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Biomedical subjects

A Mikati

Publications and source records attributed to A Mikati.

16 recordsLinked to original sources
PubMed1997

Proximal arterial dilatation developing after surgical closure of long-standing posttraumatic arteriovenous fistula.

Concomitant discovery of long-standing arteriovenous fistula (AVF) and proximal dilatation is commonplace whereas the disclosure of proximal arterial dilatation several years after closure of AVF is much more surprising and less often described. The goal of this study was to call attention to this late complication, to evaluate its prevalence, and to describe the mechanism and outcome after treatment. Six new observations were added to 11 cases already published in the literature. Most AVF were located in the popliteal or superficial femoral arteries. The mean duration of these AVF was 20 years and 7 months. The mean delay between closure of AVF and the discovery of arterial dilatation was 9 years and 8 months. One patient required emergency operation for rupture. Another patient sustained embolism. All patients were treated by exclusion-bypass. Six years after operation for arterial dilatation, one patient had to be reoperated on for impending rupture of an aortic aneurysm. These facts lead us to advocate 1) closure of all AVF, even when iatrogenic, whenever present for 45 days or longer, 2) careful observation of all patients after operation for long-standing AVF, 3) operation on all patients with arterial dilatation secondary to AVF, and 4) life-long surveillance of the proximal arteries of these patients.

Adolescent↗
PubMed1990

End-to-side aortoprosthetic anastomoses: long-term computed tomography assessment.

Fifty-two asymptomatic patients underwent routine computed tomographic evaluation of aortobifemoral bypass grafts implanted end-to-side on the aorta five to 10 years after operation. Anteroposterior diameters were measured at the level of the stem and the limbs of the graft, the aortoprosthetic anastomosis, and the infraanastomotic aorta. The stems of the prostheses were found to be dilated between 30 and 110% (mean 58%) of initial values. The limbs of the graft were dilated between 15 and 150% of initial values, the mean being 52%. The anteroposterior diameter of the aortoprosthetic anastomosis measured between 27 and 48 mm with a mean of 32 mm. Eight patients (15%) had an anastomotic false aneurysm. The aorta distal to the prosthetic anastomosis was completely occluded in 48 cases (92%). A mural thrombus was encountered at the level of the aortoprosthetic anastomosis in 21 (40%) patients. These findings raise questions as to the possible role of side-to-end aortoprosthetic anastomoses in the genesis of anastomotic dilatations, false aneurysms, intraprosthetic thrombosis, and thrombosis of the branches of aortofemoral bifurcation prosthetic grafts.

Adult↗
PubMed1988

Persistent sciatic artery: case report, anatomy, and review of the literature.

We report the case of a 64-year-old woman with an aneurysm of a left persistent sciatic artery presenting with arterial insufficiency from distal embolization. Treatment was exclusion of the aneurysm and femoropopliteal bypass after distal embolectomy with a Fogarty balloon catheter. We reviewed 71 cases in the literature to define characteristics of this anomaly which has many synonyms: including persistent sciatic artery, persistent axial artery, ischiopopliteal trunk. The persistence of the sciatic portion of the embryonic dorsal axial artery and failure of development of anastomoses with the ventral femoral network results in the anomaly. The persistent sciatic artery was "complete" in 75% of cases. In this configuration, it arises from the internal iliac artery, leaves the pelvic cavity through the lower part of the greater sciatic foramen caudad to the pyriformis muscle, reaches the posterior compartment of the thigh and continues as the popliteal artery. In 35% of cases, the artery is aneurysmal with a pulsatile mass in the buttock or a complication of the aneurysm. Arteriography required for diagnosis of the mass leads to discovery of the anomaly in many cases. The treatment of choice is exclusion followed by femoropopliteal vein bypass.

Aneurysm↗
PubMed1988

[Sexual function and aortoiliac reconstructive surgery].

In this study of 52 patients aged between 32 and 60 years, maintenance or restoration of sexual function during aorto-iliac surgery represented a usually non-priority but certainly desirable objective. Aspects studied were: place of crossed bypass and of endarterectomy-type of aorto-prosthesis anastomosis: end-to-end or end-to-side - routine or non-routine reimplantation of a hypogastric artery. Results in this series showed a lack of advantage from the sexual point of view for end-to-side over end-to-end surgery; hypogastric reimplantation offers a supplementary guarantee of efficacy but should not be performed routinely; crossed bypass operations are certainly interesting solutions in young patients. Endarterectomy should not be rejected as a matter of principle but with respect to sexual function its indications should be reserved for cases not requiring extensive dissection of arterial axes.

