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Biomedical subjects

G Avril

Publications and source records attributed to G Avril.

At least 19 recordsLinked to original sources
PubMed1996

Secondary rupture of an iliac artery aneurysm after exclusion-bypass.

We report a case of secondary rupture of a common iliac artery aneurysm into the common iliac vein. Exclusion of the iliac aneurysm had been performed 2 years earlier in association with reconstruction of an aortic aneurysm that had ruptured into the interior vena cava. After closure of the aortocaval fistula by the endoaneurysmal route, aortobifemoral bypass grafting had been performed and a caval clip had been placed. The common iliac arteries had been sutured by the endoaneurysmal route and the right common iliac artery had been excluded by ligation of the right iliac artery. Occlusion of the interior vena cava distal to the caval clip resulted in increased peripheral venous hypertension causing the secondary arteriovenous fistula (rupture of scrotal varices and edema of lower extremities) but prevented right cardiac insufficiency. This observation confirms the possibility of secondary rupture after treatment of an aneurysm by exclusion. Thus the inclusion-graft technique is more reliable.

Aged↗
PubMed1993

[Atheromatous pseudo-occlusive stenosis of the internal carotid].

Pseudo-occlusion of the internal carotid artery is defined as an angiographically occluded but anatomically patent artery. Between january 1980 and december 1990, 14 cases were diagnosed in our institution. Preoperative Doppler examination of the internal carotid artery suggested almost complete thrombosis in 11 patients and occlusion in 3. The angiographic appearance suggested internal carotid occlusion in all but the presence of the slim sign was in favor of a patent artery. All 14 patients underwent surgery. There were no postoperative deaths; one patient presented an ipsilateral TIA post operatively; 3 others presented an ipsilateral TIA after 2, 16 and 30 months respectively. All carotid arteries were found to be patent. The frequency of pseudo-occlusion of the internal carotid artery is probably underestimated. It must be kept in mind whenever an apparently occluded internal carotid continues to be symptomatic. Diagnosis is based on comparative analysis of Doppler examination and angiographic findings. Surgery is indicated whenever doubt persists.

Arteriosclerosis↗
PubMed1991

Carotid endarterectomy plaques: correlations of clinical and anatomic findings.

To establish possible relationships between the structure of carotid plaque and neurologic symptoms, 187 consecutive endarterectomy specimens were studied prospectively. Each specimen was examined for gross and histopathological features. Intraplaque hemorrhage, although found infrequently, was closely correlated with the presence of symptoms. Plaque ulcerations were encountered more often when lesions were symptomatic. Calcifications were more frequently associated with asymptomatic lesions. Consistency of plaque was related to its morphological features (stenosis or ulceration) and symptoms. Soft plaques with predominant atheromatous grumous material and hemorrhage were associated more often with tightly stenotic, ulcerated, and symptomatic lesions. Consistency of atherosclerotic carotid plaques should be assessed and considered as an important element in the therapeutic decision.

Aged↗
PubMed1991

[Behçet's disease with multiple arterial lesions and voluminous hemangioma of the brain].

A case of a 43-years-old patient with a 9-year history of Behçet's disease is reported. The diagnosis was based on the past of bilateral hypopion iritis, oral aphthous ulceration and venous thrombosis. A right lower limb monoparesia occurred. CT scan and angiography showed a voluminous intracerebral angiodysplasia and an aneurysm of the left anterior communicating artery. Careful angiographic examination of visceral and peripheral arteries showed bilateral thrombosis of subclavian arteries, thrombosis of superior and inferior mesenteric arteries and an aneurysm of the coeliac trunk. Large arterial involvement is an unusual complication of Behçet's disease. A through review of the literature showed only 2 reported cases of intracranial arterial aneurysms. This case report was the first case of Behçet's disease with an intracerebral angiodysplasia.

Adult↗
PubMed1991

[Value of axillofemoral bypass in the elderly].

The aim of this retrospective study was to assess the merits of axillofemoral bypass in elderly patients. 69 axillofemoral grafts were laid from 1981 to 1985 in 56 patients, all older than 70. They always were aimed at limb salvage due to aortoiliac obliterating lesions (the indications of sepsis of aorto-bifemoral prostheses have been excluded). 13 patients have had an axillo-bifemoral graft and 43 an unilateral axillofemoral graft. The lower anastomosis involved the common femoral artery in 30 cases, the deep femoral artery in 39. The patients were followed up for 1 to 74 months, with an average of 24 months. The operative mortality was of 10 cases (17%). During the first postoperative month, 3 major amputations were required. The cumulated survival rate at 60 months was of 18%, with the primary and secondary patency rates at 60 months being of 46% and 71%, respectively. We conclude that axillofemoral bypass is perfectly adapted to this population of elderly subjects, in whom a direct aortic approach is counterindicated.

Aged↗
PubMed1990

Neurologic complications of axillary and brachial catheter arteriography in atherosclerotic patients: predictive factors.

Catheter arteriography by the axillary or brachial route can be responsible for central neurologic complications. The objectives of this prospective study were to define the predictive factors of these complications and determine their incidence. This report is based on 288 consecutive arteriography sessions performed between January 1985 and June 1987. All patients had arterial atheromatous pathology. Ten central neurologic complications (3.5%) occurred, two of which (0.7%) were permanent. Four factors were significantly associated with increased incidence of central neurologic complications: antecedent transient ischemic attack (p less than 0.001); tight (greater than 80%) stenosis of at least one internal carotid artery (p less than 0.02); angina pectoris (p less than 0.05); age over 80 years old (p less than 0.001). Seldinger's or Dos Santos' techniques are preferable to axillary or brachial catheter techniques for investigation of the lower limbs and the abdominal aorta. The former obviates the need to catheterize the aortic arch and reduces the risk of embolism to the supraaortic arteries. Digital venous arteriography is an alternative to aortic arch catheterization when investigating the supraaortic arteries in the presence of risk factors.

