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Biomedical subjects

A Bahnini

Publications and source records attributed to A Bahnini.

At least 37 records · Page 2Linked to original sources
PubMed1994

Aberrant subclavian artery: surgical treatment in thirty-three adult patients.

PURPOSE: Because of the scarcity of large series in the literature, our experience with surgery for aberrant subclavian arteries (aSA) in adults was reviewed. METHODS: During the last 16 years we have surgically treated 33 adult patients with aSA. Twenty-eight patients had a left-sided aortic arch with a right aSA whereas five had a right-sided aortic arch with a left aSA. Eleven patients (group 1) had dysphagia caused by esophageal compression by a nonaneurysmal aSA; five patients (group 2) had ischemic symptoms caused by occlusive disease of a nonaneurysmal aSA; 10 patients (group 3) had aneurysms of the aSA with or without symptoms caused by esophageal compression or arterial thromboembolism; and seven patients (group 4) had an aSA arising from a diseased (usually aneurysmal) thoracic aorta. In all cases the divided aSA was revascularized, most often by direct transposition into the ipsilateral common carotid artery. Nine of the 16 patients in groups 1 and 2 underwent operation with a cervical approach alone. In the remaining seven, the cervical approach was combined with a median sternotomy (six cases) or a left thoracotomy (one case). In the 17 patients in groups 3 and 4, either a cervical approach (two cases), a median sternotomy (four cases), or a two-staged approach combining a supraclavicular incision on the side of the aSA with a posterolateral thoracotomy on the side of the aortic arch (11 cases) was used. Aortic cross-clamping was required in 12 of these patients to perform the transaortic closure of the origin of the aSA with patch angioplasty (three cases), or prosthetic replacement of the descending thoracic aorta (nine cases). Cardiopulmonary bypass was used in six patients (including three with hypothermic circulatory arrest). RESULTS: Four patients, all in groups 3 and 4, died after operation: two of multiorgan failure, one of heart failure, and one of esophageal rupture. Satisfactory clinical and anatomic results were obtained in the remaining 29 patients. CONCLUSIONS: The surgical approach to aSA must be flexible and adapted to the anatomic conditions found. We recommend routine reconstruction of the aSA to avoid ischemic complications in the vertebrobasilar territory or upper extremity. Provision should be made for cardiopulmonary bypass in patients with aneurysm of aSA or associated aortic aneurysm.

Adolescent↗
PubMed1994

[Loops and folds of the carotid and vertebral arteries: indications for surgery].

Tortuous variants of the carotid or vertebral morphology are apparent on 10 to 43% of angiograms. It is probable that the incidence of these anomalies is lower in the normal population. Rarely, their etiology is congenital explaining the existence of some pediatric cases. The etiology of most cases is acquired and linked with hypertension, atheroma and aging. Basically consisting of an excess of length of the common or the internal carotid artery, the tortuosity may take the form of simple or multiple kinking, coiling or looping. Isolated, these anomalies are asymptomatic in a large majority of the cases. However, hemispheric, vertebrobasilar or ocular ischemic symptoms may be caused by them through a thromboembolic or hemodynamic mechanism. Moreover, given their frequent association with atherosclerotic occlusive lesions, their participation in the production of ischemic symptoms is not easy to determine. Although not yet investigated by prospective randomized studies, symptomatic isolated of kinking or coiling of cerebral arteries are amenable to surgical revascularization in order to prevent stroke or blindness. Besides, the endarterectomy of atherosclerotic occlusive lesions of tortuous carotids requires a technical adaptation.

Adult↗
PubMed1993

[Technical aspects of the surgery of atherosclerotic carotid stenoses].

The aim of the present paper is to present a brief critical analysis of the technical aspects of surgery for atherosclerotic carotid stenoses, including reconstructive techniques, preoperative evaluation of neurologic risk and intraoperative monitoring and cerebral protection. Our present personal protocol is presented.

Arteriosclerosis↗
PubMed1993

Stenotic coiling and kinking of the internal carotid artery.

