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F Koskas

Publications and source records attributed to F Koskas.

At least 19 recordsLinked to original sources
PubMed2006

[Evolution of the treatment of chronic post-traumatic aneurysms of the descending thoracic aorta: 30 years experience].

The authors present the early and late results of a series of 40 patients treated for chronic post-traumatic aneurysms of the descending thoracic aorta from 1975 to 2005. With the exception of a patient who died of an intra-pleural rupture before surgery, the patients were treated by aortotomy and prosthetic graft (N=17), aortotomy and direct suture (N=17) or endoprosthesis (N=5). The use of distal aortic perfusion in 22 patients enabled 17 direct sutures (77.3%) thanks to extensive mobilisation of the aortic arch. Endoprostheses have been used since 1997 in high surgical risk patients with severe comorbid conditions. There were no deaths, one transient paraparesia after simple aortic clamping, one reoperation for a haemothorax and four cases of dysphonia due to paralysis of the recurrent laryngeal nerve. Thirty-five patients (90%) were followed up for an average of 119.7 +/- 16.4 months. There were no clinical complications and the late morphological results were good in all cases with the exception of one type 1 endoprosthetic leak. The treatment of chronic post-traumatic aneurysms of the descending thoracic aorta gives excellent early and late results, justifying wide operative indications. The wish to avoid use of a prosthesis in young patients with a long life expectancy should give preference to conventional surgical techniques which, providing distal aortic perfusion is employed, allow direct suture of three quarters of cases. Endovascular treatment is reserved only for "poor surgical risks".

Accidents↗
PubMed2005

[Intramuscular vascular malformations as a differential diagnosis of focal myositis].

INTRODUCTION: Focal myositis constitutes an original and rare pathological entity, characterized by a localized inflammation within skeletal muscle, presenting as a soft tissue painful tumefaction. Diagnosis requires histological confirmation because of its non-specific clinical feature and the numerous differential diagnoses. EXEGESIS: We report a 27 year-old man who presented with suggestive symptoms of focal myositis. MR imaging and echography were compatible with this diagnosis but also demonstrated the existence of a vascular component within the tumefaction. The diagnosis of a benign vascular malformation with intramuscular development was made by a surgically guided biopsy. CONCLUSION: Vascular malformations are histologically heterogeneous with extremely variable clinical expressions. When they develop within skeletal muscle, they may mimic focal myositis. Hence, their diagnosis has to be evoked before performing muscle biopsy, because of the potential hemorrhagic risk.

Adult↗
PubMed2005

Percutaneous transluminal angioplasty in severe diabetic foot ischemia: outcomes and prognostic factors.

OBJECTIVES: To evaluate the outcomes of severe ischemic diabetic foot ulcers for which percutaneous transluminal angioplasty (PTA) was considered as the first-line vascular procedure. Factors associated with successful PTA were sought. RESEARCH DESIGN AND METHODS: In 32 consecutive diabetic patients with foot ulcers and severe limb ischemia, PTA was performed if feasible; if not, primary bypass grafting was done when feasible. All patients were followed until healing or for at least one year. Patients with worsening ulcers after PTA underwent bypass grafting. Clinical and angiographic factors influencing outcomes after PTA were sought by univariate and multivariate analysis. RESULTS: PTA was done in 25 of the 32 (78%) patients, and considered clinically successful in 13 (52%). After 1 year, the healing rate was 70% and the limb salvage rate 90%. Successful PTA was significantly associated with a higher post-PTA transcutaneous oxygen pressure (P = 0.03) and presence of at least one patent pedal vessel (P = 0.03) in the univariate analysis; only a patent pedal vessel was significant in the multivariate analysis. CONCLUSION: Primary PTA in diabetic patients with severe ischemic foot ulcers provides similar outcomes to usual results obtained in severe ischemia in absence of diabetes. The presence of one patent pedal vessel on arteriography before PTA is the best prognostic factor.

Aged↗
PubMed2004

[Treatment for carotid stenosis: surgery, the reference].

