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Biomedical subjects

E Houdart

Publications and source records attributed to E Houdart.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Persistent trigeminal artery and its variant. Contribution of MRI and MR-angiography].

We describe the magnetic resonance imaging and magnetic resonance angiography findings in 5 cases of persistent trigeminal artery, and in two cases of variant trigeminal artery. Six patients underwent complete four-vessel angiography, performed to depict other pathology. Magnetic resonance imaging and magnetic resonance angiography allowed in each case to visualize this artery and to precise its latero or intrasellar situation. The variant is not defined on conventional magnetic resonance imaging, but may be individualized on magnetic resonance angiography. In each case, identification of these persistent artery is crucial if surgery of sellar or gasserian region is planned.

Adolescent↗
PubMed1997

[Angioplasty of atheromatous hemodynamic stenoses of intracranial vertebral arteries].

We describe three patients presenting transient ischemic attacks or minor stroke, relapsing despite anticoagulation and antiplatelet therapy, in relation to tight stenosis of the intracranial vertebral arteries, without functional communicating arteries. Percutaneous transluminal angioplasty was successfully performed. We have a 6, 24 and 36 months follow-up. After a review of the literature, we discuss indication and risks of this procedure.

Aged↗
PubMed1996

Place of emergency arterial embolisation in obstetric haemorrhage about 16 personal cases.

Delivery bleedings which persist despite of an efficient medical treatment must be offered embolization without delay. Embolization is efficient in nearly 100% of cases; sometimes it has to be repeated. Embolization will it correct coagulopathy in few hours. It is a conservative treatment. It is nowadays undoubtedly the treatment of choice. Territorial organization for the hospital without interventional radiology is needed to organize the transfer of the bleeding patients without delay. Thus, mortality and morbidity as well as hysterectomy will not exist anymore.

Embolization, Therapeutic↗
PubMed1996

Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization.

PURPOSE: To evaluate angiographic and clinical results in patients with a dural arteriovenous fistula (AVF) who underwent percutaneous transvenous embolization. MATERIALS AND METHODS: Retrospective chart analysis and radiologic studies were performed in 24 patients (aged 20-87 years) with a dural AVF treated with percutaneous transvenous embolization. Lesions were located in the transverse and/or sigmoid or superior sagittal sinus. Clinical follow-up was 3-44 (mean, 10.8) months. RESULTS: After percutaneous transvenous embolization of 24 dural AVFs, there was complete occlusion in 17 patients, important flow reduction in three, and moderate flow reduction in four. Twenty patients were clinically cured, 17 with complete occlusion and three with important flow reduction. In patients with moderate flow reduction, clinical improvement was good in two and moderate in one. One patient remained clinically unchanged. A transient complication was seen in one patient, and a permanent complication was seen in one patient. One patient, whose preexisting clinical status was poor, died. During long-term follow-up, the condition of two patients worsened. CONCLUSION: Percutaneous transvenous embolization appears to be effective in the treatment of dural AVFs. More experience is needed to evaluate long-term results.

Adult↗
PubMed1996

Treatment of brain arteriovenous malformations by embolization and radiosurgery.

Embolization was used to reduce the size of brain arteriovenous malformations (AVMs) prior to radiosurgical treatment in 125 patients who were poor surgical candidates or had refused surgery. Of these patients, 81% had suffered hemorrhage, and 22.4% had undergone treatment at another institution. According to the Spetzler-Martin scale, the AVMs were Grade II in 9.6%, Grade III in 31.2%, Grade IV in 30.4%, and Grades V to VI in 28.8% of the cases. Most embolizations were performed using cyanoacrylate delivered by flow-guided microcatheters. Radiosurgery was performed using a linear accelerator in 62 patients treated by the authors, and 34 patients were treated at other institutions using various methods. Embolization produced total occlusion in 11.2% of AVMs and reduced 76% of AVMs enough to allow radiosurgery. Radiosurgery produced total occlusion in 65% of the partially embolized AVMs (79% when the residual nidus was < 2 cm in diameter). Embolizations resulted in a mortality rate of 1.6% and a morbidity rate of 12.8%. No complications were associated with radiosurgery. The hemorrhage rate for partially embolized AVMs was 3% per year. No patient with a completely occluded AVM experienced rehemorrhage. Angiographic follow-up review of AVMs embolized with cyanoacrylate demonstrated a 11.8% revascularization rate, occurring within 1 year. It is concluded that after partial embolization with cyanoacrylate, the risk of hemorrhage from the residual nidus is comparable to the natural history of AVMs and that the residual nidus can be irradiated with results almost as good as for a native AVM of the same size.

