[Value of arteriography scanning in lower limb artery evaluation: a preliminary study]. / Intérêt de l'artério-scanner dans le bilan des artériopathies des membres inférieurs: étude préliminaire.

PURPOSE: The purpose of this study was to assess the feasability of CT Angiography (CTA) with a single row of detectors and to compare it to digital subtraction angiography (DSA) in the evaluation of lower limb peripheral arterial disease. MATERIAL: and methods. A total of 22 patients underwent 24 lower limb Helical CTA using a Somatom Plus 4A (Siemens) and 24 DSA using an Angiostar unit (Siemens). CT angiography was performed in one acquisition (collimation 3mm/ couch motion 9mm/ interval 2mm) with tube rotation time of 0.75 sec from the aortic bifurcation to the calf. DSA was performed after catheterization of a common femoral artery using the Seldinger technique. Arteries were classified in four categories (normal or stenosis<50%, stenosis>50%, occlusion, aneurysm). VRT images and axial source images were assessed by two independent radiologists whereas digital angiographies were read by a vascular radiologist. RESULTS: Global interobserver agreement was good (Kappa=0.71). The degree of agreement between CTA and DSA ranged from low to excellent (0.25 to 0.97) depending on the artery. CONCLUSION: Lower limb CT angiography is a promising non invasive technique. VRT allows quick evaluation. However, is not accurate enough to replace digital angiography.

Superior vena cava stent placement: results with the Wallstent endoprosthesis.

PURPOSE: To assess the clinical success and short-term patency of the Wallstent endoprosthesis in the treatment of superior vena cava (SVC) syndrome. MATERIALS AND METHODS: Twenty-one 14-mm-diameter endoprostheses were implanted in 15 patients (mean age, 60 years) treated for SVC syndrome due to malignant compression (n = 14) or postirradiation fibrotic stenosis (n = 1) of the SVC. RESULTS: Immediate technical success was achieved in all patients. Two early complications occurred: retroperitoneal hemorrhage due to venous iliac tear and early stent thrombosis. In the 14 patients without early stent occlusion, stent placement resulted in complete relief of SVC syndrome; clinical success was 93%. SVC syndrome did not recur from 1 to 14 months, until the patient died (n = 11) or until the end of the study (n = 3). Helical CT showed a patent stent in five patients, respectively, at 3, 6, 8, 10, and 11 months. CONCLUSION: SVC stent placement has good clinical results and a high patency rate at short-term follow-up in patients with SVC syndrome.

[Techniques and complications of interventional radiology in vascular diseases of transplanted kidneys]. / Techniques et complications de la radiologie interventionnelle des affections vasculaires des reins transplantés.

The authors present a general review on the various techniques of interventional radiology in the treatment of vascular complications of renal transplants. Arterial stenosis require generally percutaneous transluminal angioplasty; arterial stenting is justified in cases of multiple restenosis and occluding dissection. Arterial thrombosis is treated by fibrinolysis or clot aspiration. Treatment of venous complications, such as stenosis or thrombosis, require analogous methods. Arterio-venous fistula and arterial aneurysms due to renal biopsy can be obliterated by dissection with a guide wire, or dropping of metallic coils, or electrical embolization. The authors emphasize the technical aspects, the difficulties and the complications of these procedures. The most frequent complication is the spasm of the renal transplant artery, which may lead to thrombosis. Arterial wall rupture and dissections are very rare. Hematoma at the puncture site of the arterial access are frequent; they may lead to false aneurysm, which can be treated also by noninvasive methods of interventional radiology.

[Imaging of cervical and thoracic chordoma. Apropos of 2 cases]. / Imagerie des chordomes cervicaux et thoraciques. A propos de 2 observations.

Chordoma is a rare tumor in spine. Two cases, exceptional in adolescents, are reported. The clinical evolution is slow and progressive. CT shows a lobulated tumor, precises the degree of vertebral osteolysis and detects intra-tumoral calcifications. MRI is useful to determine especially in high in soft tissues and the vertebral canal. Arteriography is realised in pre-operative time and permits an embolization when the tumor is hypervascularised.

