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A Cardon

Publications and source records attributed to A Cardon.

At least 19 recordsLinked to original sources
PubMed2002

Coronary subclavian steal syndrome after left internal mammary bypass in a patient with Takayasu's disease.

We report the case of a 56-year-old symptomatic woman who underwent 2 coronary bypasses (left internal mammary artery on the left anterior artery and saphenous venous bypass on the circumflex) for a tight stenosis of the left main coronary. An inflammatory syndrome had been explored for 1 year without specific diagnosis. Eight months later, coronary angiography was performed for recurrence of angina: both bypasses were patent without stenosis and the left main stenosis was unchanged, but significant stenosis of the subclavian artery was found just before the LIMA. The diagnosis of Takayasu's disease was suspected in accordance with the ARC criteria and corticosteroids were started. One year later, because of recurrent angina, the patient was surgically treated with subclavian, vertebral and internal mammary endofibrectomy and an inverted saphenous vein graft from the subclavian to the axillary artery for extensive supra-aortic lesions. The patient remains symptom free at 1 year follow-up.

Female↗
PubMed2001

Influence of preoperative high-dose radiotherapy on postoperative outcome and colonic anastomotic healing: experimental study in the rat.

PURPOSE: Surgical treatment of rectal cancer is followed by local recurrence in up to 30 percent of cases. Recently, preoperative low-dose radiotherapy has been shown to improve both local recurrence rate and overall survival. Down-staging of locally advanced tumors, however, requires preoperative doses of at least 50 to 60 Gy. Most experimental studies investigating the effect of preoperative radiotherapy have made use of a single dose or a limited number of fractionated doses. Moreover, in most studies, both limbs of the anastomosis were irradiated, in contrast to clinical practice, in which one limb of the anastomosis consists of nonirradiated bowel. We studied the effect of a fractionated, clinically relevant scheme of high-dose preoperative radiotherapy on colonic anastomotic healing in the rat. METHODS: Male Wistar rats randomly received 0, 40, 60, or 80 Gy of preoperative radiotherapy on one limb of the anastomosis only. Radiotherapy doses were validated with implanted dosimeters; before the start of radiotherapy, the cecum was fixed outside the radiation field. A clinically used fractionation scheme of 2 Gy per day, 5 days per week for 4 to 8 weeks was used. The day after radiotherapy completion, a side-to-side colorectal anastomosis was performed. Rats were killed 10 days after surgery. The following parameters were determined: presence of abscess or peritonitis, anastomotic complications (stenosis, leak, or dehiscence), intestinal obstruction, anastomotic bursting pressure, and anastomotic hydroxyproline content. RESULTS: No significant differences were found in peritonitis rate, anastomotic complications, anastomotic bursting pressure, or hydroxyproline content. Irradiated animals gained weight more slowly than the control group. CONCLUSION: In this rat model, preoperative high-dose radiotherapy using a clinically relevant fractionation scheme does not affect outcome or anastomotic healing when only one limb of the anastomosis is irradiated.

Anastomosis, Surgical↗
PubMed2001

[Adjustable silicone gastric banding (ASGB, Bioenterics) and the Swedish adjustable gastric banding (SAGB, Obtech) in treatment of morbid obesity].

INTRODUCTION: Two different adjustable silicone gastric bandings were laparoscopically applied and compared regarding per- and postoperative complications and successful weight loss. PATIENTS AND METHODS: A total of 120 consecutive patients received a laparoscopic adjustable gastric banding and were prospectively documented. In the learning phase (LP) 50 patients were treated with an Adjustable Silicone Gastric Banding (ASGB, Bioenterics) using an intragastric balloon calibration technique according to Belachew. Group I (n = 29) received the same band using a surgical technique with tunneling behind the oesophagus towards His' angle, while the second group (n = 41) received a Swedish Adjustable Gastric Banding (SAGB), using the same technique as in group I. A BMI of > 35, complications secondary to obesity and failed diets were the indication for the operation. Thirty patients were male, 90 female, with a mean age of 37 years (18-60). RESULTS: In the LP 8 patients had to be reoperated (16%) for band slippage and/or pouch dilatation, in group I 6 (19%) and in group II 1 (3%) (P = 0.02, II vs I). The mean hospital stay was 3.7 +/- 0.5, 3.4 +/- 0.8 and 3.3 +/- 0.4 days in LP, I und II, respectively. LONG-TERM RESULTS: After a mean of 24 months (19-42) the loss of body weight was 8.4 kg after 3, 13.9 kg after 6, 22.1 kg after 12 and 27.8 kg after 18 months in the LP. In group I after a mean of 14 months (12-19) 10.3 kg after 3, 18.7 kg after 6, 24.8 kg after 12 months. In group II after a mean of 10 months (6-16) the loss of body weight was 7.9 kg after 3 and 19.4 kg after 6 months. CONCLUSION: In our experience it appears that the SAGB is easy to handle and less prone to complications such as dysphagia and slipping, probably due to good fixation of the band due to its width. A prospective randomized trial is warranted.