THE CONTROVERSY: The indications for carotid revascularisation are clearly codified, but the surgical treatment is debatable. The angioplasty initially proposed for non-atheromatous stenosis or for high surgical risk patients is used by some as first-line therapy, although no benefit/risk ratio in its favour has been demonstrated. ARE THERE ANY BENEFITS WITH SURGICAL TREATMENT?: The efficacy of surgery in the treatment of atheromatous carotid stenosis has been demonstrated. The interest of angioplasty The advantages expected with carotid angioplasty are the absence of cervical incision and cervical nerve lesions, together with a reduction in the duration of hospitalisation and costs. Nevertheless, there are risks inherent to the femoral puncture and endovascular propagation from the femoral to the carotid artery. Till now, the published studies have not concluded in the superiority or equivalence of angioplasty versus surgery. FOR CERTAIN SUB-GROUPS: It has not been demonstrated but it is possible that a sub-group of high-risk patients could benefit from carotid angioplasty. There are no arguments for recommending angioplasty in the treatment of carotid re-stenosis following endarterectomy or for post-radiation stenosis. ANTI-EMBOLIC TREATMENT SHOULD BE FORESEEN: Carotid angioplasty is associated with embolus, the frequency of which is 8-fold greater than that observed after endarterectomy. The systematic use of cerebral protection is therefore recommended. TODAY: The treatment of reference of carotid stenosis remains endarterectomy conducted by vascular surgeons.

Angioplasty↗
PubMed2002

Outcome of severe diabetic foot ulcers after standardised management in a specialised unit.

OBJECTIVE: The primary objective was to evaluate the efficacy in terms of limb salvage and healing time of standardised multidisciplinary management for high-grade diabetic foot ulcers. The secondary objective was to retrospectively identify the factors that influenced time to healing. STUDY DESIGN AND METHODS: Over a 2-year period, 157 patients with diabetic foot ulcers were managed in our specialised unit using a standard treatment strategy; 118 were followed until healing or for at least 7 months (range, 7-29) after hospital discharge and form the basis for this study. Predetermined criteria were used to diagnose and manage the lesions. The number of major amputations and the time to healing were the main outcome measures. Univariable and multivariable analyses were done retrospectively to look for factors associated with time to healing. RESULTS: The limb salvage rate was 97.5% and the healing rate was 50% after 10 months and 70% after 16 months. Factors significantly associated with healing time were arterial disease without bypass surgery (p<0.001) and renal replacement therapy (p<0.05). Osteomyelitis, as managed in this study, did not increase the healing time (p > 0.6). CONCLUSION: In high-grade diabetic foot ulcers, standardised conservative management with second-line bone-sparing surgery, if needed, yields an acceptable limb salvage rate. With combined medical and surgical treatment, osteomyelitis is not a poor prognosis factor.

Adult↗
PubMed2002

[Aortic dissections: recent endovascular therapeutic advances and current indications].

Dissection is one of the most serious diseases of the aorta if only because of its potential for rupture, but also for other complications which may be fatal. Replacement with a prosthesis remains the treatment of reference as an emergency for proximal dissection and as an elective procedure for selected cases of distal dissection with complications. Despite steady progress in ancillary management (distal perfusion, circulatory arrest, cardiac, neurological and visceral protection) the operation remains a very invasive procedure. Aortic endoprostheses represent the therapeutic innovation of the decade for the treatment of aortic aneurysms and their use could be extended to dissections, at least for the most distal forms and to patients at very high surgical risk.

Aortic Dissection↗
PubMed2001

Optimization of the resistance of arterial allografts to infection: comparative study with synthetic prostheses.

Arterial allografts can be used for in situ treatment of prosthetic graft infection. The purpose of this in vitro study was to compare the resistance of allografts and synthetic prostheses to infection by five strains of bacteria and to study antibiotic treatments designed to reduce allograft infection. Fresh and cryopreserved allografts were compared with synthetic prostheses made of various biomaterials including PTFE, plain Dacron, gelatine-sealed Dacron, and gelatine-sealed, rifampicine-bonded Dacron. Allografts were used with or without treatment using an antibiotic containing gentamycine, lincomycine, and vancomycine. The bacterial strains tested were Escherichia coli, Staphylococcus aureus, slime-producing Staphylococcus epidermidis, non-slime-producing Staphylococcus epidermidis, and Pseudomonas aeruginosa. Infection was evaluated by counting the number of adherent bacteria on the allograft or synthetic material after rinsing and ultrasonication. Statistical analysis was achieved using nonparametric Mann-Whitney tests. Results showed that allografts not treated with antibiotics were highly susceptible to bacterial infection. Antibiotic treatment decreased infection. Application of antibiotic after thawing cryopreserved allografts led to a significant decrease. None of the biomaterials tested provided sufficient protection against bacteria resistant to the antibiotics used.

