Use of cryopreserved arterial homografts for management of infected prosthetic grafts: a multicentric study.

The objective of this study was to evaluate the effectiveness of cryopreserved arterial homografts for management of prosthetic graft infection. Between October 1992 and July 1998, 90 patients (84 men) with a mean age of 64 years from six different hospitals were treated for prosthesis infection by in situ replacement using a cryopreserved arterial homograft (CAH). In 43 patients (47%), the primary procedure had been performed at a nonparticipating center. Prosthetic graft infection occurred early (i.e., within 1 month after the primary procedure) in 15 cases and late in 75 cases. In the late group, the mean interval between the primary procedure and CAH replacement was 34 months (range, 3 to 330 months). In 41 patients, infection was located in the aortic region, including 17 presenting with enteroprosthetic fistula (EPF). In 49 patients, infection was confined to the femoral, popliteal, or subclavian region. Bacteriologic cultures were positive for one or more germs in 75 patients and negative in 15. The surgical procedure consisted of complete or partial removal of the infected prosthetic graft, debridement, and in situ reconstruction using one or more CAH. Our results showed that management of prosthetic graft infection, a grave complication, using a CAH is a promising technique, especially for patients in stable condition prior to reconstruction.

Vascular complications of osteochondromas.

PURPOSE: Osteochondromas are the most common benign tumor of the bone. They are sometimes responsible for vascular complications involving either veins or arteries, principally around the knee. METHODS: We report six cases of such complications. An extensive review of literature through a computerized research was performed. RESULTS: We found 97 cases that were previously reported in the English literature giving sufficient details and providing data on 103 cases for analysis. CONCLUSION: Surgical treatment of vascular complications of osteochondromas is recommended as an urgent procedure to avoid irreversible damages, such as arterial occlusion, embolism, or phlebitis. Prophylactic resection of osteochondromas in the vicinity of a vessel must be performed.

Covered stents in the treatment of peripheral arterial aneurysms: procedural results and midterm follow-up.

PURPOSE: To evaluate initial and midterm results of percutaneous treatment of peripheral aneurysms using covered stents. METHODS: Between June 1994 and December 1997 we used covered stents (EndoPro System or Passager) on 19 patients with peripheral aneurysms (7 iliac, 5 subclavian, 3 femoral, 3 popliteal, 1 carotid). RESULTS: Successful aneurysm exclusion was achieved in 18 of 19 patients (95%). In the short term (<30 days), one patient died of puncture site hemorrhage complicated by myocardial infarction; two femoral stents were surgically removed because of leakage. At subsequent follow-up (mean 20 months) two further unrelated deaths occurred. At 1 year (intention-to-treat) the stent was patent in 13 of 19 patients (68%) and the aneurysm was excluded in 17 of 19 (89%). CONCLUSION: Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural success. Continued exclusion of the aneurysms is achieved in a large proportion of patients but there is a relatively high rate of stent thrombosis.

Endovascular treatment of abdominal aneurysmal aortitis in Behçet's disease.

Arterial complications of Behçet's disease are rare and affect mainly the aorta and iliac arteries. Perforation of the arterial wall is the most common lesion, predisposing to false aneurysm or rupture. Open surgical repair is difficult, and anastomotic false aneurysms often occur because of aortic wall fragility. We report here the case of using a bifurcated stent to treat aortoiliac false aneurysms in a 37-year-old patient. Endovascular repair could be an alternative treatment of aneurysmal manifestations in Behçet's disease.

The activity of c-myb antisense oligonucleotide to prevent intimal hyperplasia is nonspecific.

BACKGROUND: We sought to determine the efficacy and specificity of a new c-myb antisense by inhibiting neointimal hyperplasia in a rat abdominal aorta injury model. Using c-myb antisense oligonucleotides, inhibition of vascular smooth muscle cell proliferation has been reported. METHODS: Sixty-six male Wistar rats had a de-endothelialization of the abdominal aorta. Following a double blind randomization protocol, F127 pluronic gel containing one of the five oligonucleotides or plain gel was applied around the aorta: 1) 18-mer c-myb antisense (AS18) with four contiguous guanosines (G-quartet); 2) 15-mer c-myb antisense (AS15) without G-quartet; 3) 1-bp mismatch AS15 without G-quartet (MM1); 4) an oligonucleotide with G-quartet (4G), whereas the other bases were chosen at random; 5) 1-bp mismatch 4G without G-quartet (MM2). After 21 days all rats were sacrificed and aortas harvested for histomorphometric evaluation. Four rats were given fluorescent-labeled oligonucleotides to study in vivo localization after local advential delivery. RESULTS: Morphometric analysis showed significant suppression of neointimal hyperplasia in AS18 and 4G and MM2 groups compared with GEL, AS15 and MM1 groups (p<0.05). The oligonucleotide-labeled aortas showed penetration of the oligonucleotides into the media which increased with time. CONCLUSIONS: Our findings pointed to the potential non specificity of the c-myb antisense oligonucleotide in vivo. Such results will minimize the importance of antisense strategy as a potential therapeutic for preventing neointimal hyperplasia. The two oligonucleotides with a G-quartet inhibited neointimal hyperplasia in our model. Exploring a non-antisense mechanism, G-quartet oligonucleotides as potential drugs to reduce neointimal hyperplasia is attractive.

