Transluminal angioplasty performed by the surgeon in lower limb arterial occlusive disease: one hundred fifty cases.

From February 1985 through November 1988, we performed 159 transluminal angioplasty in 135 patients with arterial occlusive disease of the lower limb. The indications were claudication, 114 cases (72%) and limb salvage, 45 cases (28%). Lesions consisted of one or more critical stenoses in 142 cases (61 iliac, 69 femoropopliteal, and 12 following surgical revascularization) and single segmental occlusion in 17 cases (one iliac and 16 femoropopliteal). Angioplasty failed because the guidewire could not be inserted in nine (5.7%) cases. Angioplasty was performed intraoperatively in 44 (29%) cases and as an isolated procedure in 106 cases (71%). When performed as an isolated procedure, the percutaneous approach was preferred in 34 of the iliac lesions (73%), 28 of the femoropopliteal lesions (50%), and four of the postsurgical lesions (50%). Early postoperative mortality was 3.3% (five patients). Eight early occlusions (5.3%) were observed, two after iliac and six after femoropopliteal angioplasty. Secondary clinical surveillance and hemodynamic and venous digital angiographic follow-up detected 35 instances of stenosis (25%), 18 of which were equal to or greater than 60%. Nine occlusions occurred (6.5%), six after iliac angioplasty and three after femoropopliteal angioplasty. At 24 months, primary cumulative patency of all transluminal angioplasties was 84% and secondary patency was 89%. Transluminal angioplasty performed by the surgeon in the operating room provides good results whether performed as an isolated procedure or as a complement to surgery. The study of secondary deteriorations confirms the value of morphologic surveillance by arteriograms. Arteriography appears to be of paramount importance in the evaluation of results and the codification of indications.(ABSTRACT TRUNCATED AT 250 WORDS)

Extrinsic compression of the renal artery by diaphragmatic crus.

Extrinsic compression of the renal artery due to a fibromuscular band originating from the diaphragm was encountered in a 26-year-old patient who had systemic hypertension associated with stenosis and kinking of one of her renal arteries. After surgical decompression, the renal artery assumed a normal expansion with disappearance of hypertension. Six other cases of extrinsic compression of the renal artery have been found in the literature. Surgical treatment is mandatory in all cases because the mechanism that causes the lesion makes percutaneous transluminal angioplasty illusory.

[Transluminal angioplasty in a surgical setting. 150 cases]. / Angioplastie transluminale en milieu chirurgical. 150 cas.

Since 1985, 150 transluminal angioplasty operations have been performed by surgical teams, in the operating theater, for treatment of atheromatous lesions of the lower extremities, either as a complement to or in replacement of direct surgical repair. 150 angioplasties were carried out on patients with severe stage II lesions (72%). There was one or several significant stenosis in 140 of cases, and one short segmental thrombosis in 10 cases (1 common iliac and 9 superficial femoral or popliteal). These angioplasties fell into the following categories: 60 iliac, 78 femoral-popliteal and 12 angioplastic repairs of stenosis to iliac or distal femoral surgery (anastomosis, grafting, endarterectomy...). Angioplasty was combined with revascularization or lumbar sympathectomy in 29% of cases. It was performed singly in most cases (71%) and carried out percutaneously (45%) or by limited superficial proximal femoral approach under local anesthesia (26%), either directly or when the percutaneous approach failed. Eight cases of thrombosis (5.3%) developed during the first month: 2 cases after iliac angioplasty and 6 cases after femoral-popliteal angioplasty. Five deaths occurred consecutively to myocardial infarction. At long term, 4 cases of iliac thrombosis and 3 cases of thrombosis complicating femoral-popliteal angioplasty were detected. The overall cumulative permeability rate was 89% at 30 months, and there was no significant difference at one year's time between iliac and femoral-popliteal angioplasty patients (90% and 86%, respectively). Data collected from digital angiographic monitoring allowed to detect 9 cases of residual or recurrent stenosis (2 iliac, 6 femoral-popliteal and 1 postoperative lesions). Two repeat femoral-popliteal angioplasties were successfully performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Superficial and deep lymphoscintigraphic findings before and after femoro popliteal bypass.

The aim of this work is to explore the patients operated on for a femoro popliteal bypass (FPB) with lymphoscintigraphy (LS) of the lower limbs. Data concerning 35 limbs from 33 patients operated on for a FPB have been included in a prospective study. Superficial and deep LS have been performed by injecting 74 MBq 99mTc-Rhenium Sulphide Colloid into the subcutaneous tissue of the first interdigital space and of the lateral malleolus region respectively. Both superficial and deep LS have been performed before and after surgery. A postoperative oedema was found in 17 of the 35 limbs. The value of the lymphatic flow indices and their variation after surgery do not significantly differ between the oedematous and non oedematous groups. Thirteen of the 17 limbs with oedema have presented an interruption of the lymphatic circulation or a diffuse activity outside the lymphatic vessels on the postoperative superficial and/or deep LS. This proportion is only 1/18 in the non oedematous group. The difference between the two groups is highly significant (P less than 0.001). By contrast, the proportion of lymph cyst does not differ significantly between the two groups. In conclusion, this study confirms the close relationship between the oedema following FPB and surgical damage to the lymphatics.

