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Biomedical subjects

E Rosset

Publications and source records attributed to E Rosset.

At least 19 recordsLinked to original sources
PubMed2001

Endovascular treatment of occlusive lesions in the distal aorta: mid-term results in a series of 31 consecutive patients.

The purpose of this study was to evaluate the early and mid-term results of endovascular treatment of occlusive lesions in the distal aorta in a consecutive series of patients. Between February 1996 and March 1999, a total of 31 patients underwent transluminal procedures for treatment of occlusive atherosclerotic lesions located at the lower end of the aorta. Thirty patients presented with intermittent claudication and one had critical ischemia. Manifestations were bilateral in 26 cases and unilateral in 5. The lesion was confined to the lower aorta in 3 patients and extended to the common iliac arteries in 19, with predominant proximal lesions of the common iliac artery occurring in 9 patients. Fourteen patients had concurrent infracrural occlusive lesions. All patients underwent exclusive endovascular treatment without any associated open surgical procedure. The three patients with isolated aortic lesions were treated by angioplasty, followed by stent placement in two cases. The 19 patients with aortobiiliac lesions were treated by bilateral common iliac artery angioplasty according to the "kissing-balloon" technique; 7 of these patients also underwent aortic angioplasty. In these 19 patients, aortic stenting was performed in 3 cases and bilateral iliac stenting in 10 cases, including 3 in association with aortic stenting. The nine patients with a proximal lesion of the common iliac arteries were treated by angioplasty, followed by bilateral stenting in three cases and unilateral stenting in three cases. The findings of this study show that the mid-term anatomical and functional results of endovascular treatment for atherosclerotic lesions of the distal aorta are satisfactory. We recommend it as the initial treatment modality.

Adult↗
PubMed2001

Compromised hemodynamics associated with multipedicular lesions of cerebral arteries.

The purpose of this study was to demonstrate that severe multipedicular lesions involving supraaortic trunks cause compromised cerebral hemodynamics with nonhemispheric symptoms (NHS) that can be relieved by surgical treatment. A total of 11 patients were prospectively included in the study. Regional cerebral blood flow (rCBF) and cerebral blood flow reactivity (CBFR) were measured by acetazolamide single photon emission computed tomoscintigraphy scans (SPECT) before and after surgery. Seven patients presented with isolated NHS and four presented with NHS associated with hemispheric symptoms. Lesions consisted of either high-grade (>75%) bilateral carotid artery stenosis associated with vertebral or subclavian artery lesions or high-grade (>75%) bilateral vertebral or subclavian artery stenosis associated with medium-grade (>50%) carotid lesions. All patients presented with a functional circle of Willis with no significant intracranial arterial lesions and no corticosubcortical atrophy. A total of 15 procedures were performed for revascularization of 19 arteries. The cumulative morbidity/mortality rate was nil. All revascularizations were patent on postoperative controls. Results from this study show that multipedicular lesions lead to hemodynamic changes affecting hemispheric and vertebrobasilar territories. Surgical treatment can improve or normalize cerebral hemodynamic abnormalities and relieve NHS.

Aged↗
PubMed2001

Juxtarenal aneurysm. Comparative study with infrarenal abdominal aortic aneurysm and proposition of a new classification.

OBJECTIVE: to propose an anatomical classification of juxtarenal aortic aneurysm (JRA) that relates to their epidemiology and the result of surgical repair. MATERIAL AND METHODS: retrospective study of 53 JRA and 376 infrarenal aortic aneurysm (AAA) operated between January 1989 and August 1999. RESULTS: perioperative mortality after JRA repair was 19% for type A (interrenal), 13% for type B (aneurysm of one or two renal origins) and 4% for type C (no infrarenal neck). These differences were not significant. The overall perioperative mortality after JRA repair (11%) was significantly higher than mortality of AAA (3%p<0.01). Postoperative morbidity after JRA repair was 62% for type A, 75% for type B and 33% for type C. Postoperative morbidity after type B repair was significantly more frequent than after type C (p<0.001). The overall postoperative morbidity (51%) was significantly more frequent than after AAA repair (26%p<0.01). Preoperative ischaemic heart disease, aortic clamping above the coeliac axis and aortic proximal clamping longer than 30 min were significant risk factors for death after JRA repair. Survival by life-table analysis at five years after JRA repair and AAA repair were respectively 73%+/-7% and 76%+/-3%. CONCLUSION: there is a less favourable outcome after JRA repair as compared to AAA repair. The complexity of the surgical procedure requires accurate preoperative morphological assessment. The proposed classification of juxtarenal aneurysms may be helpful in guiding surgical access.