Anti-Bacterial Agents↗
PubMed2001

[Thrombopenia increased by heparin and danaparoid].

Pathogenesis, frequency, and management of heparin-induced thrombocytopaenia are well-known. They may be related with both unfractioned heparin and low-molecular weight heparin. Suspected heparin must be discontinued as soon as the diagnosis is established. Orgaran (danaparoid sodium) may be used for management of patients with heparin-associated thrombocytopaenia but can itself be associated with a thrombocytopaenia. Our case report allows us to catch in mind such a crossed complication.

Aged↗
PubMed2001

Endovascular treatment of abdominal aortic aneurysms: is there a benefit regarding postoperative outcome?

BACKGROUND AND OBJECTIVE: The endovascular treatment of abdominal aortic aneurysms has raised great interest amongst vascular surgeons. The aim of this study was to compare the postoperative morbidity and mortality rates of endovascular treatment with those of open surgery, from the anaesthesiologist's standpoint. METHODS: From January 1997 to June 2000, 425 consecutive patients with abdominal aortic aneurysms were referred for regular surgery. Thirty-nine patients who needed a visceral or renal artery revascularization, or a nephrectomy were excluded. The remaining 386 patients were studied in a prospective manner. Aneurysms were evaluated with spiral computerized tomography scanning and calibrated aortography. After informed consent, only those patients with a suitable vascular anatomy underwent endovascular treatment (n = 193). All other patients underwent open surgery and are considered as a control group (n = 193). Endovascular treatment was performed by a femoral or an iliac retroperitoneal route. All stent-grafts were made to measure using auto-expandable stainless-steel stents covered with a standard polyester prosthetic graft. RESULTS: Six patients in the endovascular treatment group needed to be converted to the open surgical technique (during the same operation) because of rupture of the iliac bifurcation (1 patient), a large endoleak (2 patients), or technical problems (3 patients). CONCLUSION: The amount of bleeding and the need for blood products were significantly lower in the endovascular treatment group. Despite the absence of significant differences regarding cardiac complications and mortality, there was a lesser incidence of pneumonia, acute respiratory and renal failure. Patients in the endovascular treatment group spent less time in the intensive care unit and in the Hospital.

Age Factors↗
PubMed2001

S-100beta protein levels do not correlate with stroke in patients undergoing carotid endarterectomy under general anesthesia.

OBJECTIVE: To establish the S-100beta protein profile during carotid artery surgery to show a possible correlation between postoperative stroke and this biochemical marker. DESIGN: Prospective, nonrandomized study. SETTING: Departments of anesthesiology, biochemistry, and vascular surgery in a single university hospital. PARTICIPANTS: One hundred patients consecutively scheduled for carotid endarterectomy. MEASUREMENTS AND MAIN RESULTS: Postoperative neurologic complications were defined as major, occurrence of a postoperative permanent stroke, or minor, occurrence of a new postoperative transient ischemic attack lasting < 2 hours. Serum samples were obtained before induction, before carotid artery cross-clamping, after declamping, at the end of surgery, during recovery, and on the first postoperative day. Concentrations of S-100beta were analyzed using a commercially available kit (LIA-mat S300 analyzer, Byk-Sangtec Medical, Bromma, Sweden). Ninety-five patients awoke without a neurologic defect. Three patients experienced a permanent stroke, and 2 patients had a transient ischemic attack. S-100 basal values were unrelated to preoperative status, including hypertension, neurologic status, renal function, and degree of the carotid lesion. S-100 concentration increased slightly but significantly at the end of surgery and remained stable until the first postoperative day. S-100 profile during the procedure was independent of the duration of carotid artery cross-clamping and the need for a shunt. S-100 serum level was not significantly different in the patients with a postoperative ischemic event in comparison with the entire group. The S-100 profile was not increased in 2 of 3 patients with a permanent stroke and in 1 of 2 patients with a transient ischemic attack in comparison with the 95 patients with uneventful recovery. CONCLUSION: S-100 concentration slightly increased at the end of surgery and remained high until the first postoperative day in all patients. S-100 was not significantly different in the patients with postoperative stroke. S-100 did not serve as a marker for postoperative stroke after carotid artery surgery. This fact must be taken into account during further investigations of S-100.

Aged↗
PubMed2001

Aneurysms of the innominate artery: surgical treatment of 27 patients.

