[Simultaneous occlusion of the abdominal aorta and both internal carotid arteries as the presenting symptoms of left atrial myxoma]. / Occlusions simultanées de l'aorte abdominale et des deux artères carotides internes révélant un myxome de l'oreillette gauche.

Myxoma is a benign tumour but which has redoubtable embolic complications. When situated in the left atrium, the emboli obstruct, in the majority of cases, the cerebral arteries, occasionally the visceral or coronary arteries, and, very rarely, the aorta. In this case, the authors report an atypical presentation with ischaemia of the lower half of the body, associated with pulmonary oedema and deep coma. The left atrial myxoma was responsible for complete and simultaneous obstruction of the internal carotid arteries and the infra-renal abdominal aorta. This report illustrates the fact that myxoma can be responsible for massive, life-threatening, embolisation.

The role of polyester patch angioplasty in carotid endarterectomy: a multicenter study.

The objectives of this study were to examine the morphology, restenosis, dilatation, and possible complications of polyester collagen impregnated carotid patches. Between March 1994 and January 1995, 207 patients (56 females and 151 males) undergoing 221 carotid endarterectomies (CE) with a collagen-impregnated knitted polyester patch were enrolled in a European prospective multicenter study. Patches were used for arteries deemed to be smaller than usual by visual inspection. General anesthesia was used in 201 procedures (91%), and a shunt was used in 76 procedures (34.4%). One hundred fourteen CE (51.6%) were checked by a perioperative arteriography or angioscopy. The diameter of the internal carotid artery (ICA) and carotid bulb (CB) were measured by duplex scan both preoperatively and every 6 months during follow-up. The main end point was carotid occlusion or restenosis, defined as a stenosis of 50% or more according to NASCET criteria. Carotid polyester-impregnated patches appear to be reliable. The patch was easy to cut and suture, and hemostasis was obtained immediately. No rupture occurred. However, the higher restenosis rate in women may restrict the use of polyester patch to men.

Early carotid endarterectomy after a nondisabling stroke: a prospective study.

On the recommendation of several studies, carotid endarterectomy (CEA) should be delayed for at least 6 weeks in patients suffering an acute nondisabling stroke. Our objective was to determine if these patients could be safely operated on earlier, thus decreasing the risk of a recurrent stroke prior to surgery. This prospective study, carried out from January 1990 to December 1997, included 72 consecutive patients having a nondisabling hemispheric stroke with severe ipsilateral carotid stenosis (NASCET 70-99%). All patients underwent CEA within 15 days of stroke onset. Patients were considered to have a nondisabling hemispheric stroke if (1) symptoms of hemispheric ischemia persisted longer than 24 hr and (2) the resulting deficit caused no major impairment in their everyday activities. All patients were examined by a neurologist prior to carotid angiography and contrast CT scan. Hemorrhage seen on the initial CT scan eliminated the patient from the study. If the CT scan with contrast injection was negative, patients underwent magnetic resonance imaging. CEA was performed under general anesthesia with intraluminal shunting. All patients had a postoperative duplex scan and yearly follow-up by a neurologist and a surgeon, with a duplex scan of the carotid arteries. Mean follow-up was 53 months. Our study shows that CEA can be performed relatively safely within 15 days following an acute nondisabling stroke. The arbitrary 6-week delay for CEA may unnecessarily expose patients with high-grade stenosis to a recurrent stroke, which could be prevented by earlier surgery.

[Value of screening of aortic aneurysms]. / Intérêt du dépistage des anévrismes aortiques.

Among the causes of mortality observed in the elderly population between 65 years and 80 years, the specific mortality rate related to AAA has been rising for several years. The interest of screening programs has been demonstrated and elective surgery is likely to reduce the incidence of rupture in at risk patients. This prospective study will allow us to know the prevalence of AAA in our country. A screening program will be set up with general practitioners and elective surgery will be proposed according to the diameter of the aorta. Cost-effectiveness of this program will be assessed. Improvement of life expectancy will be measured.

[Chickenpox and limb ischemia. Report of a case]. / Varicelle et ischémie de membre. A propos d'un cas.

We have observed in our department a subacute left inferior limb ischemia by a forty one years old man in the following of a chicken pox while big arteries (arteria profunda femoris, lateral plantar artery, arteria dorsalis pedis) were attacked. We have not noticed in the medical literature such a case described. We have treated this ischemia by an in situ fibrinolysis which lead to a total clinical recovery, a complete patency of the lateral plantar artery and the arteria dorsalis pedis, and an incomplete patency of the arteria profunda femoris. We expose a few physiopathological hypothesis. But, in any case, we have not the proof of a connection between ischemia and the viral infection.