Adult↗
PubMed2000

Results of lower limb revascularization from the descending thoracic aorta.

The aim of this retrospective study was to substantiate our results of lower limb revascularizations from the descending thoracic aorta. From November 1984 to November 1994, we used bypass grafting from the descending thoracic aorta to revascularize 69 lower limbs in 36 patients, 34 men and 2 women, whose mean age was 61.8 years. Patients were divided into two groups. Group I (primary indications) included 10 patients who had not had any prior lower limb arterial reconstruction. Group II (secondary indications) consisted of 26 patients who had had a prior arterial reconstruction that was either occluded or complicated. There were three early graft occlusions, all of them successfully treated. Complete flaccid, paraplegia occurred in one patient. Five patients presented with one or several late graft occlusions. Two patients had to undergo below-knee amputation, bilateral in one patient. Routine late control of the repair was performed by CT scanning, at a mean interval of 50.8 months. The good results recorded for bypasses revascularizing lower limbs from the descending thoracic aorta make this technique a satisfactory alternative when the abdominal aorta cannot be used.

Adult↗
PubMed2000

Surgical treatment of extracranial internal carotid artery aneurysms.

PURPOSE: Extracranial internal carotid artery aneurysms (EICAs) can be treated by carotid ligation or surgical reconstruction. In the consideration of the risk of stroke after internal carotid artery (ICA) occlusion, the aim of this study was to report the results of reconstructive surgery for these aneurysms, including lesions located at the base of the skull. METHODS: From 1980 to 1997, 25 ICA reconstructions were performed for EICA: 22 male patients and 3 female patients (mean age, 54.4 years). The cause was atherosclerosis (n = nine patients), dysplasia (n = 12 patients), trauma (n = three patients), and undetermined (n = one patient). The symptoms were focal in 15 cases (12 hemispheric, three ocular), nonfocal in three cases (trouble with balance and visual blurring), and glossopharyngeal nerve compression in one case. Six cases were asymptomatic, including three cases that were diagnosed during surveillance after ICA dissection. In nine cases, the upper limit of the EICA reached the base of the skull. A combined approach with an ear, nose, and throat surgeon allowed exposure and control of the ICA. RESULTS: After operation, there were no deaths, one temporary stroke, two transient ischemic attacks, and 11 cranial nerve palsies (one with sequelae). The ICA was patent on the postoperative angiogram in all but one case. During follow-up (mean, 66 months), there were two deaths (myocardial infarction), one occurrence of focal epileptic seizure at 2 months, and one transient ischemic attack at 2 years. In December 1998, duplex scanning showed patency of the reconstructed ICA in all but one surviving patient. CONCLUSION: Surgical reconstruction is a satisfactory therapeutic choice for EICA, even when located at the base of the skull.

Adolescent↗
PubMed1998

Surgery for asymptomatic carotid stenosis: a study of three patient subgroups.

