[Hypoplasia of the abdominal aorta. Review of the literature apropos of 4 cases]. / Hypoplasies de l'aorte abdominale. Revue de la littérature à propos de 4 observations.

The authors report 4 cases of abdominal aortic hypoplasia and, reviewing the literature, recall the anatomical classifications and the clinical aspects predominated by arterial hypertension and arterial claudication. Pathogenesis does not seem to be univocal and some arguments are in favor of a congenital origin when others plead for an acquired inflammatory disease. But above forty one must consider the possible responsibility of added atheroma. The numerous operative techniques point out the difficulties encountered in the treatment of the aortic lesions and associated arterial, mainly renal lesions. The polymorphism and complexity of these lesions oblige to vary the choice of indications.

[Indications and results of combined urokinase-lys plasminogen in acute ischemic pathology of the legs]. / Indications et résultats de l'association urokinase-lys plasminogène dans la pathologie ischémique aiguë des membres inférieurs.

Low dose urokinase-lys plasminogen was used to treat 10 patients with acute ischemia of lower limbs. Preliminary results are reported and indications defined, the combination producing effective relief and being very well tolerated biologically and clinically. All patients presented clear signs of ischemia provoking a short term risk for the limb. Direct femoral puncture arteriography of the ischemic limb was an essential pretreatment investigation. A thin catheter left in contact with the thrombus allowed localized fibrinolysis to be performed. Follow up arteriography examinations assessed clinicopathologic results, while biologic surveillance of principal coagulation parameters showed a lack of significant alterations during treatment. Ischemic signs were totally relieved in 7 cases, with arterial repermeabilization allowing recuperation of one (3 cases) or both (2 cases) distal pulses. Persistence of a popliteal thrombus in one case required a fogarty after a direct approach and the limb was saved. Two patients had to be amputated because of delayed treatment. These encouraging results suggest that this procedure of local thrombolysis be reserved for popliteal or infra-popliteal occlusions accompanied by sensory-motor signs and of recent (less than 72 hours) onset. Follow up for 8 months is insufficient but has shown the absence of deterioration, but this is obviously a function of the natural course of the underlying atheromatous disease.

[Percutaneous transluminal angioplasty in chronic arteriopathies of the lower limbs. Immediate anatomo-radiological results and functional outcome]. / Les angioplasties transluminales percutanées dans les artériopathies chroniques des membres inférieurs. Résultats anatomo-radiologiques immédiats et devenir fonctionnel.

The immediate anatomo-radiological results and functional outcome of a continuous series of 100 percutaneous transluminal angioplasties (PTA) in patients with chronic obliterative arterial disease of the lower limbs are reported. In 8 out of 10 cases, the patients had no previous surgical history. The iliac axis was more commonly affected than the infracrural arteries (57% compared to 43%). The indication of choice was the Leriche stage II (73%). The arterial lesion was responsible for the ischaemic pathology in 2 out of 3 cases. There was a higher incidence of preocclusive lesions (46%) than thromboses to be recanalised (23%) or significant stenoses (23%). The anatomo-radiological results were satisfactory in 80% of cases: a normal calibre was restored in 31% and stenosis was reduced to non-significant levels in 49% of cases. The morbidity associated with this technique was 7%: inability to dilate or thrombosis of the vessel. In 7 cases, failure was due to inability to pass the catheter across the stenotic lesion. Complementary surgical treatment was carried out on "accessory" arterial lesions in 33 cases; 32 sympathectomies for distal lower limb lesions and I femoro-popliteal bypass after iliac PTA. A total of 86.6% of PTA were followed up for an average of 22 months; 72% were totally asymptomatic; 21 were classified as stage II with improvement of their walking limits. The 3 year success rate was 0.92 +/- 0.1. Arterial surgery was necessary in 5.6% of cases for persistent severe intermittent claudication.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of thrombolytic treatment in thrombosis of valvular prostheses. Apropos of 2 cases and review of the world literature]. / Place du traitement thrombolytique dans les thromboses des prothèses valvulaires. A propos de 2 cas et revue de la littérature mondiale.

