility of activated partial thromboplastin time (APTT), plasma heparin (HEP) and fibrinogen on the Fibrintimer 10, a study of the correlation between the results we got with the F 10 and the thermostat water-bath for the APTT and the HEP and between those we got on the F 10 and the fibrometer for the fibrinogen. The F 10 has allowed us to save more time whilst keeping the same technics and reagents. The determination of the heparin activity, by thrombin clotting time with variable concentration, gives us a method which is quick, cheap and useful for the following-up of the patients undergoing a treatment with standard heparin. The reproducibility and repeatability prove to be good for the 3 tests in our operatory conditions as well as the correlations between the results we get with both methods.