Primary supraceliac aortic pseudoaneurysm due to a septic aortic rupture.
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Aged↗
Biomedical subjects
E Chemla
Publications and source records attributed to E Chemla.
[Anatomic variations of the vascularization of the pelvic kidney: apropos of a case and review of the literature].
Blood supply in pelvic kidney presents with more anatomic variations than in a normal positioned lumbar kidney. We report a patient with a right pelvic kidney and a particularly atypic vascularisation. In addition we present a review of the literature with all possible pelvic arterial variations and their frequency.
Aortic Aneurysm, Abdominal↗
Molecular diagnosis of a vascular prosthesis infection, due to Propionibacterium acnes, by amplification and sequencing of 16S rDNA.
We describe a case of indolent vascular prosthesis infection due to Propionibacterium acnes. The microorganism was identified only by amplification and sequencing of 16S rDNA, while standard cultures remained negative. This observation underscores the usefulness of molecular techniques for the diagnosis of infection caused by fastidious microorganisms.
Anti-Bacterial Agents↗
Posterior approach for simultaneous access to the popliteal and anterior tibial arteries: applications to distal arterial bypass.
Arterial surgery to salvage the lower limb tends to make use of the great saphenous vein, harvested with the subject in the supine position. If this is not possible the small saphenous vein is used, harvested with the subject in the prone position, however this requires a perioperative modification of the procedure. A bypass between the popliteal and anterior tibial arteries can be performed using either a lateral or a medial and lateral approach with the patient supine. In the event of trophic disorders of the lateral compartment of the leg, these approaches are not applicable. In such cases we propose a single posterior approach. The single posterior approach was used on 10 lower limbs from 5 cadavers in the prone position. Approach to the lower part of the popliteal artery was undertaken posteriorly between the two heads of gastrocnemius. The small saphenous vein was entirely dissected 10 cm above the lateral malleolus, the Achilles tendon and short fibular vessels were retracted medially to expose the interossous fascia, which was divided over 10 cm. Medial rotation of the limb by 30 degrees exposed the anterior tibial artery. For 3 of the lower limbs an 8 cm fibular resection was necessary, whereas on the remaining 7 medial rotation enabled excellent exposure of the anterior tibial artery. The single posterior approach to the anterior tibial artery can be applied in cases requiring distal bypass, using the small saphenous vein, between the inferior part of the popliteal artery and the anterior tibial artery.
Anastomosis, Surgical↗
Influence of coronary artery and contralateral carotid artery status on long-term results of carotid artery surgery.
The main cause of death and long-term disability of patients undergoing carotid artery surgery is coronary artery disease. To identify the prognostic value of the status of the contralateral artery, we studied the course of 224 consecutive patients in whom one or both carotid arteries were operated on at our institution between 1985 and 1995. The 224 patients were divided into three groups: group I (n = 56) had an occluded contralateral carotid artery, in group II (n = 56) both carotids were operated on, and group III (n = 112) had a normal contralateral carotid artery. The clinical status of all patients except one was ascertained by one of us. We found that the status of the contralateral artery does not influence the long-term prognosis of patients undergoing carotid artery surgery. A periodic cardiological and vascular follow-up of these patients seems warranted to improve their survival.
Actuarial Analysis↗
Bilateral carotid dissection and factor V mutation: a second case.
A young woman 38 years of age underwent Doppler ultrasonography following the spontaneous appearance of cervical pain causing loss of sleep. The examination revealed bilateral dissection of the internal carotid arteries, confirmed by supraaortic arteriography. Two successive CT scans showed no cerebral lesions. A thrombosis of the great saphenous vein was recorded as the only vascular event in her medical history. Thrombophilia was assessed following discovery of the dissection, and upon examination a heterozygotic mutation of Factor V Leiden was revealed. This observation is the second case of carotid dissection occurring in a subject presenting a factor V mutation. At the present time, however, there are no results to justify the assumption of a direct link between these two pathologies.