Adolescent↗
PubMed2001

[Endarteriectomy of the femoral tripod: long-term results and analysis of failure factors].

STUDY AIM: The aim of this retrospective study was to report immediate and long term results of endarteriectomies of the common femoral artery (CFA) and/or femoral tripod and to analyse predictive factors of failure. PATIENTS AND METHODS: Between 1982 and 1995, 110 endarteriectomies were performed in 101 patients, 52% of them in limb salvage situation. The arteriogram showed a thrombosis or stenosis of the common femoral artery in 100% of cases. There was a stenosis of the deep femoral artery (DFA) in 79% of cases. The superficial femoral artery (SFA) was thrombosed in 40% of cases. One artery only of the lower leg was permeable in 43.3% of cases. Run off was judged bad in 38% of patients. RESULTS: The endarteriectomy could be realised in 93 patients (84.5%). It concerned the only common femoral artery in 20% of cases (patch angioplasty in 55% of cases), common and deep femoral arteries in 50.5% of cases (82% of patch), CFA, DFA and SFA at its origin in 29.1% of cases (93% of patch). Perioperative mortality rate was 1%. Local morbidity rate was 21.6% with 18% of minor complications and 3.6% of complications requiring a second operation. There were 2% of vascular complications (1 thrombosis and 1 false-aneurysm). Mean follow-up was 43 months in 90 patients. There were restenosis or thrombosis (5.5%), false-aneurysms (2.2%) and amputations (6.6%). Femoro-popliteal (10%) and iliac complementary bypasses (6.6%) were necessary. Permeability was 94.9% at 3 years and 88.8% at 5 years. Clinical results were considered good in 80.7% of the cases at 3 years and in 71.7% at 5 years. With univariate analysis, the predictive factors for failure were: limb salvage (P < 0.01), altered popliteal run off (P < 0.03) and extended distortion of the deep femoral artery (P < 0.05). CONCLUSION: Isolated endarteriectomy of the femoral tripod is a low risk and effective technique. A femoropopliteal revascularisation should be associated in case of a major alteration of the deep femoral artery.

Adult↗
PubMed2001

Pseudo-aneurysm of the popliteal artery by femoral exostosis in a young child.

Exostosis is a solitary benign bone tumor frequently observed in children. It may be totally quiescent or provoke complications. We report a case of pseudo-aneurysm of the popliteal artery caused by an exostosis on the lower metaphysis of the femur in a 12-year-old boy. This unusual complication mostly reported in young males (mean age 19 years) occurs in the context of an initial trauma in half the cases. Surgical treatment is a semi-emergency requiring both bone and arterial repair. Preventive surgery should be discussed for all cases of exostosis with a risk of arterial damage due to the gravity of the potential vascular complications.

Aneurysm, False↗
PubMed2000

Sealing of polyester prostheses with autologous fibrin glue and bone marrow.

The purpose of this study was to develop a sealing technique for polyester prosthetic grafts able to promote healing and reduce intimal hyperplasia. The porcine experimental model was aortoiliac bypass with a 6-mm diameter knitted polyester prosthetic graft implanted for 14 and 90 days. Animals were divided into three groups according to sealing technique as follows: pre-clotting with blood (group I, n = 12), sealing with autologous fibrin glue (group II, n = 14), and sealing with autologous fibrin glue and bone marrow cells (group III, n = 16). Feasibility and quality of sealing were evaluated by scanning electron microscopy prior to implantation and by assessment of blood loss. After removal, prostheses were cut into three segments comprising the proximal anastomosis, midsection, and distal anastomosis. Pieces were fixed, embedded in paraffin, and serially sectioned for histologic study. Histological study focused on the degree of stenosis and hyperplasia of the neointima of each prosthesis. The results of this short-term study indicate that sealing of polyester vascular prosthetic grafts with autologous fibrin glue and bone marrow cells is effective in reducing intimal hyperplasia. However further study will be needed to assess long-term healing.