The purpose of this retrospective study was to determine whether patients who undergo prophylactic surgery for asymptomatic carotid stenosis represent a single homogeneous population. Of the 805 carotid reconstructions performed between January 1984 and December 1992, a total of 357 were for asymptomatic atherosclerotic stenosis in 312 patients (227 men, 85 women) with a mean age of 69.6 years. Patients were divided into three groups. Group I included 141 patients (161 procedures) who presented no neurologic manifestations. Group II included 49 patients (55 procedures) who underwent carotid reconstruction before or at the same time as another cardiovascular procedure. Group III included 122 patients (141 procedures) who presented nonhemispheric manifestations. Patients in group III had a significantly higher number of obstructive lesions in brain arteries (p < 0.01). Seven patients died within the first 30 postoperative days, including three who underwent combined single-stage procedures. Nine patients presented nonfatal stroke, including three who progressively recovered. The cumulative death-stroke rate (CDSR) was 5.12% overall, 3.54% in group I, 12.24% in group II, and 4.09% in group III. The difference between groups I and II was statistically significant (p < 0.05). Taking into account only deaths related to carotid surgery and stroke with permanent disability, the CDSR was 2. 83% in group I and 3.25% in group III. Follow-up ranged from 24 to 132 months (mean: 66.2) with a total of 11 patients being lost from follow-up. Actuarial 5-year survival was 81.99 +/- 7.13% in group I, 70.65 +/- 13.72% in group II, and 68.51 +/- 8.93% in group III. Differences between group I and both groups II (p < 0.01) and III (p < 0.05) were statistically significant. Overall 5-year patency was 95.59 +/- 2.28%. Stroke occurred during follow-up in 13 patients. The probability of stroke-free survival was 95.29 +/- 3.76% in group I, 91.03 +/- 8.52% in group II, and 89.09 +/- 6.39% in group III. The difference between groups I and III was statistically significant (p < 0.05). Patients with asymptomatic carotid lesions can be divided into different prognostic groups. Life expectancy is shorter for patients with multiple artery disease. Long-term stroke risk is higher in patients with nonhemispheric neurological manifestations.

Actuarial Analysis↗
PubMed1997

Homocysteine induces synthesis of a serine elastase in arterial smooth muscle cells from multi-organ donors.

OBJECTIVES: In heart transplant recipients with diffuse coronary arteriopathy, we have previously demonstrated the prevalence of elevated homocysteinemia, also known as an independent risk factor for myocardial infarction and stroke. In hyperhomocysteinemic mini-pigs we also observed early detectable pathologic changes in the elastic laminae. We hypothesized that homocysteine causes premature breakdown in the arterial elastic fibers by activation of the elastolytic activities. METHODS: We examined the effect of homocysteine on elastase-like production by smooth muscle cells from sub-inguinal arteries of multi-organ donors (23.4 +/- 3.4 yr, n = 8). The freshly isolated cells were incubated for 0-72 h with homocysteine (0-250 microM), in the presence or absence of specific protease inhibitors. RESULTS: Homocysteine was devoid of a direct effect, but after 18 h incubation the elastase-like activities increased by 5-6-fold in the extracellular medium. The enzymes were characterized as serine proteases. Incubation of cells with a nucleic acid synthesis inhibitor (actinomycin D) or a protein synthesis inhibitor (cycloheximide) suppressed the enzyme induction. CONCLUSIONS: This is the first report of serine protease induction by homocysteine in vascular smooth muscle cells. The process may require protein synthesis and account for the early alterations of the arterial elastic structures in heart transplant recipients, and in other hyperhomocysteinemic patients, as well.

Adult↗
PubMed1997

Morphologic assessment of abdominal aortic aneurysms by spiral computed tomographic scanning.

PURPOSE: The aim of this study was to seek a relationship between the morphologic features of abdominal aortic aneurysms and the feasibility of endoaortic grafting. METHODS: Between June 1995 and January 1996, 86 patients were prospectively studied with contrast-enhanced spiral computed tomographic scans, which provided 35 parameters concerning the aorta and iliac arteries. Four groups were established according to the diameter of abdominal aortic aneurysms: group A, 40 to 49 mm, 36 patients; group B, 50 to 59 mm, 26 patients; group C, 60 to 69 mm, 10 patients; and group D, greater than 70 mm, 14 patients. RESULTS: There was a correlation between the diameter and length of the aneurysm (p < 0.0001) and between aneurysm diameter and length of the proximal neck (p < 0.001). Presence of a proximal neck or a distal neck was more frequent in groups A and B than in groups C and D (p < 0.01). The feasibility of endovascular grafting was estimated at between 50% and 61.6% and was higher in groups A and B than in groups C and D (p < 0.01). CONCLUSIONS: This study has shown an inverse relationship between the diameter of the aneurysm and the length of the aortic neck (correlation coefficient, -0.3640, p < 0.001). The diameter of an aneurysm was the most useful of the 31 parameters measured in predicting the feasibility of endoaortic grafting, estimated at 71% for aneurysms less than 60 mm in diameter and 37.5% for aneurysms greater than 60 mm in diameter (p < 0.01).