Between January 1979 and December 1991, 174 of a total of 2304 carotid reconstructions (7.5%) were performed in 166 patients for stenotic coiling or kinking of the internal carotid artery. There was a 1.4 male predominance and the mean age of the patients was 66.3 +/- 9.6 years (range 38 to 91 years). Seventeen patients (9.8%) were asymptomatic, 54 (31%) were symptomatic because of a previous stroke, and 103 (59.2%) had had transient ischemic attacks. The symptoms were hemispheric in 108 (62.1%) cases, ocular in 19 (10.9%), and vertebrobasilar in 30 (17.2%). The stenotic coiling or kinking was isolated in 35 (20.1%) cases and associated with other lesions of the internal carotid artery in 139 (79.9%). These included 119 atherosclerotic stenoses, 14 aneurysms, and six stenotic lesions due to fibromuscular dysplasia. Angioplasty of the carotid bifurcation was performed in 102 (58.6%) patients, associated with endarterectomy in 84 (48.3%) cases and with dilatation of dysplastic lesions in six (3.5%) cases. A bypass graft and resection and anastomosis of the carotid artery were performed in 36 (20.7%) patients each. There were four postoperative deaths (2.3%): two were due to neurologic causes, one to heart disease, and one to complications of an associated surgical procedure. Five patients (2.9%) had postoperative strokes and eight (4.6%) had transient ischemic attacks. At postoperative follow-up investigations four (2.3%) patients had carotid occlusions and 10 (5.7%) had morphologic abnormalities. At 5 years, actuarial survival was 80.97 +/- 8.8%, patency was 96.12 +/- 2.95%, and the ipsilateral stroke-free rate was 93.12 +/- 4.49%. Treatment of stenotic coiling or kinking of the internal carotid artery yields satisfactory results, comparable to those of endarterectomy, for isolated atherosclerotic carotid stenoses and is effective in the prevention of ipsilateral ischemic stroke.

Adult↗
PubMed1993

In situ allograft replacement of infected infrarenal aortic prosthetic grafts: results in forty-three patients.

PURPOSE: Dissatisfaction with conventional methods of treatment of infected infrarenal aortic prosthetic grafts and excellent long-term results reported by heart surgeons after allograft replacement for management of infections involving the ascending aorta have prompted us to investigate allograft replacement in the management of arterial infections. METHODS: From October 1988 to April 1992, 43 consecutive patients with infected infrarenal aortic prosthetic grafts underwent in situ replacement with preserved allografts obtained from cadavers as part of a program to retrieve multiorgan transplant tissue. Thirty-four patients had isolated prosthetic infections, whereas nine had aortoenteric fistulas. One patient had a concomitant below-knee amputation for septic arthritis of the ankle as a result of septic emboli. Nineteen patients had nonvascular-associated procedures, including 17 intestinal procedures. RESULTS: Five patients (12%) died after operation: four of general causes and one of rupture of the native aorta as a result of persistent infection. Three patients successfully underwent repeat operation for allograft-related complications (one case each of occlusion, septic rupture, and graft-enteric fistula). All surviving patients were discharged after control angiography showed patent allografts. Two patients were unavailable for follow-up. The other 36 patients have been monitored with serial duplex and computed tomography scanning for a mean follow-up of 13.8 months (range 1 to 42 months). There were four late deaths: three were unrelated to the vascular operation, and one may have been caused by late persistent or recurrent infection. Nine patients (26%) have had pathologic changes in the allograft, with three (9%) requiring repeat operation. There were no early or late postoperative amputations in the entire series. CONCLUSIONS: Although complete protection against persistent or recurrent infection has not been achieved and late deterioration may be expected, in situ allograft replacement seems to be a major advance in the management of infected infrarenal aortic prosthetic grafts.

Adult↗
PubMed1991

Surgical reconstruction of the internal carotid artery with contralateral occlusion without use of shunt.