PURPOSE: Aneurysms of the innominate artery (AIA) are widely considered to be a rare entity. We describe our experience with AIAs in the last three decades. METHODS: From October 1973 to October 2000, we operated on 27 patients with an AIA. The underlying cause of aneurysm was Takayasu's disease in 7 patients, degenerative disease in 6 patients, syphilis in 5 patients, chronic dissection in 3 patients, trauma in 2 patients, infection in 2 patients, a postoperative complication in 1 patient, and Marfan syndrome in 1 patient. AIA was associated with an aortic aneurysm in 17 patients. Fourteen patients had no symptoms. The remaining patients had symptoms, with thromboembolic complications in 7 patients, pain without rupture in 3 patients, and a ruptured aneurysm in 3 patients. In two patients at high risk for surgery who had a small AIA with embolic complications, a cervical approach was used as a means of performing distal exclusion and crossover bypass. In the remaining 25 patients, a midline sternotomy was used. One patient with a ruptured AIA exsanguinated during sternotomy. Ten patients underwent a prosthetic replacement of the ascending aorta and/or aortic arch with a separate prosthetic branch to the innominate artery (IA). Thirteen patients underwent ascending aorta-to-IA prosthetic bypass in association with lateral suture (8 patients) or prosthetic patching (5 patients) of the aorta. One patient with an infected aneurysm was treated by means of resection of the aneurysm, proximal ligation of the IA, and transposition of the right into the left common carotid artery. Cardiopulmonary bypass with deep hypothermic circulatory arrest was used in 10 patients. RESULTS: Three perioperative deaths occurred (2 of 4 in association with emergency treatment and 1 of 23 with elective treatment). Respiratory complications requiring prolonged artificial ventilation developed in five patients. Two patients had transient worsening of preoperative neurologic deficits. Late results, with a mean follow-up of 85 months, were good. CONCLUSION: The etiology and presentation of AIAs are variable. Surgical management with current cardiovascular techniques achieves excellent results.

Adult↗
PubMed2001

Carotid artery stenosis: prospective comparison of CT, three-dimensional gadolinium-enhanced MR, and conventional angiography.

PURPOSE: To prospectively compare gadolinium-enhanced magnetic resonance (MR) angiography and computed tomographic (CT) angiography with digital subtraction angiography (DSA) for use in detecting atheromatous stenosis and plaque morphology at the carotid bifurcation. MATERIALS AND METHODS: Forty-four carotid arteries (in 22 patients) were analyzed by using CT angiography, enhanced MR angiography, and DSA. CT and enhanced MR angiograms were reconstructed with maximum intensity projection and multiplanar volume reconstruction. The following four features were analyzed: degree of stenosis on the basis of North American Symptomatic Carotid Endarterectomy Trial criteria, length of stenosis, luminal surface, and presence of ulcers. RESULTS: There was significant correlation between CT angiography, enhanced MR angiography, and DSA for degree and length of stenosis. With enhanced MR angiography and CT angiography, degree of stenosis was underestimated in two of 44 cases. No case of overestimation with CT angiography was found. Severe internal carotid artery stenoses were detected with high sensitivity and specificity: 100% and 100%, respectively, with CT angiography; 93% and 100%, respectively, with enhanced MR angiography. Luminal surface irregularities were most frequently seen at CT angiography. With CT angiography and enhanced MR angiography, more ulceration was detected than with DSA. CONCLUSION: There was a significant correlation between CT angiography, enhanced MR angiography, and DSA in evaluation of carotid artery stenosis. Enhanced MR angiography or CT angiography can be used to adequately evaluate carotid stenosis.

Aged↗
PubMed2001

[Exploration of the origin of supra-aortic arterial trunk: can MR angiography with gadolinium injection replace digital angiography?].

Ostial stenosis of the craniocervical vessels are frequently associated with carotid stenosis. Consequently, exploration of the aortic arch is necessary prior to carotid endarterectomy. Contrast-enhanced MR angiography (gRMA) could replace digital substraction angiography (DSA). The goal of this work was to evaluate gRMA for the detection of ostial stenosis of the craniocervical vessels. Twenty two patients with carotid stenosis > 50% on sonography examination prospectively underwent gRMA and DSA. We analyzed the overall quality of each gRMA and the degree of ostial stenosis of the craniocervical vessels (innominate, left carotid, subclavian and vertebral arteries). Thirteen gRMA examination was considered as good quality and 8 as adequate for diagnosis. There was significant correlation between gRMA and DSA for degree of stenosis (k = 0.82, p < 0.0001). gRMA tends to overestimate degree of ostial stenosis, especially for vertebral arteries. We conclude that gRMA is a promising tool but cannot yet be used as a stand-alone procedure for the evaluation of ostial stenosis of the craniocervical vessels.

