Biomedical subjects
Publications and source records attributed to B Enon.
A case is reported of arteriovenous fistula of the anterior tibial vessels following a spiral fracture of the tibia treated conservatively. The fistula was operated on at the seventh month, after bony union had occurred and the artery was repaired by a venous graft.
Temporary hemostasis with an inflatable intra-arterial balloon is useful in injuries of the great vessels. It permitted repair under satisfactory conditions of a perforating wound of the abdominal aorta.
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A 48-year-old man, operated upon with a diagnosis of perforation of a hollow viscus, in whom a spontaneous perforation of the rectum was discovered. Such perforations are rare since only 36 cases have been reported in the literature. The mechanism is unknown and various factors have been suggested, including increased pressure or local ischaemia. Treatment is rendered difficult by local infection and the frequently fragile general condition of the patients.
PURPOSE: To report a combined conventional and endovascular strategy to treat a descending aorta anastomotic aneurysm. CASE REPORT: A 60-year-old man with previous obliteration of the infra renal aorta suffered from bilateral lower limb acute ischemia. Lower limb vascularization was provided by a previous thoraco-bifemoral bypass. Computed tomography and angiography revealed an aortic anastomotic false aneurysm and an embolic aspect of the first centimeters of the graft. Treatment combined revascularisation of the lower limbs by an ascending aorta bifemoral bypass through a median sternotomy and endovascular coverage of the false aneurysm by stent-graft placement in the descending aorta. Stent-grafts were introduced through a graft's limb and across the anastomosis in the ascending aorta. Imaging at 3 months revealed no endoleak and perfect patency of the bypass. CONCLUSION: This case illustrates how combined endovascular and conventional procedures can minimize surgical risks in complex cases.
114 patients aged over 75 underwent surgery for aneurysm of the infra-renal abdominal aorta in the University Teaching Hospitals in Nantes and Angers between 1979 and 1988. A retrospective study of these patients was performed to evaluate the immediate and long-term results. The mean age of the patients was 79 (+/- 4) years, the oldest being 94. 70% were men. Half of the patients underwent emergency or semi-emergency surgery (52 cases). Cardiovascular factors (in particular coronary insufficiency in 17% of cases) were the most common risk factors. In all cases grafting after laying open the aneurysm was performed, with an aorto-aortic graft in 32% of patients, an aorto-iliac graft in 37% or an aorto-bifemoral graft in 27% of patients. Combined intestinal revascularisation was performed in 10% of case either involving the inferior mesenteric artery or at least one internal iliac artery; renal revascularisation was performed in 3.5% of cases. 75% of patients underwent simple grafting. The mean duration of hospitalisation was 14 days (+/- 6), including a mean period of 7 days in ICU. 36 patients (31%) died in the first post-operative month. The mortality rate in patients who underwent emergency surgery for a complication of the aneurysm (essentially rupture) was 61% versus 6' for elective surgery. 96% of the patients who survived the first post-operative month were independent at the end of the study or at the time of their death.(ABSTRACT TRUNCATED AT 250 WORDS)
In the light of a case of endotheliosarcoma of the thoracic aorta, the authors found in the literature 33 cases of aortic sarcomas and 13 of sarcomas of peripheral arteries. The clinical diagnosis of this rare tumor is difficult. The diagnosis can be made before surgery only on the basis of angiographic and CT scan findings, whilst in most instances common arterial lesions are suspected whether of atheromatous or embolic origin. The positive diagnosis of arterial sarcoma remains histological. The diagnosis of an endothelial tumor can be made with the help of the techniques of factor VIII, antigen H and, more recently, lectins. Surgical treatment by excision and restoration of continuity has most often been used. Alone or in combination with chemo and/or radiotherapy, it would seem to be inadequate to prevent progression which involves the invasion of adjacent tissues, tumor emboli or generalized metastases. The prognosis of such a tumor remains gloomy with an average life expectancy of one year and 7 months, regardless of the histological type of arterial sarcoma.
This case of aorto-duodenal fistula was due to fistulization of a tuberculous lymph node between an atheromatous aneurysm of the infra-renal aorta and the third part of the duodenum. CAT scan provided the diagnosis of an aorto-duodenal fistula. The tuberculous origin of the fistula was confirmed by bacteriological and histological examinations. The outcome was favourable after revascularisation "in situ" combined with epiplooplasty and prolonged antituberculous drug therapy.
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Isotopic phlebography with microspheres containing 99 mTc aggregated human albumin is a simple and easily reproducible means of controlling the results of venous surgery of the lower limb and ilio-caval confluent. A comparison in 34 cases with the results obtained by conventional contrast phlebography showed close correlation between the two methods. However, since the images are not as sharp as with contrast phlebography, isotopic phlebography cannot be used for planning procedures prior to reconstructive venous surgery and should be reserved to post-operative control.