Between 1979 and 1989, 133 carotid artery reconstructions were performed in 130 patients with contralateral internal carotid artery occlusion. These 133 reconstructions represent 7.3% of 1815 revascularizations of the internal carotid artery for atheromatous lesions performed during the same period. There were 113 men (87%) and 17 women (13%) whose mean age was 64.8 years (range 38 to 83 years). Forty-two patients (32%) had coronary artery disease and 77 (59%) were hypertensive. Nineteen patients (14%) were asymptomatic; 16 (12%) had symptoms of isolated vertebrobasilar insufficiency; 19 (14%) had ipsilateral carotid symptoms (on the side of operation); 67 (51%) had contralateral symptoms (on the side of occlusion); and 12 (9%) had bilateral carotid symptoms. All procedures were performed under general anesthesia without the use of a shunt. Nine patients (6.8%) died in the postoperative period (eight of neurologic and one of respiratory causes). Twelve patients (9%) sustained a cerebral vascular accident (eight ipsilateral and four contralateral). Four of these cerebral vascular accidents were diagnosed upon awakening, the remaining eight occurred after an initial uneventful recovery. Combined neurologic mortality and morbidity was 9.8%. Patients with occlusive lesions of the contralateral carotid artery undergoing internal carotid artery reconstruction are at high risk for postoperative cerebral vascular accidents. It is in this group of patients that the various methods of monitoring and cerebral protection should be evaluated.

Adult↗
PubMed1991

Leiomyosarcoma of the inferior vena cava. Experience with 7 patients and literature review.

Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumor originating in the smooth muscle of the media. Although rare, it is the most common malignancy in the IVC. One hundred and six cases have been reported thus far in the world literature, usually as isolated case reports. Clinical, radiologic, and therapeutic management and follow-up, including 7 additional cases, have been reviewed and summarized. Clinical manifestations are dependent upon the location of the tumor. The main symptom was a palpable mass for a tumor in segment I, abdominal pain for segment II, the presence of Budd-Chiari syndrome for segment III. Segment II was the most frequent site of leiomyosarcoma of the IVC, alone (n = 41) or with other segments (n = 39). Before laparotomy, clinical recognition was difficult or impossible. Recently, however, newer imaging modalities including ultrasound and CT scan have permitted earlier diagnosis. Metastases, when diagnosed, were either present at diagnosis (n = 20) or appeared as the disease progressed (n = 18). Metastatic disease frequently involved the liver, lung, lymph nodes, or bone. The small number of patients alive without metastases (16/113) must be analyzed all the more carefully because these patients were followed for less than 2 years. When prolonged follow-up is possible, the number of patients alive without neoplastic disease is significantly reduced. We found the prognosis of patients with LMS of the IVC to be poor. Diagnosis was made at autopsy for 27 patients. Among the 86 patients with follow-up information, 59 died within a mean of 16 months, and 26 were alive 25 months after the diagnosis. The main prognostic factor is topography, particularly the highest level of extension of the tumor. The upper-segment tumors have the poorest prognosis. The best therapeutic management is difficult to recommend because most of the cases in the literature did not include a sufficient follow-up. Given the very small number of patients completely free of neoplastic disease after sufficient follow-up, it seems unlikely that leiomyosarcoma of the IVC can now be cured. Patients who received a combination of surgery, radiotherapy and chemotherapy remained free of disease for longer periods. The unanswered question is: what is the best timing for each of these treatments? We recommend diagnosis of leiomyosarcoma of the IVC through biopsy guided by ultrasonography or computed tomographic scan. Therapeutic management should include large doses of chemotherapy preoperatively with or without radiotherapy to reduce tumor size.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Long term results of surgery of aortic aneurysms].