[Value and strategy of paraclinical studies in the diagnosis of aneurysm of the abdominal aorta]. / Valeur et stratégie des examens paracliniques pour le diagnostic des anévrysmes de l'aorte abdominale.

With the development of abdominal echotomography and computed tomography, the abdominal aortic aneurysm is no longer explored by arteriography alone. After a retrospective review of 167 patients with aneurysms, the authors propose a schematic diagnostic procedure in 4 arms: positive diagnosis, extension evaluation, emergency statement and follow-up of the aneurysm. The expenditure with these tools has to be considered because of the large deviations in cost price between them. Arteriography is still selectively used for exploration of renal segment but it can often be replaced by computed tomography which is cheaper, external, simply and repeatedly used.

[Hemangiopericytoma. Apropos of a case in the thoracic muscles. Contribution of imaging technics (excluding MRI). Review of the literature]. / L'hémangiopéricytome. A propos d'un cas, musculaire, thoracique. Apport de l'imagerie (IRM exclue). Revue de la littérature.

The authors describe a recurrent case of an hemangiopericytoma of the left serratus anterior muscle, touching a 21 year-old woman. The different ways of imaging are exposed and compared with data of literature. It seems that none of them offers any decisive possibility of nature diagnosis. Conversely, radiological examinations are of greatest interest in the initial lesional statement, in the follow up and in early discovery of a possible recurrence, principally in case of difficulties in the pathological examination. CT appears to have the first role among the different ways of medical imaging, initially and in the appreciation of clinical course.

Intervertebral disk space infection following translumbar aortography.

After 1,748 translumbar aortograms three cases of intervertebral disk space infection were observed over a five-year period, for an incidence of 0.15%. Cultures suggested that the intervertebral disk had been inoculated with digestive tract organisms by the needle used to puncture the aorta. Diagnosis of this complication can be made early by retrieval of the responsible organisms from the intervertebral disk under CT control. Treatment consists of prolonged immobilization associated with appropriate antibiotic therapy for at least three months.

[Arterial hypertension caused by extrinsic compression of the renal artery of tumor origin in a child]. / Hypertension artérielle par compression extrinsèque d'origine tumorale de l'artere rénale chez l'enfant.

Stenosis of the renal artery secondary to an extrinsic acquired compression of the renal artery because of a tumor is rare. We report two cases. The first case is a boy of 14 months with a large neurogenic tumor from the right renal plexus with compression of the right renal artery. The second case is a girl of 2 years which had a neuroblastoma displacing the right kidney. The right renal vessels were invaded by very calcified solid masses and the removal was very difficult. Arterial hypertension secondary to an acquired unilateral renal stenosis may be healed definitely thanks to surgery.

[Arteriography of the hand in Raynaud's phenomenon]. / L'artériographie de la main dans le phénomène de Raynaud.

Analysis of 356 angiographic images of hand from 216 patients with Raynaud's phenomenon confirmed the higher prevalence of occlusive arterial lesions (75% of cases) when compared with idiopathic Raynaud's syndrome. The ulnar artery (30% of cases) and digital collateral arteries of free borders of hand (45 to 62% of cases) were the most frequently affected. This preferential localization of the arterial thromboses can be explained by repeated microtrauma from manual occupations (markedly increased in cases of digital arteriopathy). Correlation between the occlusive lesions and a thoracic outlet syndrome is lacking.

[The scimitar sign: a pulmonary vein or systemic artery? Apropos of a case of pure vascular sequestration]. / Le signe du cimeterre: veine pulmonaire ou artère systémique? A propos d'un cas de séquestration vasculaire pure.