Adult↗
Peroperative factors influencing the outcome of elective abdominal aorta aneurysm repair.
PURPOSE: To identify perioperative variables which may influence mortality of elective abdominal aneurysm repair (AAA). METHOD: prospective study of patients undergoing elective AAA repair between 1986 and 1997. RESULTS: Four hundred and seventy patients (438 men, 32 females) with a mean age of 69.4+/-13 years and aneurysms with a diameter of 60+/-3 mm were operated on with a 1-month mortality rate of 5.3%. Multivariate analysis identified the following independent risk factors for mortality: age >70 (p<0.0001), a past history of myocardial infarction (p<0.0001), preoperative renal insufficiency (p<0.0001), reoperation (p<0.0001), colonic necrosis (p<0.0001), and severe postoperative medical complications (p<0.0001). CONCLUSION: Intra- and postoperative events affect the outcome of AAA repair, independently of preoperative factors, and should be described when presenting the results of AAA repair.
Aged↗
Endovascular repair of aortic allograft aneurysmal degeneration: a case report.
Aortoenteric graft fistula remains a dreadful complication of aortic surgery. Good results have been reported using in situ graft replacement with arterial allografts. Late aneurysmal degeneration of the graft itself may necessitate further repair. We report the case of such an aneurysmal degeneration 7 years after implantation of the allograft. Endovascular repair was performed with a Vanguard device; complete exclusion was obtained immediately. At 6-month follow-up, the patient was alive and well. Duplex and computed tomography scans showed an excluded aneurysm with a slight reduction in size. Endovascular stent grafting may be a therapeutic option for treating patients with late allograft degeneration.
Aged↗
Preoperative assessment of the efficacy of distal radial artery ligation in treatment of steal syndrome complicating access for hemodialysis.
Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. We report here a case in which we applied a new diagnostic method to assess the efficacy of distal radial ligation to treat this syndrome. A favorable comparison of distal radial artery pressure measurements before and after temporary occlusion of the artery with a balloon catheter indicated that perfusion of the hand would be dramatically improved after surgical artery ligation.
Angiography↗
[Do the long-term results of carotid surgery influence the status of the contralateral carotid artery?].
AIM: The main cause of long-term death and disability of patients undergoing carotid artery surgery is coronary artery disease. To identify the prognostic value of the status of the contralateral artery, we studied the course of 224 patients operated consecutively on one or both carotid arteries in the same institution between 1985 and 1995. PATIENTS AND METHODS: The 224 patients were divided into three groups: group I (n = 56) having an occluded contralateral carotid artery; group II (n = 56) in which both carotids were operated on; and, group III (n = 112) having a normal contralateral carotid artery. The clinical status of all patients was ascertained by one of us for all patients except one. This study concerned also the course of 40 patients (group R) belonging to the three groups, who had during the follow-up period a coronary and/or a peripheral vascular intervention with a preoperative coronarography. RESULTS: The median follow-up was 62.8, 78 and 65 months for groups I, II and III, respectively. Actuarial survival rates were 67%, 73%, 72.5% at 5 years, and 39%, 51.5% and 42% at 10 years, for group I, II and III respectively. Actuarial stroke-free rates were 96%, 100%, 91% at 5 years, and 96%, 100% and 78.5% at 10 years for group I, II and III respectively. Actuarial cardiac death rates were 26%, 23%, 19% at 5 years, and 49%, 42% and 37% at 10 years for group I, II and III, respectively. None of the differences between the three groups regarding these three different end-points was significant. The group R fatal or non-fatal cardiac event-free rates at 5 and 10 years were 88% and 53% respectively. When compared with the rates of other patients (without revascularization): 68% and 25.5% at 5 and 10 years, the results were almost significant (P = 0.07). Average age for group R patients was significantly lower (65 vs. 69 years, P < 0.05). Using Cox's model, age alone emerged as a factor influencing survival (P = 0.07) but not revascularization (P = 0.13). CONCLUSION: The status of the contralateral artery does not influence the long-term prognosis of patients undergoing carotid artery surgery. A periodic cardiological and vascular follow-up of these patients tends to improve their survival.