Transvenous interruption of the inferior vena cava. New model of vena cava filter. Preliminary results in 35 cases.

Partial interruption of inferior vena cava (I.C.V.) forms an integral part of treatment of thromboembolic disease. The most frequently used filter worldwide is currently that of Greenfield, but although its effectiveness and permeability are remarkable it can be the subject of transfixions, sliding movements and migrations. A new model of the authors' own conception is presented which eliminates these faults. The "2612" filter is based on the same concepts, but has added to it 6 lateral flanges soldered to the base of the arms, these applying pressure to the I.V.C. and ensuring its perfect positioning, and 12 hooks (6 turned downwards and 6 upwards) ensuring perfect stability. Results of a multicentre trial in 35 patients, after insertion of the "2612" filter and follow-up assessment after 3 months (28 cases) by cavography and in some patients by a scan, showed permeability of 93% and total efficacy. No side effects were reported. This filter appears to represent true progress in the means of interrupting I.V.C., and further studies are contemplated.

[Partial interruption of the inferior vena cava using the 2612 filter. Apropos of 35 patients]. / Interruption partielle de la veine cave inférieure (I.P.V.C.I.) par le filtre "2612". A propos de 35 patients.

Partial interruption of inferior vena cava (I.C.V.) forms an integral part of treatment of thromboembolic disease. The most frequently used filter worldwide is currently that of Greenfield, but although its effectiveness and permeability are remarkable it can be the subject of transfixions, sliding movements and migrations. A new model of the authors' own conception is presented which eliminates these faults. The "2612" filter is based on the same concepts, but has added to it 6 lateral flanges soldered to the base of the arms, these applying pressure to the I.V.C. and ensuring its perfect positioning, and 12 hooks (6 turned downwards and 6 upwards) ensuring perfect stability. Results of a multicentre trial in 35 patients, after insertion of the "2612" filter and follow up assessment after 3 months (28 cases) by cavography and in some patients by a scan, showed permeability of 93% and total efficacy. No side effects were reported. This filter appears to represent true progress in the means of interrupting I.V.C., and further studies are contemplated.

[Value of exploring the deep lymphatic system of the lower limbs using lymphoscintigraphy. Preliminary study of 18 patients with arteritis]. / Intérêt de l'exploration du système lymphatique profond des membres inférieurs par lymphoscintigraphie. Etude préliminaire de 18 patients artéritiques.

Lymphoscintigraphy of lower limbs generally involves bilateral subcutaneous injection of a radioactive colloid into the first or second interdigital space: only the superficial internal saphenous pathway is visualized in this way (superficial lymphoscintigraphy: SL). However, the external saphenous and deep pathways can be explored by an external retromalleolar injection as demonstrated in radiology. Isotopic exploration of the external saphenous pathway and deep lymphatics (deep lymphoscintigraphy: DL) was carried out in 18 patients with arteritis also investigated by SL. The study forms part of a prospective trial of edema developing after femoro-popliteal shunts. The deep lymphatics are correctly and easily visualized, and in about 20% of cases there exist anomalies of distribution of superficial or deep lymphatic flow, morphologic anomalies developing postoperatively in one pathway only, or in both pathways. DL is a simple, reliable method of investigation of deep lymphatics, and complete exploration of lymphatics of lower limbs should include both SL and DL.

[Hemangioendothelioma of the right supra-clavicular region. Clinicopathologic study and management. Report of a case (author's transl)]. / Hémangioendothéliome du creux sus-claviculaire. Aspect diagnostique et thérapeutique. A propos d'une observation.

The authors present a case of hemangioendothelioma of the right supra-clavicular region in a 14-year-old boy. Interest of scanner in extension bilan and supraselective arteriography with tumor embolisation are stressed. Complete excision was possible and no sign of recurrence is noted 18 months later. Essential characteristics of a such tumor are reviewed.

[Per-operative blood flow measurement, complement to arteriography. Control and prognostic appreciation method (author's transl)]. / Débitmétrie per-opératoire, complément a l'artériographie. Méthode de contrôle et d'appréciation pronostique.

Per-operative blood flow measurement is studied as hemodynamic control in complement of arteriography (anatomic control). Early (1 month) and late (2 years) results are so reviewed in 217 popliteal or distal revascularisation. The authors attach more importance to the late value of peripheral arterial resistance with appears in relationship with early prognostic and post-operative failure. The authors recommend a vascodilative test to define maximum flow and real value of peripheral arterial resistance. The study of intra-arterial vasodilator response appreciates better the value of distal run-off receptivity and was found to correlate well with clinical results. The present study demonstrates prognostic significance of per-operative flow data.