Aged↗
PubMed1996

Cervical interbody xenograft with plate fixation: evaluation of fusion after 7 years of use in post-traumatic discoligamentous instability.

STUDY DESIGN: This retrospective study analyzed clinical and radiologic follow-up evaluations of cervical arthrodesis where interbody xenograft combined with internal fixation was used for management of post-traumatic discoligamentous instability. OBJECTIVES: To report results of use of xenograft to avoid the various disadvantages linked to the use of autologous or allogenous bone graft. SUMMARY OF BACKGROUND DATA: Ligamentous instability of the cervical spine is unlikely to heal in a high proportion of cases, and surgical arthrodesis is usually indicated. Anterior arthrodesis has proved to be a safe procedure, but many problems are associated with the use of autograft or allograft. Given the great number of xenograft procedures, there are relatively few reports in the literature. METHODS: A retrospective study analyzed a consecutive series of 52 patients presenting with post-traumatic discoligamentous instability of the cervical spine in which cervical interbody xenografts with plate fixations were done. Follow-up clinical evaluation for neck pain and radiologic evaluation for arthrodesis stability and xenograft fusion at various points in time were done. RESULTS: The long-term results in 41 patients were satisfactory: no infectious complications, extrusion, fracture, loss of height, or resorption of the graft. Seventy-five percent fusion was seen before 9 months after surgery, and 100% fusion was seen 3-18 months after surgery (average, 7.4 months). CONCLUSIONS: Interbody xenograft combined with a rigid plate fixation avoids the problems linked to autologous or allogenous bone graft and gives a safe and solid interbody fusion when arthrodesis is required in ligamentous instability of the cervical spine.

Adolescent↗
PubMed1996

Viscoelastic properties of human arteries. Methodology and preliminary results.

In order to study the biomechanical properties of the arterial wall and to compare arteries with different histologic structures, we designed a device that allows testing of arterial segments under near-physiologic conditions. A hydrodynamic generator simulates systolo-diastolic pressures in an open loop. An intraarterial pressure sensor and a sonomicrometer connected to two piezoelectric crystals placed in diametric opposition on the arterial wall allow computer calculation of compliance, stiffness, midwall radial arterial stress, Young modulus, and incremental modulus for a given arterial segment at a given pressure setting. Seven healthy common carotid artery (CCA) segments and seven healthy (superficial) femoral artery (FA) segments were studied immediately after removal from brain-dead donors between the ages of 18 and 35 years. Histologic examination was performed to determine the density of elastic fibers in the arterial wall. Hysteresis was observed in all segments regardless of pressure settings. Compliance was greater and modulus values and stiffness were lower in CCA than in FA. No evidence of structural change was noted after testing in the circulation loop. These preliminary results open the way to a wide variety of applications for our hydrodynamic circulation loop. Experiments will be undertaken to compare the mechanical properties of arteries before and after cryopreservation.

Adolescent↗
PubMed1996

Effects of cryopreservation on the viscoelastic properties of human arteries.