Actuarial Analysis↗
Comparative study of different biological glues in an experimental model of surgical bleeding in anesthetized rats: platelet-rich and -poor plasma-based glue with and without aprotinin versus commercial fibrinogen-based glue.
The use of fibrin glue in cardiovascular surgery has been associated with decreased operative time, effective control of localized bleeding, and reduced postoperative blood loss. All preparations of fibrin glue mimic the final common pathway of the coagulation cascade in which fibrinogen is converted to fibrin in the presence of thrombin and calcium. The goal of the study was to compare five different types of fibrin glue, with or without aprotinin, on a surgical bleeding model in the rat. In 70 anesthetized Wistar rats, after laparotomy, a 3 cm liver incision was performed. After randomization, seven groups were studied. In the first group, Biocol was used as a pinpoint application to the bleeding site. Four groups received a fibrin glue obtained from a single human donor plasma using Cell Saver V (Haemonetics). The sealant was applied as a two-component system. The first component of the glue was either platelet-rich-plasma (PRP) or platelet-poor-plasma (PPP). The second component consisted of a mixture of 0.5 ml CaCl 10% with 1000 U of human thrombin, with or without 400KUI of aprotinin (AP). The last two groups, control and aprotinin were treated using saline solution or topical aprotinin respectively. Hemoglobin and hematocrit were measured before surgery and 30 min after application of the glue. The decrease in hemoglobin (Hb) and hematocrit (Hct) was the primary efficacy variable. Before surgery, there was no difference regarding Hb and Hct values between groups. Thirty min after the application of the glue, the decrease in hemoglobin expressed as percent of the control values is only significantly lower in the Biocol group when compared to control. No significant difference was observed with the other groups in comparison to control. The commercial fibrin glue (Biocol) is more efficient than other preparations. This efficacy is likely due to a higher fibrinogen concentration.
Animals↗
Influence of the status of the contralateral carotid artery on the outcome of carotid surgery.
From 1985 to 1995, 747 carotid arteries were operated on in 694 patients, who were under general anesthesia and continuous electroencephalogram (EEG) monitoring. These patients were divided into three groups according to contralateral carotid status. Group 1 consisted of 58 patients who had contralateral occlusion; group 2, 53 patients who had contralateral stenosis and bilateral staged surgery; and group 3, 583 patients who had nonstenotic contralateral internal carotid artery. All groups were similar with regard to age and sex ratio. There were more asymptomatic patients in group 3 than in group 1 (39.9% vs. 25.8%) (p < 0.05), and less preoperative strokes in group 2 than in the other groups (3.7% vs. 17.2% and 13. 6%, respectively) (p < 0.05). Among risk factors, smoking was less frequent in group 3 (59.5%) than in group 1 (82.7%) and group 2 (77%) (p < 0.01), and coronary artery disease was more frequent in group 2 (60%) than in group 1 (32.7%) and Group 3 (26.4%) (p < 0.01). EEG changes occurred more frequently in group 1 (25.8%) than in group 2 [5.6% (first stage) and 3.8% (second stage)] and in group 3 (4.9%) (p < 0.01). A shunt was used only when EEG changes did not disappear after pharmacologic increasing of central blood pressure, which occurred more frequently in group 1 (10.3%) than in group 2 (0%) and group 3 (0.3%) (p < 0.05). The combined morbidity/mortality rate was similar for groups 1 and 3 (1.7% and 1.5%, respectively), however, transient morbidity was more frequent in group 1 (6.9%) than in group 3 (1.5%) (p < 0.05). The combined morbidity/mortality rate was higher in group 2 than in group 3 (7.5% vs. 1.5%) (p < 0. 05), and all strokes in group 2 were seen during the second-stage operation. In conclusion, contralateral carotid artery occlusion had minimal influence over carotid surgery results. Selective use of a shunt based on EEG monitoring prevented ischemic strokes, with minimal neurologic morbidity. Contralateral carotid stenosis did not affect operative strategy for first stage, but we noted a higher incidence of strokes during the second procedure.