The authors report 2 cases of thrombolytic therapy by Urokinase at the dose of 4 500 U/kg/hour, for 24 hours, in patients with thrombosis of a Bjork aortic and Lillehei mitral valve prostheses, and assess the efficacy with a review of the world literature. The first case was a 65 year old woman who received a Bjork No 25 aortic valve prosthesis for aortic regurgitation. Two years later oral anti-vitamin K anticoagulants were replaced by an association of Aspirin-Persantine. She developed acute pulmonary oedema secondary to thrombosis of her valve during the fifth postoperative year. Treatment with Urokinase was successful (4 500 U/kg/hour for 24 hours). The second cases was a 33 year old woman who received a Lillehei No 27 mitral valve prosthesis for mitral regurgitation due to infective endocarditis. Six years later, during a period of apparently ineffective oral anticoagulation, she developed subacute pulmonary oedema due to thrombosis of her prosthesis. Urokinase therapy was successful after 4 hours, but the valve surface area on cardiac catheterisation was decreased and elective reoperation to change the prosthesis was decided upon. Prosthetic valve thrombosis is a serious complication with an operative mortality of 68.6% (35 deaths out of 51 reoperations in the worl literature) whilst the efficacy of thrombolytic therapy would appear to be about 80%. When thrombosis is progressive, the valve has to be changed surgically, but when it is secondary, thrombolytic therapy at least helps the patient survive the acute phase.

[Aorto-enteric and paraprosthetic fistulas. Apropos of 5 cases]. / Fistules aorto-entériques et paraprothétiques. A propos de 5 cas.

Five cases of aorto-enteric fistula (AEF) are reported. The first case was a primary AEF from rupture of the infrarenal section of the abdominal aorta treated successfully by an obliteration and graft. The second patient had a primary AEF from rupture of an abdominal aorta aneurysm, complicated after an obliteration and graft of the primary AEF, requiring excision of the graft and an extra-anatomical shunt (EAS): healing following parenteral hypernutrition. The third case, a patient with a primary AEF from rupture of an aortic adventitial cyst in the left colon, died from septic complications. The fourth case died with heart rhythm disorders on the 4th day after resection and EAS for an aortic fistula. The fifth patient had a secondary AEF with cataclysmic digestive hemorrhage: excision of the graft with digestive closure and aortofemoral bypass did not prevent a fatal outcome on the 20 th day. Digestive hemorrhage and septic signs may be combined or occur as isolated complications. The most valid complementary investigation is fibroscopy, bacteriological culture of arterial blood distal to the prosthesis having an orientation value. Ultrasound, computed tomography or Gallium scintigraphy imaging may detect a retroperitoneal abscess. Effective treatment of all aneurysms can prevent primary AEF and avoidance of infection and interpositioning of viable tissue between duodenum and anastomotic line reduce the risk of secondary AEF. Maximum chances of success require aggressive surgery: aortic ligature; excision of all septic material and duodenal closure or segmental digestive resection with discharge of proximal pocket. Lower limb ischemia is treated by insertion of an EAS.

[Prospective study of the long-term permeability of the internal saphenous vein and of polytetrafluoroethylene in the lower femoro-popliteal bypass. Results after 5 years in 100 patients]. / Etude prospective de la perméabilité à long terme de la veine saphène interne et du polytétrafluoroéthylène dans les pontages de sauvetage fémoro-poplité bas. Résultats à cinq ans chez 100 malades.

Autogenous saphenous vein (ASV) (50 patients-group I) was compared to polytetrafluoroethylene (PTFE) (50 patients group II), in 100 below-knee femoropopliteal bypass (FPB) procedures performed for limb salvage during à 5 year-period. PTFE was used as an alternative procedure in the absence of a suitable ASV. Each group made of 50 patients was not significantly different from the other. The mean follow up period for patent graft is now 35 months (12-60 months) and the overall life table cumulative patency at 5 years, is 65% in group I and 18% in group II (P less than 0.05) whereas the limb salvage rate (LSR) is 81% with ASV and 26% PTFE (P less than 0.05). No correlation was demonstrated between patency and run-off. The graft described was used in elderly patients most of whom would have had amputation before the introduction of PTFE. Theses results advocate the use of PTFE only in secondary intention and never to shorter operation time.

Clinical results of the aortic Medtronic-Hall prosthesis.

Between July 1979 and June 1982 we implanted aortic Medtronic-Hall prostheses in 40 patients. Ages ranged between 25 and 75, with a mean of 56 years. There were 38 cases of elective surgery (group I) and 2 acute aortic dissections (group II). All patients received anticoagulant medication. Follow-up ranged between 8 and 39 months with a mean of 22.5 months. Excluding operative mortality (7.5%) the 2-year actuarial survival rate is 97.2%. No death was related to the valve or its dysfunction. The overall thromboembolic rate is 0.78 per 100 patient years. No thromboembolic episode occurred in group I. No hemolysis was encountered and most patients experienced marked postoperative improvement. We consider that aortic Medtronic-Hall valves are valuable but further studies are necessary to confirm the results we obtained.