The purpose of this study was to use our newly developed mock circulation loop to determine the effects of cryopreservation on the common carotid artery (CCA) and the superficial femoral artery (SFA). Fourteen healthy arteries (7 CCA and 7 SFA) harvested from multiple organ donors between the ages of 18 and 35 years were tested before and after cryopreservation at -140 degrees C using dimethyl sulfoxide and the vapor phase of liquid nitrogen. Mean storage time was 4.2 months. The mock pulse rate was 60 beats/min and the following four systolic/diastolic pressures settings were used: 50/110, 80/140, 110/170, and 140/200 mm Hg. Simultaneous measurements of intra-arterial pressure and external arterial diameter were made using an intra-arterial pressure sensor and external piezoelectric sensors. Measured data were used to calculate pulsatility, volumetric compliance, stiffness, midwall radial arterial stress, Young's modulus, and the incremental modulus. After SFA cryopreservation, no significant changes were observed. Conversely, CCA cryopreservation led to a significant decrease in compliance and pulsatility and a significant increase in stiffness. Young's modulus, the incremental modulus, and midwall radial arterial stress did not change significantly. A clearcut decrease in hysteresis was observed after cryopreservation in the CCA. No evidence of structural changes was detected on light and scanning electron microscopy. Baseline findings in this study were consistent with classification of the CCA as an elastic artery and the SFA as a muscular artery. Cryopreservation had no effect on the viscoelastic properties of muscular arteries (SFA). Cryopreservation affected only values related to the cylindrical shape of the elastic arteries (CCA). It had no effect on values related to wall structure.

Adult↗
PubMed1996

Saphenous vein bypass: an alternative to internal carotid reconstruction.

OBJECTIVE: Venous grafting is rarely employed for carotid reconstruction; the aim of this retrospective study was to assess its value as an alternative to endarterectomy. MATERIAL: Between January 1980 and June 1990, we performed 212 carotid artery venous bypasses (CVB) on 208 patients. Twenty-nine patients were asymptomatic, 60 had non-hemispheric symptoms and 119 focal symptoms. The indication for surgery was stenosis in 185 cases, kinking in 18 and aneurysms in nine. The main criteria to use CVB were length of the lesion in 86 cases, extent of atherosclerosis in 75, dysplasia in 12, intraoperative failure of endarterectomy in 21, aneurysms in seven and long-term restenosis or occlusion in 12. RESULTS: There were 11 deaths, three strokes and nine transient ischaemic attacks. Angiographic control showed one occlusion giving an immediate patency rate of 99.5%. Mean follow-up was 104.3 +/- 46.1 months with 15 patients lost to follow-up. Eighty patients died; life expectancy was 52.4 +/- 7.5 at 10 years. Including occlusions and restenosis as failures, the secondary patency rate was 96.4 +/- 3.7 at 10 years. The annual stroke rate was 1.3% and the neurologic event-free-population 87 +/- 2.4% at 10 years. CONCLUSION: CVB is a valuable alternative to endarterectomy for reconstruction of the carotid artery. The indications are extensive atherosclerosis involving the common carotid artery, intraoperative anatomic failure of endarterectomy, and long-term restenosis.

Adult↗
PubMed1996

[Entero-mesenteric infarction: diagnostic and predictive criteria of severity. Therapeutic implications. Multifactor prospective study of a series of 61 cases].

The study includes a group of 61 patients (31 males, 30 females), mean age 72 +/- 13 years with entero-mesenteric ischemia. The authors studied prospectively clinical, biological and radiological parameters in order to reinforce the diagnostic of the disease. Correlations between these parameters and peroperative findings and anatomopathology after resection were able to point out factors of severity. These factors should have a therapeutic incidence in order to improve the outcome usely bad.

Adult↗
PubMed1996

[Mechanical properties of the arteries. Effects of cryopreservation].

The viscoelastic properties of the arterial wall are responsible for the blood pressure wave propagation throughout the arterial system. Arterial diseases may cause disorders in this propagation. We have developed a mock circulation system that allows assessment of viscoelastic properties in fresh or cryopreserved human arteries. It includes the following components:--a hydrodynamic generator that can simulate physiological pressure variations in fresh segments of human arteries;--a lightweight miniature flexible probe that can be placed around the artery to measure changes in the external diameter during systolo-diastolic cycles;--a computer program to analyse pressure and diameter data measured during a cardiac cycle. Using this system, it is possible to evaluate the main viscoelastic properties of the arterial wall (arterial compliance, arterial stiffness, midwall aortic stress, Young elastic modulus, incremental modulus). Human arterial samples were collected during organ harvesting in subjects from 18 to 35 years of age. Correlation between viscoelastic properties, arterial wall status, and histological aspect in nitrogen vapor (-140 degree C) were established. No statistically significant difference was observed in femoral arteries characteristics. Compliance decreased, while stiffness increased with statistically significant difference after cryopreservation in carotid arteries. No histological difference was observed in both arteries before and after cryopreservation.

