[Percutaneous endoluminal angioplasty of the supra-aortic arterial trunks. Immediate and remote results]. / Angioplastie endoluminale percutanée des troncs artériels supra-aortiques. Résultats immédiats et à distance.

Twelve tight stenoses (9 of the subclavian artery, 1 of the axillary artery and 2 of the brachio-cephalic artery) were dilated with immediate satisfactory results in all cases. Only one complication (regressive lesion of the median nerve) was recorded. Eight patients were followed-up for a mean period of 13 months: all were symptom-free, and digital angiography by the intravenous route showed a stable image of patency. From a review of published dilatations of the subclavian artery it appeared that the method is 95% effective, that its mortality is nil and that no complication, notably embolism, has been reported. In view of the risks involved in surgical procedures and of the advantages of percutaneous transluminal angioplasty, at least in theory, this technique seems to be a suitable alternative to surgery in stenoses of the subclavian arteries.

[Other applications of numeric angiography]. / Les autres applications de l'angiographie numérique.

Digital subtraction angiography (DSA) is a valuable technique to study the aorta and its branches by intravenous injection. This technique is particularly devoted to study hypertensive patients and renal transplants. Nevertheless, the intravenous injection presents some limits, so the arterial route is sometimes still necessary. The arterial approach is particularly useful for studying immediate results of the arterial angioplasty.

[Numeric angiography: theoretical basis and practical realization]. / Angiographie numérique: bases théoriques et réalisation pratique.

Digital subtraction angiography (DSA) is a new technique for non-invasive visualization of the cardio-vascular system. The digitalization allows the post-processing of the images without loss of information. We can predict that DSA will replaced conventional angiography in many indications.

Improved diagnosis of unilateral renal artery lesions after captopril administration.

Captopril was administered (1 mg/kg of body weight) to 37 unselected hypertensive patients undergoing bilateral renal vein catheterization to determine its safety and efficacy in diagnosing hypertension related to unilateral renal artery lesions. In the 18 patients who had a unilateral renal artery lesion demonstrated by angiography, the ratio of plasma renin activity of the involved to uninvolved renal vein rose significantly after administration of captopril, whether or not patients were taking antihypertensive medication. This postcaptopril ratio differentiated cases of unilateral lesions from cases of bilateral lesions or absence of lesions without any overlap. The test was well tolerated despite occasional large drops in blood pressure. These data show that converting enzyme inhibition increases the diagnostic accuracy of renal vein catheterization by increasing the difference between the amount of plasma renin secreted by the two kidneys in cases of unilateral renal artery lesions.

[Contribution of digital intravenous angiography in the assessment of the postoperative results after surgery of the vessels of the neck]. / Apport de l'angiographie numérique par voie intra-veineuse dans l'appréciation du résultat post-opératoire de la chirurgie des vaisseaux du cou.

Forty-six patients who had undergone neck vessel surgery were investigated postoperatively by intravenous digitalised angiography. In 30 patients an endarterectomy had been performed and in one case the examination did not provide satisfactory opacification of the carotid vessels. In 29 cases the result was of satisfactory quality: the appearance of the operative site was normal in 21 patients, dilated in 3, irregular in 7 and stenosed in 1. Twenty patients had undergone a bypass. There was one failure and 19 results suitable for analysis. The bypass was normal in appearance and permeable in 14 cases, irregular in 1, dilated in 2 and obstructed in 2. Overall, intravenous digitalised angiography provided satisfactory assessment of the operative result in 96% of patients.

[Intravenous subtraction angiography in kidney transplant patients]. / L'angiographie intraveineuse numérique chez les transplantés rénaux.

Conventional arteriography in patients with kidney transplants and severe hypertension is performed principally to determine the presence of a renal artery stenosis. In patients with renal failure its use enables detection of any arterial lesions. Technological advantages provided by computerized angiography within the field of medical imaging should permit earlier diagnosis of arterial lesions, with a reduced risk and at a lower cost using a simple intravenous injection of the iodized contrast medium.

[Numerical angiography in the evaluation of arterial hypertension]. / Apport de l'angiographie numérique dans le bilan de l'hypertension artérielle.