Aged↗
PubMed2000

Expression of platelet-activating factor receptor in human carotid atherosclerotic plaques: relevance to progression of atherosclerosis.

BACKGROUND: Human monocyte-derived macrophages synthesize numerous proinflammatory and prothrombotic substances, including lipid mediators, such as platelet-activating factor (PAF), which may play a major role in the onset and perpetuation of atherosclerotic lesions. In addition, both monocytes and macrophages express PAF receptors (PAF-R). The expression of PAF-R is transcriptionally downregulated by oxidized LDL in in vitro primary cultures of monocyte/macrophages. In this study, we evaluated the expression of PAF-R in human carotid plaque tissue, in foam cells isolated from human carotid plaques, and in primary cultures of umbilical smooth muscle cells (SMCs). METHODS AND RESULTS: We show that PAF-R was expressed at low levels in foam cells compared with monocyte/macrophages in plaques, as assessed by immunohistochemical staining and in situ hybridization. In addition, low levels of mRNA were also detected by RT-PCR in isolated human carotid foam cells. A prominent finding of our study was the demonstration that contractile SMCs were positive for PAF-R, and its mRNA was extracted from primary cultures of umbilical SMCs. CONCLUSIONS: As macrophages loose their inflammatory phenotype on transformation into foam cells, they may equally loose their capacity of defense against aggression. We postulate that the diminished expression of PAF-R may be deleterious in the context of plaque formation and progression. The observation that arterial SMCs of contractile phenotype express PAF-R opens new avenues concerning the migration of these cells from media to intima and atherosclerotic plaque formation.

Antigens, Differentiation↗
PubMed2000

Treatment of aortic arch dissection using the elephant trunk technique.

The elephant trunk technique was developed to facilitate multiple-stage treatment of extensive aneurysm of the thoracic aorta. However, little information is available concerning its usefulness for aortic dissection. From April 1992 to July 1998, we used the elephant trunk technique for treatment of aortic arch dissection in 22 patients (including 19 men) with a mean age of 58.5 years (range 21 to 85 years). Twelve patients presented with type A dissection (acute in 3 and chronic in 9), 3 with type B acute dissection, and 7 with "non A/non B" dissections with retrograde extension to the aortic arch or entry site located in the aortic arch without involvement of the ascending aorta. All patients had aneurysms of the descending (n = 7) or thoracoabdominal (n = 15) aorta. Procedures were performed under hypothermic circulatory arrest at between 15 degrees and 20 degrees C. Antegrade cerebral perfusion was used in three cases. The procedure was associated with aortic valve replacement and/or coronary bypass in 6 cases and bypass of one or more supraaortic vessels in 13. In two patients the distal end of the elephant trunk was attached with an endovascular prosthesis during the same procedure. The ensuing results in these patients indicate that the elephant trunk technique can be highly effective for treatment of complex aortic arch dissection.

Adult↗
PubMed2000

[Endovascular treatment of aorto-iliac aneurysms. Made-to-measure endoprotheses increase the feasibility].

The authors describe their experience of tailoring endoprostheses for endovascular treatment of aorto-iliac aneurysms with components available on the market. Between January 1996 and December 1999, 188 aorto-iliac aneurysms were treated by tailor-made endoprostheses using self-expanding Z stents made of stainless steel compiled with polyester ligatures and covered with standard commercially available polyester prostheses. These endoprostheses were implanted with an 18 to 24 Fr (usually 20 Fr) introducer and positioned by a surgical approach. This method allows construction of tubular, bifurcated, digressive or occlusive endoprostheses associated with an extra-anatomical bypass graft. It increased the number of endovascular procedures for aorto-iliac aneurysms in the authors' department. This number has been further increased by using endoprostheses with an uncovered proximal or distal stent for cases with particularly short or angled necks and by using hybrid endoprostheses with one or more extremities without a stent, allowing surgical suture of the anastomosis. The authors' results show that tailoring endoprostheses considerably increased the feasibility of endovascular treatment of aorto-iliac aneurysms, even in unselected patients whilst providing an effectiveness and safety to justify the continuation of this experience.

Aortic Aneurysm, Abdominal↗