Adolescent↗
PubMed1995

Arterial embolisation to treat uterine myomata.

Haemorrhage, probably related to hypervascularisation, is the commonest complication of uterine myomata and is difficult to treat. 16 patients, aged 34-48 years, with symptomatic uterine myomata, for which a major surgical procedure was planned after failure of medical treatment, were treated by selective free-flow arterial embolisation of the myomata with Ivalon particles. With a mean follow-up of 20 months (range 11-48) in the responders, symptoms resolved in 11 patients; menstrual cycles returned to normal in ten of these. Three patients had partial improvement. Two failures required surgery. In 14 cases embolisation caused pelvic pain, which required analgesia in all.

Adult↗
PubMed1995

Percutaneous transcatheter embolization in multiply injured patients with pelvic ring disruption associated with severe haemorrhage and coagulopathy.

Six multiply injured patients with pelvic fractures were treated by percutaneous transcatheter embolization during a 10 month period. Diagnosis and therapy were carried out early in two cases (first day of admission into the trauma unit). Three patients were treated on the second day after admission. The last patient was embolized on the third day. Two patients underwent one and two remote embolizations. Embolization was indicated due to uncontrolled haemorrhaging, requiring large volumes of packed erythrocytes (median: 11.3) and fresh frozen plasma units (median: 6.8). Three patients had severe coagulopathy (disseminated intravascular coagulation). From two to 12 arteries were embolized per patient (median: 5). After successful transcatheter embolization, the circulation and coagulation stabilized rapidly without recurrence of haemorrhage or coagulopathy.

Adult↗
PubMed1995

Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.

PURPOSE: To review the symptoms and progression of dural arteriovenous fistulas (AVFs) and correlate the findings with various angiographic patterns. MATERIALS AND METHODS: Patterns of venous drainage allowed classification of dural AVFs into five types: type I, located in the main sinus, with antegrade flow; type II, in the main sinus, with reflux into the sinus (IIa), cortical veins (IIb), or both (IIa + b); type III, with direct cortical venous drainage without venous ectasia; type IV, with direct cortical venous drainage with venous ectasia; and type V, with spinal venous drainage. RESULTS: Type I dural AVFs had a benign course. In type II, reflux into the sinus induced intracranial hypertension in 20% of cases, and reflux into cortical veins induced hemorrhage in 10%. Hemorrhage was present in 40% of cases of type III dural AVFs and 65% of type IV. Type V produced progressive myelopathy in 50% of cases. CONCLUSION: This classification provides useful data for determination of the risk with each dural AVF and enables decision-making about the appropriate therapy.

Arteriovenous Fistula↗
PubMed1994

Intratumoral embolization of intracranial and extracranial tumors: technical note.

A new technique of intratumoral embolization is described. An intratumoral injection of N-butylcyanoacrylate is performed either perioperatively by direct puncture of the tumor or preoperatively through the nose or through the skin. The indications for this technique are hypervascularized tumors, such as juvenile angiofibroma, hemangiopericytoma, or paraganglioma. This technique has been applied in 21 patients with excellent results in terms of devascularization.

Aged↗
PubMed1994

Devascularization of craniofacial tumors by percutaneous tumor puncture.

