[Diagnosis of thoracic outlet syndrome. Value of angiography in the sitting position]. / Diagnostic des syndromes du défilé cervico-thoraco-brachial: apport de l'artériographie réalisée en position assise.

PURPOSE: Thoracic outlet syndrome includes arterial, venous or neurological symptoms. Frequently difficult to diagnose clinically, confirmatory imaging studies are usually required. The purpose of this study is to review the diagnostic work-up during management of patients with thoracic outlet syndrome and demonstrate the value of angiography in the sitting position. MATERIALS AND METHODS: Retrospective study of 81 surgical procedures for thoracic outlet syndrome, between 1997 and 2005, in 56 patients aged 17-57 years. Surgery was bilateral in 26 cases, with bilateral surgery in a single setting for 1 patient. All patients presented clinical symptoms confirmed on US, angiography, venogram or EMG. Angiography, from a transfemoral approach, was initially performed in the supine position, without and with dynamic maneuver, and in the sitting position with dynamic maneuver when needed. RESULTS: In 48 patients, supine rest angiography showed stenosis in 6% of cases and supine dynamic angiography showed stenosis in 81% of cases, with severe stenosis in only 35% of cases (stenosis>80% or arterial occlusion). Angiography in the sitting position was performed in 33 patients, showing worsening of stenosis in 91% of cases, with severe stenosis in 87%. CONCLUSION: Angiography in the sitting position with dynamic maneuver improves the sensitivity for detection of thoraci coutlet syndrome. This procedure may be considered in addition to other imaging modalities routinely used including Doppler US, CT and MRI.

[Double aneurysm occurring on a venous aortocoronary graft]. / Double anévrysme sur greffon veineux aorto-coronaire.

The authors report the case of a 48-year old patient admitted to hospital for unstable angina 13 years after primary myocardial revascularisation by a saphenous vein aorto-coronary bypass graft. Routine chest X-ray showed a left para-hilar opacity which CT scan and angiography confirmed to be aneurysmal and pseudoaneurysmal dilatations of the saphenous vein bypass graft.

[Aneurysms of the popliteal artery. Intravascular bypass using the internal saphenous vein]. / Anévrysmes de l'artère poplitée. Pontage intravasculaire en veine saphène interne.

We used the internal saphenous vein to create an intravascular bypass for the treatment of aneurysms of the popliteal artery. The saphenous vein was positioned within the lumen of the aneurysmal popliteal artery and in the superficial femoral artery at its origin. Two end-to-end anastomoses were made including the venous wall within the suture. This new surgical technique is based on 3 criteria. i) anatomic: the venous bypass follows the exact path as the artery since it is situated within the lumen; ii) haemodynamic: end-to-end anastomoses are used to avoid turbulence created with end-to-side sutures; iii) histologic: the venous endothelium protects better against thrombus formation ensuring good long-term permeability.