Intravenous numeric angiography is a new method of medical imaging for investigation of possible renovascular causes of arterial hypertension. A non-invasive examination, it is less costly than conventional renal arteriography and can be performed in outpatients. Satisfactory images of the renal arteries were obtained in 80 p. cent of 200 hypertensive patients, and the presence of lesions was confirmed in 47 cases.

Percutaneous transluminal angioplasty of stenotic lesions in dialysis vascular accesses.

Forty-five stenoses behind arteriovenous fistulas in 35' haemodialysed patients were treated with percutaneous transluminal angioplasty (PTA). Immediate stenoses dilatation results in relation to the AVF type were haemodynamically significant in 40 cases (88%), with poorer results on bovine heterograft stenoses. Dilatation results in relation to the site of the lesion showed haemodynamically efficient angioplasty on stenoses next to the anastomosis (67.5%) but a poor result on distal lesions (4 cases). We observed 4 cases of thrombosis but 2 recovered after treatment, one after local fibrinolytic perfusion one after surgical thrombectomy. Follow-up over a period of one to 18 months (mean 8 months) including angiography and appreciation of the dialysis quality were performed in 30 patients who had a successful dilatation. PTA appears to be a technically feasible and clinically effective method of treating stenoses lying on the venous limb fistula in patients on chronic haemodialysis.

[Current indications for intravenous numerical angiography in the study of the ilio-femoral axis]. / Indications actuelles de l'angiographie numérique par voie veineuse dans l'étude des axes ilio-fémoraux.

A study of the arterial axis from the aortic bifurcation to the femoral bifurcation was conducted by intravenous digital angiography in 40 patients. In 92.5% of these, opacification and visualization of the arteries were good or excellent. In 12 out of 15 patients the images were judged to be of the same quality as those obtained by conventional arteriography. A limitation of the method is the size of the intensifying screen (23 cm), which only allows exploration of one segment at each injection. This, however, is a minor drawback when this technique is used for control examination after percutaneous angioplasty or to investigate an accident of catheterization.

[Hypoxemia after heart surgery by a right-left shunt via a permeable unrecognized foramen ovale]. / Hypoxémie après chirurgie cardiaque par shunt droite-gauche à travers un foramen ovale perméable et méconnu.

Hypoxemia is a relatively common complication in the immediate postoperative period after cardiac surgery under cardio-pulmonary bypass, usually due to pulmonary disease. When this does not improve with oxygen therapy and in the absence of pulmonary disease, it may be due to a right-to-left shunt. We report a case with a right-to-left intracardiac shunt due to persistence of a patent foramen ovale, which became functional again under the new hemodynamic conditions after surgery under cardiopulmonary bypass and assisted ventilation. The diagnosis and physiopathological mechanism were studied by cardiac catheterisation and angiography. Contrast echocardiography should be able to detect these acquired shunts relatively easily. The diagnosis requires appropriate therapy: discontinuation of ineffective assisted ventilation as this may aggravate the situation by increasing pulmonary resistance, and anticoagulant therapy to prevent potentially disastrous paradoxical thromboembolism.

[Percutaneous transluminal angioplasty of the iliac arteries. Immediate and long-term results]. / Angioplastie endoluminale percutanée des artères iliaques. Résultats immédiats et à distance.

Percutaneous transluminal angioplasty (PTA) was performed 30 times in 28 patients aged from 31 to 77 years (mean: 50.8 years) with stenosis of the iliac arteries. All patients were evaluated before and immediately after PTA by measuring the trans-stenotic pressure gradient and the degree of angiographic stenosis (grade 1 less than or equal to 50%; grade 2 = 50 to less than 75% and grade 3 greater than or equal to 75%). Prior to PTA 27 patients had grade 3 and three patients had grade 2 stenosis. The figures after PTA were 23 grade 1 and seven grade 2 stenosis. The mean trans-stenotic pressure gradient was reduced from 43 +/- 35 to 2.3 +/- 5.9 mmHg, the difference being highly significant (p less than 0.001). Eighteen patients were evaluated clinically and angiographically 8.4 +/- 6.1 months after PTA. Considerable clinical improvement was observed in 15, and 16 had a residual stenosis of less than 50%. PTA therefore appears to be a satisfactory treatment of stenosis of the iliac arteries. The long-term results can be assessed by graded intravenous angiography without any risk of damage to the arteries.