During 10 years, between 01.01.80 and 01.12.89, 838 patients have been operated on consequently for a A.A.A. in the vascular surgery department of the Hospital Pitié-Salpêtrière (Paris). Post-operative death was 7.3% (51 patients) among 692 operated on without emergency and 41.7% (60 patients) among 146 patients operated on emergency. The study was undertaken with the 727 surviving patients (86.8%) for the long term follow-up. Only 25 patients (3.4%) were lost out, so 702 patients (96.6%) had complete recalls even to their late death until the fourth trimester 1990. Total deaths, were 172 patients, (24.5%) out of the 702 patients in the follow-up. 60 patients (34.9%) died from cancer, 52 patients (30.2%) from heart disease, 21 patients (12.2%) from C.V.A. (cerebro-vascular-accident), 8 (4.6%) from rupture of aneurysm, 6 (3.6%) from renal insufficiency, 5 (2.9%) from prosthesis infection, 10 (5.8%) died from known reasons, 10 (5.8%) from unknown reasons. All these results were studied according to the "actuarial method" and the conclusions were as follow. The actual survival rate at 5 years was 72.1% +/- 5.6% and the average annual death rate was 5.8%. The factors which have influenced the late death are: a) Patients age: survival rate at 5 years and average annual death rate were significantly different whether the patients were less or more than 70 at the time of surgery. b) Surgical circonstances: late survival was significatively less with patients operated on emergency. c) Cerebro-vascular insufficiency. The average annual rates from cardio-vascular and cerebro-vascular accident were significatively more important in patients which previously had cerebro-vascular insufficiency. This work shows out that cardiac death are slightly overcame by cancer, but these two factors represent almost 2/3 (65.1%) of late death. So it should be important for prevention of late death to screen for lung and E.N.T. cancers. Some authors have proposed for prevention of coronarian accidents extensive use of coronarography and myocardial revascularisation. We prefer more acute screening than aggressive methods for patients with coronary problem who had surgery for A.A.A. and specially when they are less than 70 at surgical time.

Adult↗
PubMed1991

In situ fresh allograft replacement of an infected aortic prosthetic graft: eighteen months' follow-up.

We report a case in which an allogenic aortic graft was used to treat the last one of a series of infectious graft complications. The original operation was a Dacron aortobifemoral bypass for aortoiliac occlusive disease in an institution other than ours. The patient was referred for the treatment of the infection of the prosthetic implant. We inserted a prosthetic bypass from the left axillary to the left deep femoral artery, as well as a crossover autogenous saphenous vein graft from the prosthesis to the right deep femoral artery; in the same operation the infected intraabdominal prosthesis was removed with closure of the proximal aortic stump. Subsequent stenosis of the vein graft made it necessary to insert a prosthetic bypass between the descending thoracic aorta and the two deep femoral arteries. Infection of the last named prosthesis made it necessary to remove it and replace it with a tailored allogenic arterial allograft between the infrarenal abdominal aorta and both deep femoral arteries. The patient had an uneventful recovery as the infection was controlled and both lower limbs were salvaged. Eighteen months later the allograft was patent without any signs of degeneration. Further clinical experience under appropriate conditions may prove the use of allografts effective in the treatment of selected cases of aortic prosthetic infection.

Aged↗
PubMed1988

[Behçet's disease and vascular surgery].

The role of vascular surgery in Behçet's disease is limited. It is concerned with the two types of lesion, venous and arterial, usually encountered. Indications for surgery in venous thrombosis did not differ from those in ordinary thrombo-embolic disease. The multicenter study reported divided arterial lesions into three groups: aneurysmal, occlusive or traumatic (arterial puncture) lesions. While surgery offers satisfactory results in the treatment of aneurysmal or traumatic lesions, the treatment of occlusive lesions is disappointing. Surgery is thus indicated only in patients with an aneurysm, bleeding or severe ischemia.

Aneurysm↗
PubMed1986

Gunshot pellet embolus to the middle cerebral artery.

A 24-year-old man sustained a gunshot wound to the upper right hemithorax and neck, with injury to the subclavian and carotid arteries. A cerebral artery pellet embolus resulted in contralateral hemiplegia. The injured vessels were repaired, but the middle cerebral artery pellet was left undisturbed. Neurologic improvement occurred. Fifteen cases of foreign body embolus to cerebral vessels are reviewed and the management of this unusual injury is discussed.

Adult↗