PURPOSE: To present and evaluate a devascularization technique for hypervascular tumors of the head and neck by direct tumor puncture. METHODS: Tumor puncture was performed percutaneously or via natural orifices (nose and mouth). In one case, an intrasellar tumor was embolized via a transseptosphenoidal surgical approach. The embolization material used was NBCA, lipiodol, and tungsten in the majority of tumors (14 out of 17) and alcohol for 3 metastases of the calvarium. We used this technique to embolize 10 nasopharyngeal fibromas, 4 tumors of the calvarium (3 metastases and 1 hemangiopericytoma), 1 intrasellar hemangiopericytoma, and 2 glomus tumors. Reflux of blood was obtained in every case after direct puncture of the tumor. Direct injection of contrast agent into the tumor revealed local parenchymography followed by local and regional venous drainage without extravasation. RESULTS: Total devascularization was obtained in 14 cases, and devascularization greater than 90% was obtained in 3 cases. Thirteen tumors were totally resected without requiring blood transfusion. During surgery, the limits of the exsanguinated tumor were very well defined in every case by the black staining induced by tungsten. Of the 4 tumors embolized but not operated on (3 metastases and 1 glomus tumor), 2 metastases needed retreatment after 6 and 8 months of remission, respectively. The other metastasis is still in remission after 3 months, and the volume of the glomus tumor decreased by 80% remains unchanged after 8 months. CONCLUSION: This technique was initially used to devascularize tumors with difficult or dangerous intravascular access, but in view of the hemodynamic and surgical results obtained, we believe that the indications for this technique can be extended to hypervascular tumors accessible to conventional embolization.

Angiofibroma↗
PubMed1994

Spinal vascular malformations: endovascular therapy.

Over the past 30 years, the development of diagnostic spinal angiography has led to effective endovascular techniques for treatment of spinal vascular malformations. Specific location, size, rapidity of shunt, and clinical presentation determine the best treatment and prognosis.

Arteriovenous Malformations↗
PubMed1994

Percutaneous puncture of the external carotid artery or its branches after surgical ligation.

PURPOSE: To describe the technique and results of percutaneous puncture of the external carotid artery or one of its branches distal to a surgical arterial ligation. METHODS: Forty-three patients underwent 64 embolization attempts by percutaneous arterial puncture distal to an external carotid artery ligation. The punctured arteries were the trunk of the external carotid artery in 31 patients, the internal maxillary artery in nine, the facial artery in nine, the lingual artery in eight, the occipital artery in four, and the superficial temporal artery in three. RESULTS: In 64 attempts 57 were successful in one session, six were successful in two sessions, and one failed. Puncture-related complications were eight spontaneously resolving hematomas and six asymptomatic punctures of the internal carotid artery. CONCLUSION: After surgical ligation of the external carotid artery or its branches, arterial puncture above the ligation allowed selective catheterization and endovascular occlusion of vascular lesions.

Adolescent↗
PubMed1993

[Endovascular treatments of internal carotid artery diseases].

Rapid progress has recently been made in endovascular treatment of the internal carotid artery, with little-invasive, new interventions often replacing, or facilitating, surgery. Treatments of aneurysms, tumoural embolisation and haemostasis are well established. Promising techniques for revascularisation (fibrinolysis, dilatation) are under evaluation. We discuss their interest and respective indications.

Angioplasty, Balloon↗
PubMed1993

A proposed angiographic classification of intracranial arteriovenous fistulae and malformations.

We propose an angioarchitectural classification of intracranial vascular lesions as arteriovenous, arteriolovenous and arteriolovenulous fistulae. In order to validate this classification, 99 intracranial arteriovenous lesions were reviewed in 98 patients. Arteriolovenulous fistulae included 39 isolated brain arteriovenous malformations (AVMs) and 1 AVM associated with a giant arteriovenous fistula (AVF). Arteriovenous fistulae included 8 giant AVFs of the brain, 6 vein of Galen aneurysms and 10 direct caroticocavernous fistulae. Arteriolovenous fistulae included 1 isolated brain AVM, 4 vein of Galen aneurysms and 30 dural AVMs. The angioarchitectural classification has three advantages. It is simple and accurate, with no reference to the congenital or acquired nature of the lesion. It allows separate identification of a special group, the arteriolovenous fistulae. It also indicates the endovascular approach: arteriolovenulous fistulae should be treated via the arterial route only, while arteriovenous and arteriolovenous fistulae can be treated via transarterial or transvenous approaches.

Arteriovenous Fistula↗