Coil embolization of a gluteal false aneurysm in a patient with Marfan syndrome.

Gluteal aneurysms, whether true or false, are exceptional. They represent less than 1% of all aneurysms and develop within the superior or inferior gluteal arteries, being branches of the internal iliac artery. We report here the case of a 35-year-old patient with Marfan syndrome in whom annuloaortic ectasia and Barlow's disease with mitral valve insufficiency successively developed followed by a gluteal false aneurysm, which led us to investigate the etiologic mechanism of the patient's conditions. The gluteal aneurysm was successfully treated by selective embolization, which would appear to be the elective therapeutic approach for these lesions.

[Effects on myointimal proliferation of an antisense oligonucleotide directed against c-myb: specificity of action and consequences on vasoreactivity]. / Effets sur la prolifération myo-intimale d'un oligonucléotide antisens dirigé contre le c-myb: spécificité d'action et conséquences sur la vasoréactivité.

Several reports have shown that an antisense oligonucleotide directed against c-myb (AS 18) inhibits the proliferation of smooth muscle cell. The aims of this study were to confirm the specificity of a new c-myb antisens and to evaluate changes in vasoreactivity following treatment with a c-myb antisense. Five groups of rats were constituted. All underwent desendothelialisation of the abdominal aorta. A solution containing pluronic gel, or one of the following oligonucleotides: AS 18, 15 mere antisense directed against c-myb, an aleatory 4G sequence containing 4 consecutive guanosines, a 15 mere antisense mismatch (n = 11), was applied around the aorta. After 21 days, the thickness and mean surface areas of the media and intima were calculated. Four groups of rats were constituted for the reactivity study: control (A), desendothelialisation (B), desendothelialisation + application of AS 18 (C), and application of AS 18 alone (D). One ring per aorta was sampled at the 21st day and analysed in an organ chamber. The following results were obtained: the thickness and average surface areas of the intima were smaller (p < 0.05) in the 4G and AS 18 groups; in group B, none of the 8 segments responded to acetylcholine; in group C, 6 out of 8 segments responded. The contraction study showed no difference between groups A and D or between B and C. The mode of action of AS 18 antisense of c-myb is non specific but due to the presence of 4 consecutive guanosines in the oligonucleotide. Oligonucleotide with this sequence inhibits myo-intimal hyperplasia and improves endothelium-dependent relaxation in this model without affecting the contraction.

[Effects of an anti-c-myb antisense oligonucleotide on myo-intimal proliferation. Specificity of action and consequences on vasoreactivity]. / Effets sur la prolifération myo-intimale d'un oligonucléotide antisens dirigé contre le c-myb. Spécificité d' action et conséquences sur la vasoréactivité.

Several reports have shown that an 18-mere antisense oligonucleotide directed against c-myb (AS 18) inhibits the proliferation of smooth muscle. The aims of this study were to confirm the specificity of a new anti-c-myb antisense and to evaluate changes in vasoreactivity following treatment with a c-myb antisense. Five groups of rats. All underwent desendothelialisation of the abdominal aorta. A solution containing pluronic gel, or one of the following oligonucleotides: AS 18, 15 mere antisense directed against c-myb, an aleatory 4G sequence containing 4 consecutive guanosines, a 15 mere antisense mismatch (n = 11), was applied around the aorta. After 21 days, the thickness and mean surface areas of the media and intima were calculated. Four groups of rats were constituted for the vasoreactivity study: control (A), desendothelialisation (B), desendothelialisation + application of AS 18 (C) and application of AS 18 alone (D). One ring per aorta was sampled at the 21st day and analysed in an organ chamber. The following results were obtained: the thickness and average surface areas of the intima were smaller (p < 0.05) in the 4G and AS 18-groups; in group B, none of the 8 segments responded to acetylcholine; in group C, 6 out of 8 segments responded. The contraction study showed no differences between groups A and D or between groups B and C. The authors conclude that the mode of action of AS 18 antisense of c-myb is non-specific but due to the presence of 4 consecutive guanosines in the oligonucleotide. Oligonucleotide with this sequence inhibits myo-intimal hyperplasia and improves endothelium-dependent relaxation in this model without affecting the contraction.