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Biomedical subjects

F Gigou

Publications and source records attributed to F Gigou.

At least 37 records · Page 2Linked to original sources
PubMed1990

Pelvic arteriovenous fistulas: therapeutic strategy in five cases.

Pelvic arteriovenous fistulas are rare. They may be defined as arteriovenous communications developing in the pelvis from the internal iliac artery, the origin of its posterior trunk or branches of its anterior trunk. Congenital arteriovenous malformations, more common in women, and posttraumatic arteriovenous fistulas are the two main etiological forms. Diagnostic problems include appreciation of visceral extension in arteriovenous malformations and precise localization of fistulas especially when they affect the internal iliac artery itself. Therapy is aimed at complete closure of arteriovenous communications using interventional radiologic methods or surgery. Although indications are difficult to assess, complete, one-stage therapy is preferable due to surgical difficulties following failed or incomplete radiological or surgical attempts.

Adult↗
PubMed1990

Renal artery revascularization with polytetrafluoroethylene bypass graft.

Between January 1979 and December 1986, a total of 74 renal revascularizations were performed in 68 patients using the reinforced expanded polytetrafluoroethylene prosthetic graft. These 74 revascularizations represent 29% of 251 surgical renal revascularizations performed during the same period of time. Eight patients had a total of nine revascularizations in the emergency setting (group I) for ruptured suprarenal aneurysm or acute thrombosis of the renal arteries. Only one patient survived and six years later, his anatomic and functional results are satisfactory. Sixty-five revascularizations were performed electively in 60 patients (group II). This group consisted of 19 renal revascularizations alone, and 46 combined aortic and renal revascularizations. One patient died of respiratory complications two months after operation after his thoracoabdominal aneurysm was cured. Early repeat postoperative arteriography showed that six reconstructions had occluded (three major renal arteries, three polar arteries). One patient was lost to follow-up. The remaining patients were followed for a mean of 41 months. Follow-up arteriograms obtained during 1987 showed that there were two late occlusions and two distal anastomotic stenoses. Actuarial patency was 85 +/- 10% at 72 months. Polytetrafluoroethylene prosthetic grafts constitute a reliable material for renal revascularization and combined aortic and renal reconstruction in certain anatomic conditions.

Adult↗
PubMed1989

Arterial complications of the thoracic outlet syndrome: fifty-five operative cases.

Between January 1, 1969, and December 31, 1984, 55 operative procedures were carried out in 47 patients to correct subclavian-axillary artery lesions resulting from compression at the thoracic outlet. The most common causes of compression were a long cervical rib (27) and an anomalous first rib (15). Presenting features included claudication, vasomotor phenomena, digital gangrene, and acute limb-threatening ischemia. A combined supraclavicular and infraclavicular approach was preferred. Decompression was best achieved by excision of the cervical rib and the first rib and division of all soft tissue elements. The most common methods of arterial repair were resection-anastomosis (23) and replacement of vein graft (11). Embolic occlusions were frequently present (35). Axillary emboli were amenable to direct revascularization at the time of subclavian artery repair. If possible, more-distal embolic occlusions were managed without recourse to embolectomy catheter manipulations. The mean follow-up was 5 years 8 months (range 4 months to 16 years). Patients were assessed clinically, and the arterial repair was monitored by Doppler ultrasonography, B-mode scanning, and digital subtraction angiography. Of the 39 patients available for follow-up, 35 had no symptoms and four had residual claudication. There were no amputations. In the remaining cases the subclavian-axillary artery segment showed no hemodynamic or anatomic abnormality.

Adolescent↗
PubMed1988

[Arterial thrombolysis. Review and future prospects].

After describing the mechanism of action, results and local and general complications of classical thrombolytic agents (streptokinase and urokinase) administered systemically, locally and peroperatively, then of modern thrombolytic agents (acyl enzyme, tPA and scuPA), the future perspectives of arterial fibrinolysis are discussed. These are based upon: analysis of the comparative efficacy of the different thrombolytic agents in the light of results seen, not only in peripheral arterial pathology but also in other indications, as in coronary pathology; discussion of the methods of administration of the thrombolytic agent in such a way as to obtain an optimal local concentration and at the same time reduced systemic fibrinolysis. better definition of the indications of thrombolysis in acute ischemia of the limbs in comparison with other therapeutic approaches, in particular surgery, taking into account the degree of ischemia, of etiological mechanism and the site of the arterial obstruction.

Enzyme Precursors↗
PubMed1987

Polytetrafluoroethylene bypass for revascularization of the atherosclerotic internal carotid artery: late results.