The scimitar sign, characterised by a vertical opacity crossing the medial part of the right diaphragm, is generally attributed to abnormal pulmonary venous return draining into the inferior vena cava. This is not the only situation in which the scimitar sign is observed, which can also be seen in association with systemic anomalies, in particular sequestration. The authors report the case of a young adult in whom the chest x-ray presented the scimitar sign from childhood. This image was related to a pure pulmonary vessel sequestration by a right sub-phrenic artery. The authors stress the possibility of a purely arterial origin for the scimitar sign in the absence of any abnormality of pulmonary venous return.

[Late complications of catheterization of the subclavian vein]. / Complications tardives du cathétérisme de la veine sous-clavière.

Percutaneous subclavian venous cannulation has now become a routine procedure in anaesthesia and intensive care. Its early complications are well-known, but its delayed complications, somewhat rarer, remain often undiagnosed. A case is reported of a 32 year old man who presented with a subclavian arterial pseudo-aneurysm associated with a recurrent nerve palsy some 18 months after undergoing major trauma in a car crash. The post-traumatic origin of this complication is discussed. It was probably due to percutaneous venous cannulation, which led to a subclavian arterial lesion.

[Evaluation of the role of angiography in the diagnosis and surveillance of hepatic alveolar echinococcosis]. / Evaluation de la place de l'angiographie dans le diagnostic et la surveillance de l'échinococcose alvéolaire hépatique.

The authors recall the main pathologic and physiopathologic data necessary to understand the angiographic patterns of hepatic alveolar echinococcosis, by means of a rereading of a personal series of 37 cases. They show that this affection has a diagnostic angiographic shape which associate four signs: avascular aspect of the lesions, regular invasion of vessels, presence of a collateral circulation, absence of neovascularisation. Digestive angiography stays a good diagnostic method for the parasitosis, when epidemiological context, ultrasound or CT scan gave no explicit conclusion. It keeps an interest in the preoperative evaluation and in the supervision of portal vein.

[Value of intravenous arterio-nephro-urotomography in the evaluation of renal injuries]. / Intérêt de l'artério-néphro-urotomographie intraveineuse dans le bilan des traumatismes rénaux.

I.V. arterio-nephro- urotomogram turns out to be very useful in the work-up of renal traumas mainly by studying the cortical phase and the arterial phase. This technique allows to limit the indications for selective renal arteriogram.

[Spasm of the renal and digestive arteries. Radiologic aspect]. / Le spasme au niveau des artères rénales et digestives. Aspect radiologique.

Spasms of the mesenteric and renal arteries are of great concern to the radiologist specialized in angiography. In most cases, they appear to be of iatrogenic origin, due to difficulties in selective catheterization and especially in superselective catheterization of the mesenteric and renal arteries. In this case, spasm may be a most unwelcome side-effect. In other less frequent cases, spasms appear as indirect signs of an underlying spasmogenic disease, such as G. I. tract carcinoid, pheochromocytoma, pancreatitis or poisoning such as ergotism or digitalis overdosage. Most of all, it may occur during some non-occlusive intestinal ischemias. On the other hand, spasm can be considered as a way of treatment, especially in cases of G. I. bleeding, particularly due to ulcerations.

[Arterial spasms of the limbs]. / Spasmes artériels des membres.

After rapidly reviewing the anatomy and the physiology of vasoconstrictive pathways and numbering predisposing factors involved in vasoconstrictive, the authors report different causes of peripheral arterial spasm. They particularly insist upon the causes of acute ischemia or the causes which may result on a long term in cutaneous sign of chronic ischemia. Arterial spasm due to arteriography itself is evoked. Studies are based on vascular radiographic opacification after arteriography: constituting a precise and easy technique, this allowing identification, localization as well as definition of the different images uncountered in arterial spasm. Arteriography is not mandatory for diagnostic evidence, but good technical conditions allow a precise view of the arterial status of the limbs taken as a whole, as well as a pathophysiological view of the mechanism involved in same vasomotor troubles. It may also reveal complications. In a great number of cases, indications for treatment can be adapted.