Patency after iliofemoral and iliocaval venous thrombectomy.

Between 1981 and 1984, 42 iliac venous thrombectomies were performed in 41 patients with recent iliofemoral venous thromboses. Of the 42 thromboses, 18 extended into the inferior vena cava. In 31 cases a temporary arteriovenous fistula was constructed and in 21 cases the inferior vena cava was partially interrupted. Early postoperative venography was performed in 40 of 42 thrombectomy cases. One or more late venograms were done one to four years postoperatively. None of the patients died during the hospital stay, and there were no cases of intraoperative or early postoperative pulmonary embolism. Six postoperative hematomas were evacuated. Patency of the iliac veins was maintained in 93% of cases. When performed with care venous iliac thrombectomy associated with a temporary arteriovenous fistula appears to be the appropriate treatment for iliofemoral or iliocaval thromboses less than ten days old.

[Contribution of complementary examinations in the diagnosis and treatment of emboligenic cardiopathies. Retrospective study apropos of 46 cases]. / Apport des examens complémentaires dans le diagnostic et dans le traitement des cardiopathies emboligènes. Etude prospective à propos de 46 cas.

The aim of this prospective study was to assess the value of complementary investigations in the diagnosis and follow-up of embolic heart disease. Forty-six patients having presented a systemic embolism cardiac origin underwent a standard work up which included clinical examination, ECG, chest X-ray and 2D echocardiography. Other investigations were carried out in some patients: CT cardiac scan (11 cases), gamma scintigraphy with Indium III labelled platelets (6 cases) and angiocardiography (12 cases). The diagnosis of an embolic cardiac lesion was made after the standard investigations in 82% of cases. The remaining 18% of cases hall had echocardiographic abnormalities and enable the diagnosis of clinically imapparent conditions: mitral valve prolapse, aneurysm of the interatrial septum, valvular calcification and cardiomyopathy. A potentially embolic mass was visualised in 18 patients; 6 valvular vegetations, 12 left atrial or ventricular thrombi. The other specialised radionuclide, angiographic and CT investigations only confirmed the echocardiographic diagnosis of intravavitary thrombosis. These results were confirmed surgically in 19% of cases. This study shows that complementary investigations especially echocardiography, allow diagnosis of latent embolic cardiac lesions, some of which may benefit from surgical treatment. In addition, potentially embolic intracardiac masses may be visualised, so confirming the origin of systemic emboli. When surgery is not indicated, echocardiography is a good method of following up the results of medical treatment in some of these masses.

[Photoplethysmography in chronic venous insufficiency]. / La photopléthysmographie dans les insuffisances veineuses chroniques.

Venous photoplethysmography (P.P.G.) is a non-invasive diagnostic technique using reflection of infrared light on the skin. The record gives a curve analogous to venous pressure. Normally the venous pressure of the leg decreases in response to calf muscle exercise. We have affixed the P.P.G. transducer to the skin above the medial malleolus and have analyzed the recovery half time (T 1/2) on 170 limbs: 49 normal, 82 with superficial venous insufficiency and 39 with deep venous insufficiency. Reference tests were ascending and retrograde phlebography and venous Doppler evaluation. A tourniquet was used to occlude the superficial venous network. T 1/2 without tourniquet is useful to screen limbs with venous insufficiency. T 1/2 with tourniquet differentiates deep and superficial venous insufficiency. P.P. G. can document the rise of deep venous insufficiency in patients with varicose veins and or repermeation of deep veins or post phlebitic syndrome among patients who have had thrombophlebitis.