Between 1979 and 1986, 60 patients underwent a total of 62 revascularizations of the internal carotid artery with an expanded polytetrafluoroethylene (ePTFE) bypass. In 54 cases, the indication for surgery was the presence of extensive lesions in both the internal and common carotid arteries and, in 8 cases, a late complication of a previous surgical procedure. There were no early postoperative deaths (within 30 days). Three patients (5%) experienced postoperative neurologic complications. Two complications resolved completely whereas one left minimal residua. The bypasses remained patent in all three cases. All patients had early postoperative Doppler B-mode ultrasonography. Two early occlusions (3.2%) were disclosed but the patients remained symptom-free. Four neurologic complications were observed over long-term (average 23 months) follow-up. None were related to the operated carotid artery. There were no cases of infection or late occlusion. No hemodynamic or morphologic anomalies were observed on late follow-up ultrasound studies. These favorable results support the use of ePTFE as a reliable substitute when adequate autologous saphenous vein is not available for carotid bypass. Routine utilization might be indicated in cases of long bypasses, especially when it is necessary to implant the bypass on the ascending aorta, or when the proximal site of implantation is made on a thickened arterial wall.

Aged↗
PubMed1986

[Hemorrhagic vascular complications of pelvic fractures . The role of embolization. 9 cases].

Emergency haemostatic embolization of the branches of the hypogastric artery was performed within 24 hours in 9 patients with fracture of the pelvis and major progressive retroperitoneal haematoma. Eight to 48 units of blood had been transfused. The patient in the worst condition (48 units of blood) died of respiratory failure and myocardial incompetence 2 hours after embolization. In the remaining 8 patients, embolization was effective without any immediate or delayed complication of the angiographic procedure. The usefulness of emergency angiographic exploration and the possible applications of endovascular haemostasis are discussed.

Adolescent↗
PubMed1986

Aorto-femoral bypass with polytetrafluoroethylene prostheses: preliminary results in 363 cases.

From October 1977 to October 1982, 363 unilateral aorto-femoral bypasses using polytetrafluoroethylene (PTFE) prostheses were performed for predominantly unilateral aorto-iliac disease. The distal anastomosis was extended into the deep femoral artery in 57% of the patients. The postoperative mortality was 0.5%. The actuarial patency rate after 6 years was 87% in patients with claudication and 77% in those with critical ischemia. No false aneurysm developed. Thrombosis of the prosthesis was due to progression of distal disease, intimal hyperplasia and postural extrinsic compression. The latter seems to be characteristic of PTFE prostheses and can be treated by thrombectomy. In 21 cases a cross-over femoro-femoral bypass was done during the follow-up period because of contralateral progression of disease.

Adult↗
PubMed1986

[Interruption of the vena cava inferior. A comparative study of the Adams de Weese clip and the Kimray Greenfield filter].

Efficacy of two methods for interruption of inferior vena cava was compared after insertion of 95 Adams de Weese clips by the sub or trans-peritoneal route and of 72 Greenfield filters usually by a jugular approach. Introducing Greenfield's filter to produce caval interruption did not require modification of operative indications. In contrast, it allowed caval blockade to be performed in more elderly patients, generally in a poorer condition, at the price of higher mortality, due more to the clinical circumstances of the interruption rather than the caval blockade itself. Postoperative follow up showed fewer caval thromboses after Greenfield's filter (15%) than after the pericaval clip (35%).

Adult↗
PubMed1985

[Limitations and results of revascularization of the lower extremities of diabetics].

Both the possibility and prognosis of procedures for revascularization of lower limbs are still the subject of discussion. In 1976, Tingaud et al. emphasized the deceptive nature of femorotibial bypass operations, whereas more recently, the inverse position was taken by Logerfo who considered that therapy should be identical for diabetic and non-diabetic arterial diseases. As a function of experience gained in the Hospital Saint-Joseph with vascular surgery in diabetics, results of revascularization in diabetics were compared with those in non-diabetic patients (the possible influence of the type of diabetes-particularly whether insulin-dependent or not- could not be assessed because of the variable use of insulin apart from precise cases).

Diabetic Angiopathies↗
PubMed1984

[Axillo-femoral bypass using PTFE. Early and secondary results. 104 patients].

Between 1977 and 1981, 104 patients underwent 115 axillo-femoral bypass operations (AFB). All the indications were based upon limb salvage. Ninety-nine unilateral bypasses and only 8 axillo-bi-femoral procedures were performed. Prolongation of revascularisation by femoro-popliteal bypass was necessary in 10 cases, in 1 or 2 stages. Secondary bilateralisation of an unilateral bypass was required in only 6 cases because of the development of gangrene of the other limb. The postoperative mortality was 6% (5 patients) in the gangrene group and was 33% (6 patients) in the acute ischaemia group. Study of the cumulative permeability of bypasses until the time of their first thrombosis showed that 62% were permeable at 1 year and 44% at 4 years. Thrombectomy was followed by a percentage permeability of 10%. Weight bearing was still possible by 75% of limbs after 5 years. In conclusion to this study: axillo-femoral bypass remains reserved for salvage of the limb; extension of implantations to the distal and/or pathological artery remains legitimate; PTFE seems the most suitable material at present; the development of a thrombosis in the first 18 months should be treated by thrombectomy in order to decrease the number of amputations.