Animals↗
PubMed2000

[Isolated popliteal arteries: results of surgical treatment and causes of failure].

UNLABELLED: Isolated popliteal artery is defined as an obstruction of a superficial femoral artery with a patent popliteal segment followed by an obstructed distal popliteal artery or a patent leg artery less than 5 cm long. PURPOSE: The aim of this retrospective study was to report the results of surgical treatment and the causes of failures. PATIENTS AND METHODS: From 1988 to 1996, 31 patients with isolated popliteal artery were operated on with femoropopliteal bypass. The age of the patients ranged from 45 to 92 years, (mean: 79 years); all had critical ischemia that threatened limb viability. All underwent preoperative arteriography and diagnosis was confirmed by intraoperative arteriography. RESULTS: In the postoperative course, there were 22 patent bypasses (68%) with minor amputation in five patients, and nine thromboses that required a major amputation in seven patients, a trans-metatarsal amputation in one, and a medical treatment in one. With a mean 37-month follow-up, seven thromboses required a major amputation in five patients, a new bypass in one and a medical treatment in one. The death rate was 34% at two years. The actuarial patency rates of the bypasses were 51% at one year, 38% at two years and 25% at five years. The limb salvage rate was identical. The patency rates were 65% at one, two and five years for venous bypasses and 38%, 13% and 0% respectively for PTFE bypasses. Statistical analysis showed two causes of failure: the absence of a run-off branch and the use of PTFE prostheses. No other statistically significant cause of failure was demonstrated among those analysed. Favourable anatomic conditions for a bypass to a leg artery were not predictive of failure of a femoro-popliteal bypass on the isolated arterial segment. CONCLUSION: Bypass to isolated popliteal artery is indicated in patients whose limb viability is jeopardized. Results may be considered as satisfactory especially if there is a run-off branch and if a venous graft is available for the bypass.

Aged↗
PubMed1999

A model for laparoscopic aortic aneurysm resection.

BACKGROUND: The laparoscopic treatment of abdominal aortic aneurysm (AAA) could improve the perioperative course of patients suffering from this disease. The goal of the current experiment was to develop an animal model that could simulate many of the difficulties encountered in the treatment of human AAA. METHODS: Twelve piglets were submitted to a laparotomy. An AAA was created by suturing a 12- by 5-cm piece of knitted dacron to an aortotomy. Four to 15 days later, the piglets underwent the laparoscopic treatment of their AAA. RESULTS: All procedures were completed successfully. The average duration of the laparoscopic intervention was 210 min (range, 150-300 min). Aortic cross-clamping took 55 min (range, 38-72 min). Blood loss averaged 150 ml (range, 80-250 ml). During each procedure, four to six lumbar arteries were treated by intraluminal aortic clip application. Intraoperative complications consisted of one splenic trauma, one anastomotic stenosis, and one case of bleeding from a lumbar vein. CONCLUSION: Laparoscopic AAA resection is feasible in this animal model, which presents similarities to human AAA.

Anastomosis, Surgical↗
PubMed1999

Use of ipsilateral greater saphenous vein as a valved transplant in management of post-thrombotic deep venous insufficiency: long-term results.

Incompetence of the deep venous valve is a common feature of post-thrombotic deep venous insufficiency. Various surgical techniques have been proposed to treat reflux. In this study we describe long-term results of a novel transposition technique using the ipsilateral greater saphenous vein. From 1984 to 1994 we used this procedure to treat 16 patients including 10 men and 6 women with a mean age of 56 years (range: 25 to 76 years). In all 16 cases the indication for surgery was incapacitating pain associated with recurring ulceration in 9 patients. From the results of using this technique we conclude that transposition using the ipsilateral greater saphenous vein is safe and effective with good mid-term results, especially for pain. For ulcers the primary success rate was 55% but this increased to 84% with proper surveillance and treatment of secondary insufficiency of the superficial venous system.