Aged↗
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.
Animals↗
[Surgery of subrenal abdominal aortic aneurysms. Impact of anatomic factors and of comorbidity on perioperative morbidity and mortality].
PURPOSE: To determine the predictivity of anatomic and co-morbid factors for peri-operative mortality of patients operated for a non-ruptured abdominal aortic aneurysm (AAA). METHODS: Between 1986 and 1996, data had been collected prospectively in a computerized date base. A chi-square test was performed for 5 anatomic, and 8 co-morbid criteria. RESULTS: 25 of 470 patients (5.3%) died within one month after surgery. Aneurysm diameter (P = 0.004) and aneurysmal internal iliac artery (P = 0.019) were associated with an increased mortality whereas upper extension of the disease necessitating a juxta-renal anastomosis, the need for inferior mesenteric artery reimplantation, or a symptomatic ilio-femoral occlusive disease, were not. Age (P = 0.016), obesity (P = 0.03), alteration of left ventricular function (P = 0.0014), and preoperative renal failure (P = 0.0001) were associated with increased mortality. CONCLUSION: Both anatomic and co-morbid factors can predict outcome after elective surgery for non-ruptured AAA. The criteria might help to selection patients who might benefit from endovascular treatment of AAA.
Aortic Aneurysm, Abdominal↗
Inhibition of intimal hyperplasia by an antisense oligonucleotide of farnesyl transferase delivered endoluminally during iliac angioplasty in a rabbit model.
The major complication of vascular recanalization is intimal hyperplasia which is due mainly to proliferation and migration of smooth muscle cells (SMC). Activation of SMC results from stimulation of protooncogens (c-myb, c-myc, c-fos) by growth factors induced by activated ras-proteins. Ras-proteins become activated after receiving a farnesyl group in a reaction catalyzed by famesyl transferase. The purpose of this study was to test the effectiveness in preventing intimal hyperplasia of an antisense oligonucleotide of the alpha subunit of farnesyl-transferase delivered endoluminally during angioplasty of the common iliac artery in rabbit model. Twenty-one male New Zealand rabbits with a mean weight of 3.3 kg fed a high cholesterol diet underwent bilateral angioplasty of the common iliac artery using hydrogel-coated balloon catheters. On the right side three types of treatment were randomly performed by adding one of the following three oligonucleotides to the hydrogel precoating:antisense oligonucleotide of farnesyl transferase (n = 7), mismatch oligonucleotide (n = 7), and scramble oligonucleotide (n = 7). On the left side hydrogel was used with saline so that each animal served as its own control. Animals were killed 6 weeks after angioplasty and arteries were studied. The thickness and mean surface of the neointima (MTI and MSI) and the ratio (R) of the neointima to neointima + media were calculated. In the scramble and mismatch groups there was no difference between the treated and control arteries with regard to MTI, MSI, or R. In the antisense group mean all three values were significantly lower on the treated side than the control side (EMI: p < 0.02, SMI: p < 0.02, and R: p < 0.01). Treated arteries in the antisense group presented significantly lower EMI (p < 0.02), SMI (p < 0.02), and R (p < 0.01) than treated arteries in the other groups whereas the thickness and mean surface of the media were comparable. Endoluminal administration of an antisense oligonucleotide against the alpha subunit of farneysyl transferase inhibited intimal hyperplasia in our model.
Alkyl and Aryl Transferases↗
[Effects on myointimal proliferation of an antisense oligonucleotide directed against c-myb: specificity of action and consequences on vasoreactivity].
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.
Animals↗
[Aneurysm developed at the level of a femoropopliteal bypass with ex-situ venous graft 10 years later].
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Aged↗
[Effects of an anti-c-myb antisense oligonucleotide on myo-intimal proliferation. Specificity of action and consequences on vasoreactivity].
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.
Animals↗