[In situ thrombolysis in the treatment of venous thrombosis of effort in the arm]. / Thrombolyse in situ dans le traitement des thromboses veineuses d'effort du membre supérieur.

From March 1989 to March 1993, six athletic patients were treated in our institution by thrombolytic therapy for acute effort axillary-subclavian vein thrombosis in thoracic outlet syndrome. Mean age of these patients was 20 (range 14 to 27). An in situ infusion with urokinase (2,500 U/kg/h) and Heparin (100 U/kg/12 hours) was given during 64 hours (Range 14 to 72). Phlebography showed a complete reperfusion in three cases (the treatment began within an average period of 5.6 days), partial reperfusion in two cases (the treatment began within an average period of 8.5 days). In one case there was no reperfusion on phlebography: treatment began within an average period of 15 days. For this patient, a venous axillo-jugular bypass graft was performed. In all cases, there was no bleeding complication. A trans-axillary first rib resection was done three months later. Mean follow up was 31 months (range: two to 51 months). All patients recovered their previous physical status. Echo-Doppler exam showed normal subclavian vein flow in four cases, partial occlusion in one case and a total occlusion of the subclavian vein flow in one case. In this last case, the thrombolytic therapy failed to restore the permeability of the subclavian vein. Bypassgraft was patent. Axillary-subclavian vein thrombosis seen within a period of seven days should be treated by local thrombolytic therapy using urokinase and heparin.

Chronic pain of vascular origin caused by a parietopulmonary fistula of the thoracic wall.

We describe the case history of a patient who suffered from dorsal thoracic nonpenetrating trauma after a fall, with rupture of the aortic isthmus treated by thoracotomy. Arteriovenous fistula between the thoracic wall and the lung, with hypervascularization of the left thoracic wall, was revealed by atypical chronic thoracic pain and a murmur. This case demonstrates that chronic thoracic pain of vascular origin must be considered.

[Angiographic study of collateral circulation in coronary occlusion]. / Etude angiographique de la circulation de suppléance au cours des occlusions coronaires.

To define the collateral circulation pathways between coronary arteries, 101 coronarographies of patients who had at least one occlusion of a coronary artery (left-anterior descending artery, circumflex, right coronary) were analysed. We found 12 collateral pathways for the right coronary, 8 for the anterior descending artery, and 4 for the circumflex artery. These collateral circulation pathways have been mapped and compared to those of literature.