Female↗
PubMed1999

Impregnated polyester arterial prostheses: performance and prospects.

Impregnated polyester arterial prostheses have gained wide acceptance by most vascular surgery teams, probably because these prostheses are easy to use, without any preclotting. We offer here a synthesis of the main studies that have appraised the experimental and clinical performance of these prostheses, and we delineate their major prospects.

Animals↗
PubMed1999

Fat- and bone marrow-impregnated small diameter PTFE grafts.

OBJECTIVES: to evaluate an alternative and simple technique which consists in impregnation of a synthetic prosthesis with either autogenic omental fat or bone marrow. These tissues have been selected based on previous works and because they contain multiple cellular and extracellular compounds with biological healing properties (i.e. angiogenesis, endothelialisation, etc.). DESIGN: PTFE grafts of Group 1 were impregnated with fatty tissue, those of Group 2 with bone marrow and those of Group 3 served as controls. MATERIALS: nine mongrel dogs divided among these three groups. PTFE grafts are 3 mm in diameter. METHODS: in each animal, both iliac arteries were submitted to an end-to-side ilio-iliac bypass. At 3 months, pathology assessment was performed. RESULTS: group 1: all grafts were thrombosed and intimal hyperplasia was found occluding the anastomotic sites. Group 2: 4/6 grafts were patent and their mid-portion presented a thin neointima which did not totally cover the anastomotic sites. Group 3: 2/5 grafts were patent and their mid-portion as well as the anastomotic sites were covered with neointima which was hyperplastic in some areas. CONCLUSIONS: addition of bone marrow cells may contribute to improve the quality of the healing process.

Adipose Tissue↗
PubMed1999

Peribulbar anaesthesia during keratoplasty: a prospective study of 100 cases.

AIMS: A prospective study was carried out in order to evaluate the efficacy and safety of peribulbar anaesthesia during keratoplasty and to describe surgical conditions. METHODS: Of 137 consecutive keratoplasties, 100 (73%) were performed under peribulbar anaesthesia. Patients received a mean volume of 16.5 (SD 4) ml (range 9-22 ml) of a mixture of etidocaine, bupivacaine, and hyaluronidase. Ocular compression duration was at least 20 minutes and intraocular pressure (IOP) was measured with a Tonopen after injection, compression, and before trephination. Degree of akinesia, pain scoring, complications, and surgical conditions were studied. RESULTS: Before trephination, IOP was 5.73 mm Hg below the preinjection value and was never above 21 mm Hg. Akinesia was complete in 80% of cases and 94% of patients found that surgery was painless. Two patients (2%) were very agitated during surgery. The last patient presented with an acute intraoperative suprachoroidal haemorrhage that did not result in a true expulsive haemorrhage despite an "open sky" situation. Surgical conditions were judged to be optimal by the patients in 92% of cases and by the surgeon in 98% of cases. CONCLUSION: These results demonstrate that peribulbar anaesthesia offers excellent anaesthesia and akinesia during keratoplasty and may be recommended for this type of surgery.

Adolescent↗
PubMed1999

Alternative technique for creation of a proximal gastric pouch in laparoscopic adjustable silicone gastric banding.

BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) has become a widely used procedure for the treatment of morbid obesity. The original operation, as described by Kuzmak, has been subjected to modifications. Construction of a proximal gastric pouch is an important part of the operation. Until now, we used the technique of Niville. Since this was often complicated by gastric bleeding and/or serosal tears, we developed a new technique to construct a pouch. SURGICAL TECHNIQUE: A new technique, using a thread previously fixed to that portion of the fundus that will be used to construct the pouch, is described. CONCLUSION: A safe and easy adaptation of the LASGB technique is proposed to create the gastric pouch.

Gastroplasty↗
PubMed1999

Retrospective analysis of laparoscopic gastric banding technique: short-term and mid-term follow-up.