Adult↗
PubMed1983

[Anastomosis of the low popliteal and leg arteries without clamping].

Using an Esmarch's bandage and a lower thigh tourniquet makes it possible to suppress flow and backflow in arteries below the knees. Distal anastomosis without proximal and distal clamps can then be performed on arteries with pathological wall but with adequate residual lumen. The elective indication is bypass on partially calcified arteries of the leg.

Arteries↗
PubMed1983

[4-year clinical experience with gelatin-resorcinol-formol glue in acute dissections of the ascending aorta].

The gelatine-resorcine-formol glue (GRF) was used to reinforce the tissues of 25 patients operated for acute dissection of the ascending aorta, between January 1977 and September 1980. The results were compared with those of a control group of 25 patients operated between 1970 and 1976 by "classical techniques". There were no significant differences between the two groups as regards age, anatomical and preoperative clinical states. The ascending aorta was replaced in all patients; the aortic valve was replaced three times (12 p. 100) in the GRF group and twelve times (48 p. 100) in the control group: the coronary arteries were bypassed or reimplanted in 20 p. 100 of patients in both groups. The average peroperative blood loss was 5,800 ml in the control group and 2,100 ml in the GRF group (p less than 0,01). There were four peroperative deaths (16 p. 100) in the control group and no peroperative deaths in the GRF group. Postoperative complications (renal failure, cerebral ischemia, persistent peripheral ischemia or infection) were much more common in the control group. They were responsible for eight hospital deaths in the control group and two hospital deaths in the GRF group (p less than 0,01). Therefore, global hospital mortality was reduced from 48 p. 100 (control group) to 8 p. 100 (GRF group) (p less than 0,01). Two late deaths occurred in the control group, but there were none in the GRF one, all survivors being in good clinical condition. Sixteen patients in the GRF group underwent 19 angiographic controls, 2 to 36 months after surgery. These investigations showed two moderate aortic regurgitations (8 p. 100), three persistent dissections of the descending aorta but a stable, good quality repair in the other patients. In conclusion, the use of GRF glue significantly reduced: 1) the number of aortic valve replacements, 2) per- and postoperative blood loss, 3) the incidence and severity of postoperative complications. The long-term survival rate (4 years) has improved from 40 to 91 p. 100.

Acute Disease↗
PubMed1982

[Intraluminal angioplasty in the treatment of femoro-popliteal atheromatous lesions. Apropos of 57 cases].

Close cooperation between radiologist and surgeon is essential to prevent major complications of intra-luminal angioplasty, an only mildly aggressive revascularization procedure. Though evolution of an arteritis of the lower limbs can be halted by relief of the stenosis in some cases, the problem remains as to whether this technique is justified at the stage of claudication, even severe. The wider indications for dilatation at the iliac in relation to the femoropopliteal levels in this most recent series reported, testify this tendency.

Aged↗
PubMed1982

[Venous graft versus carotid thromboendarterectomy (T.E.) (author's transl)].

497 cases of carotid stenosis were operated upon with 2 operative series: one with a venous graft technique and the other by thromboendarterectomy (T.E.). 228 grafts were thus compared with 192 T.E. during the initial postoperative period and 2 and a 1/2 years follow up. The prevalence of immediate postoperative complications was lower in the venous graft group than in the T.E. group but the distribution of patients in terms of neurological symptomatology was not strictly identical. By contrast, comparison of the asymptomatic patients in the two groups showed no morbidity nor mortality. It is thus not possible to state that vein graft is superior to T.E. in the prevention in particular of early embolic complications with the thromboendarterectomized zone as the point of departure and the follow up period is too short to assess the superiority of one or other method in the long term. During the 2 and a 1/2 year follow up period of the present study no pathology related to the vein graft has been seen, confirming the trial already reported.

Adult↗
PubMed1982

[Associated lesions of the aorta and visceral arteries. A special anatomo-clinical form of atheromatous disease].

The data of 124 observations of atheroma associated lesions of the aorta and its visceral branches, renal and mesenteric was collated. This retrospective study makes it clear that cases of atheromatous lesions involving the renal and mesenteric arteries can be considered as a special group. Aortic lesions above the level of the renal arteries have a variable outcome--the most commonly seen pattern is that of a thick circumferential plaque which encroaches on the openings of the visceral arteries. These lesions are either ulcerated or smooth and sometimes overlain by voluminous mural thrombus above the renal arteries. This group is associated with widespread atheromatous disease in the coronary and cerebral circulations. The prognosis is poor. A special approach to management is thus required since many arteries are affected and since usually, associated revascularization of the aorta and these four visceral branches is not present. This form of treatment is justified by a post-operative mortality of nil. There is a 50% mortality at three years, almost completely due to coronary disease.

Aorta, Abdominal↗