Adult↗
PubMed1995

Popliteal artery entrapment syndrome. Anatomic and embryologic bases, diagnostic and therapeutic considerations following a series of 15 cases with a review of the literature.

We report 15 examples of popliteal artery entrapment syndrome observed in 11 patients. The anatomical causes were as follows: in one case, the popliteal artery presented an aberrant course medially to the medial head of the gastrocnemius muscle. In 5 cases, there was a small fibrous band linking the medial head of the gastrocnemius muscle to the lateral condyle and crossing behind the popliteal artery; in 5 cases this anomaly was also found in association with an abnormally high and/or internal insertion of the medial head of gastrocnemius muscle. In the last 4 cases, there was a muscular insertion anomaly associated with muscular hypertrophy causing arterial compression. Arteriography performed in the 11 patients showed evocative signs of the diagnosis in all cases where the artery was patent. Two popliteal arteries were occluded. CT scan and MRI examination of the popliteal fossa enabled us to define the muscular origin of the popliteal compression. All of the patients were operated upon; two received a reversed saphenous bypass and all of the others were treated by liberation of the popliteal artery and/or vein by a posterior approach. Follow-up in all patients at long term showed good prognosis. All of the patients were able to take up their previous physical activities without sequelae. Our review of the literature, which is based on 374 cases of popliteal artery entrapment observed in 280 patients, made it possible to define the frequency of the various anomalies observed, their symptoms and the different therapeutic possibilities. The multiple anatomical classifications as well as the arterial and muscular embryology are also described.

Adult↗
PubMed1995

Anatomic basis of the liver for the development of a perihepatic prosthesis.

We studied specimens from 50 cadavers (27 men and 23 women) to obtain anatomical data concerning the liver and its attachments. The results allowed us to develop a polyglactin perihepatic prosthesis for compression of the injured liver. The falciform ligament and a narrowing of the hepatic parenchyma at this level allow attachment of the prosthesis. Separate prostheses were designed for each lobe. Clinical use has demonstrated that our prosthesis can be used to achieve effective control of haemorrhage and bile leakage.

Adult↗
PubMed1995

Value of angioscopy for intraoperative assessment of carotid endarterectomy.

From March 1992 to November 1993 we used angioscopy and arteriography for intraoperative assessment of 103 carotid endarterectomies in 96 patients. The indication for surgery was asymptomatic stenosis in 55 cases and neurologic and/or ocular symptoms in 48. Intraoperative angioscopy and arteriography were performed to allow comparison of findings. Intraoperative angioscopic images were normal in 67 cases and abnormal in 36. The defect was an intimal flap in 26 cases, detachment of the distal plaque in seven cases, and an intimal wedge in five cases. In two cases both detachment and a wedge were observed. The defect was not considered severe enough to warrant revision in 31 cases and was corrected in five cases by either vein bypass (n = 1) or revision of the endarterectomy (n = 4). In the latter four cases repeat angioscopy showed normal findings. Arteriographic and angioscopic findings were compared in 102 cases. In the 71 cases in which angioscopic findings were normal, arteriography revealed a major abnormality in three cases: kinking in one and stenosis > 40% in two. Kinking was treated by attachment of the common carotid artery and stenosis by venous bypass. In the 31 cases in which angioscopy revealed defects not considered to warrant revision, arteriography revealed stenosis > 40% in three cases treated by either prosthetic bypass (n = 2) or revision of the endarterectomy (n = 1). The false negative rate for angioscopy was 5.9% and concordance between the two methods was 94.1%. The combined mortality-morbidity rate was 1.9% (one stroke and one death). Postoperative evaluation of anatomic findings by arteriography or Doppler ultrasonography revealed asymptomatic internal carotid occlusion in one and internal carotid stenosis < 30% in four cases. Angioscopy is a simple, low-cost method in intraoperative control that can be used either as an adjunct to arteriography or as an alternative if arteriography cannot be performed.

Adult↗