BACKGROUND: Although adjustable gastric banding shows good results concerning weight loss, several complications such as excessive vomiting, total dysphagia, and slipping of the stomach through the band with pouch dilatation may occur rather frequently. Different types of adjustable bands are available to prevent these short- and mid-term complications. METHODS: In this retrospective study, 120 consecutive laparoscopic adjustable gastric bandings were performed. In group I, 50 patients were treated with adjustable silicone gastric banding (ASGB) by an intragastric balloon calibration technique. Group II (n = 29) received the same band by a surgical technique with tunneling behind the esophagus toward the angle of His. Group III (n = 41) received Swedish adjustable gastric banding (SAGB) by the same technique as in Group II. RESULTS: Weight loss was approximately 15% of the excess weight after 3 months, 30% after 6 months, and 45% after 12 months in all groups. Total dysphagia was significantly more frequent in Groups I and II. The incidence of slipping of the band and pouch dilatation was more frequent in Group II. CONCLUSION: The diameter of the ASGB band is rather small and can cause total dysphagia independently of surgical technique. The SAGB is easy to perform and seems less vulnerable to complications like dysphagia and slipping of the band, probably because of the individual adjustment of the stoma diameter during surgery and good fixation of both band and ventral pouch with separate posterolateral sutures.

Adult↗
PubMed1999

[Biomechanical study of the vasomotor system of the arterial smooth muscle after long-term cryopreservation of a human arterial graft at two different temperatures -80 and -150C].

We conducted two parallel studies on cryopreserved arterial homografts: a biomechanical study based on traction tests and a functional study coupled with a histology examination. Twenty-four arterial segments from 6 donors (2 iliac and 2 superficial femoral segments per donor) were cryopreserved at -150 degrees C and -80 degrees C. Cryopreservation lasted at least 6 months. Lengthening at rupture, the Young elasticity module, and rupture stress were calculated from the traction test. Results were significantly different depending on the preservation temperature. The functional properties of the cryopreserved arterial grafts were evaluated by studying the vasomotricity capacity of the vascular smooth muscle (VSM) and the endothelium. The expected results (direct contracture of VSM induced by PHE and endothelial dependent relaxation of VSM induced by ACH) were measured on fresh arteries. Cryopreserved arteries showed no response to physiological doses of PHE and ACH, whatever the preservation temperature. In one-third of the cases, a lower amplitude vasoconstriction was obtained using nonphysiological doses of PHE; there was no relaxation with ACH.

Adult↗
PubMed1999

Laparoscopic aorto-iliac surgery: present status and future perspectives.

Over the past few years, the concept of "minimally invasive surgery" has generated a significant interest in the field of cardiovascular surgery. Congenital heart diseases such as patent ductus arteriosus, vascular ring or atrial septal defect have been treated using video-assisted technology. Although patients have undergone mitral valve replacement and repair, the focus of interest in the development of video-assisted cardiac surgery is in the treatment of coronary artery disease.

Journal Article↗
PubMed1998

Results of isolated carotid surgery in patients with vertebrobasilar insufficiency.

The purpose of this study was to establish whether carotid-revascularized patients who had preoperative vertebrobasilar insufficiency (VBI) displayed distinctive characteristics and whether a particular prognosis would ensure. From January 1985 to December 1993, 1022 carotid revascularizations were performed, of which 114 (11%) were for high-grade stenosis associated with VBI. The group with VBI and the group without VBI were compared according to a set of 121 prospectively collected variables. Of all the demographic and risk-factor variables, only female prevalence (42% vs. 27%) and hypertension (77% vs. 27%) distinguished the group with VBI, who also exhibited a significantly higher proportion of significant contralateral carotid lesions (27.2% vs. 8.9%) and vertebrosubclavian lesions (38.6% vs. 24.8%). Following isolated carotid surgery, there was no statistically significant difference between the two groups as to their cumulative rate of permanent neurological mortality and morbidity (2.6% in the group with VBI vs. 3.4% in the group without it). With an average follow-up of 60 months, VBI was cured in 82.4% and improved condition shown in 6.5% of patients. However, the proportion of good results fell to 65% in patients with a nonfunctional circle of Willis. Out of 13 cases of failure to control VBI, cure was finally effected by means of contralateral revascularization in 3 cases and by means of vertebrosubclavian revascularization in 5 cases out of 6. At 5 years, the actuarial rates of neurological event-free intervals and survival were not different from one group to another. In most cases, isolated carotid surgery is sufficient to bring vertebrobasilar insufficiency under control, except when significant vertebrosubclavian lesions and a nonpatent circle of Willis call for simultaneous carotid and vertebral artery surgery.

Aged↗