Adult↗
PubMed1985

[The irrigraphic profile, an orienting element in the indications for lumbar sympathectomy].

A retrospective study of 108 case-reports of patients treated by lumbar sympathectomy was conducted to determine irrigraphic parameters possessing possible predictive value for the indication of sympathectomy. The value of the Index 6 (distal irrigation index) must be certainly taken into account; the Index 1 (proximal index) appears to be of interest when analyzing data with a view to sympathectomy in diffuse forms of arteritis. Three profile-types were distinguished; statistical analysis showed no significant difference in these profiles, with respect to the sympathectomy, in relation to the clinical results obtained. Irrigraphic modifications after sympathectomy were analyzed in 72 cases; results confirmed the improved efficacy of sympathectomy at Stage 2 than at Stages 3 and 4, but also showed that at Stage 2 the profile II appeared to react more favorably and that at Stages 3 and 4 the profile I appears to react less well than the other profiles. Also studied were patients with diabetes, who react less favorably to sympathectomy, patients who fail-to respond to sympathectomy, and those with worsening of irrigraphic profiles after sympathectomy, mainly in diabetics with profile I. These findings show that it is not possible to define a precise irrigraphic profile more favorable to sympathectomy, but that they provide interesting elements to be confronted with clinical and arteriographic data when deciding on the need for sympathectomy.

Adult↗
PubMed1985

[The future of the asymptomatic leg after unilateral iliac artery repair].

A retrospective study was carried out in 30 patients after unilateral iliac endarterectomy, the contralateral limb being asymptomatic, to assess the evolution of the unoperated limb. Findings indicated 4 claudications uncovered by the unilateral operation, 8 secondary thromboses (including one asymptomatic lesion) of the unoperated iliac axis--repeat operation was necessary in only one patient. Findings emphasize the importance of control of risk factors to prevent secondary deterioration of an unoperated limb. The risk of thrombosis in the primarily asymptomatic side appears to lessen with immediate insertion of an aorto-bifemoral prosthesis, but risks inherent in prosthesis application--sepsis, false aneurysm--must be allowed for.

Endarterectomy↗
PubMedDate not supplied

Treatment of lymphorrhea with exposed or infected vascular prosthetic grafts in the groin using sartorius myoplasty.

Thirteen myoplasties using the sartorius muscle were performed on 12 patients from 1980 to 1985 for "healing problems" in the groin with subjacent synthetic grafts. Persistant aseptic lymphorrhea was the indication for 4 patients. In 3 other cases, bacterial cultures from the wound were positive. In 2 other patients there was clinical evidence of sepsis with purulent discharge from the wound and an exposed graft. In 3 cases myoplasty was used as a preventive measure after reoperation on patients in poor general condition. Follow-up extends from 3 to 54 months. There was only one recurrence observed at 19 months which was successfully treated by segmental resection of the infected graft and insertion of a new prosthesis through the obturator canal. No recurrence was observed among the other patients as judged by clinical observation and biological tests for inflammation, echotomography, CT scan and indium scintigraphy. The treatment of choice for an infected prosthesis should be removal of the graft and extra-anatomic bypass in the majority of cases. However in some situations, excision of the wound and myoplasty using the sartorius muscle may be of some value and needs further evaluation.

Blood Vessel Prosthesis↗
PubMedDate not supplied

[Etiologic diversity of digital arteritis].

The etiological study of a series of 30 cases of digital arteritis, shows that there may be various causes at the origin of a digital arteritis. In elderly patients, atherosclerosis appears as the most frequent cause. At a middle age, digital arteritis frequently occurs in a context of vasomotor pathology: in this case, sclerodermis is a frequent cause to examine systematically but some cases are secondary to a Raynaud's phenomenon, apparently idiopathic. Other etiologies: traumatic, hematologic, iatrogenic... may be pointed out; but in some cases, digital arteritis occurs alone without any apparent reason.

Adult↗