Age Factors↗
PubMed1990

[Prognosis of acute ischemia of the lower limbs in patients over 80 years of age. A prospective study].

To demonstrate the importance of age in the prognosis of acute lower limb ischemia, a prospective study was performed in 137 patients over 24 months. Group I contained 75 patients aged under 80 years and group II 62 patients aged over 80 years. Risk factors and previous history were equally distributed in the two groups. The level of arterial blockage and the treatment were comparable in the two groups. Mortality was higher in group II than in group I (p less than 0.01). In both groups deaths were principally due to cardiac causes and a revascularisation syndrome. Amputation at thigh level was more common in group II (p less than 0.01). Mortality was higher in group II for combined thigh level amputation and cardiac or coronary insufficiency (p less than 0.05). This study demonstrated that, in terms of prognosis of acute lower limb ischemia, the critical threshold is 80 years.

Actuarial Analysis↗
PubMed1990

Human umbilical vein grafts as infrainguinal bypasses: long-term clinical follow-up and pathological investigation of explanted grafts.

This retrospective study examines 105 consecutive infrainguinal bypasses using human umbilical vein (HUV) grafts as blood conduits over a 9 year period. In addition, 39 segments of these grafts were harvested at reoperation and submitted for morphologic, histologic, and scanning electron microscopy examinations. Fifty-two below-knee femoro-popliteal and 53 femoro-distal bypasses were performed in 93 patients. Sixty-seven per cent of these bypasses were performed for either rest pain (18%) or gangrene (49%) and 29% were performed for acute ischemia. Primary and secondary patency rates were not statistically different and were 38% and 29% at 1 and 3 years respectively. Factors found to have a significant effect on patency were site of distal anastomosis, state of distal run-off, and indication for operation. Other complications requiring reoperation included aneurysm formation (8 cases), infection (6 cases), mural thrombus (2 cases), and stenosis (2 cases). Pathologic examination revealed a damaged luminal surface in 22 grafts, deep folds in 8 grafts and delamination of the graft wall in 16 cases. Bacteria were seen in the folds of the grafts and, in addition, the presence of bacteria was documented in 7 out of 26 clinically non-infected grafts. The combination of poor patency rates and pathologic evidence of biodegradative phenomena have led us to discontinue HUV as an arterial substitute.

Adult↗
PubMed1990

Femorodistal bypass using the chemically processed human umbilical vein graft: 9-year experience.

To evaluate patency, limb salvage rates and complications associated with the use of human umbilical vein as an arterial substitute, the authors carried out a retrospective review of 52 femorodistal bypasses performed over 9 years using human umbilical vein. Indications for operation included acute ischemia, rest pain and nonhealing ulceration or gangrene. There were 28 early occlusions, which resulted in a 1-month primary patency rate of 46% and a secondary patency rate of 52%. The primary and secondary patency rates at 1 year were 18% and 19% respectively. The mean limb salvage rate at 1 month was 57% and at 1 year 34%. Three aneurysms occurred (two anastomotic, one graft). Factors found to have a significant effect on patency rates were indication for operation and state of distal runoff. Infection occurred in 6% of grafts and led to amputation in every case. These disappointing results have caused the authors to discontinue use of human umbilical vein as an arterial substitute.

Adult↗
PubMed1989

An histo-morphological evaluation of ninety surgically excised human umbilical vein grafts.

Morphological, histological, and scanning electron microscopy examinations were performed on 90 surgically excised human umbilical vein grafts. Most of the explanted grafts were removed because of thrombosis or infection and were removed typically from a patient in the mid 60s and after an average duration of implantation of 11 months. Multiple structural defects were found including deep folds, breaks on the luminal surface, and delamination. These areas as well as anastomotic sites represented potential areas for thrombotic accumulation. A higher incidence of infection was observed in grafts composed of 2 or 3 segments. Bacteria were often found in folds and could be seen invading the wall of the prosthesis. In addition, bacteremic colonization was often seen in noninfected grafts. The late aneurysmal formations were also of particular concern. The biodegradation of the wall and the disruption of the polyester mesh were the probable causes. The second generation Dardik Biograft aimed at reducing these formations. The success of this new processing remains to be evaluated.

Adult↗
PubMed1989

Traumatic fistula between the aorta and the left renal vein: case report and review of the literature.

This report of an aorto-left renal vein fistula (ALRVF) of traumatic origin is the sixth such case on record. The fistula was successfully repaired, with preservation of the kidney, by autotransfusion. Review of the English language literature revealed the differences between spontaneous and traumatic ALRVF. Spontaneous fistulas were caused by rupture of an abdominal aortic aneurysm into a retroaortic left renal vein. Hematuria was almost constant (93% of cases). The operative mortality rate was 14%. By contrast, traumatic ALRVFs were the result of a penetrating wound to the abdomen. The left renal vein was in a normal position, anterior to the aorta. Hematuria was less common (16% of cases). The diagnosis was delayed because clinical signs were less acute. There were no reports of postoperative deaths.

Abdominal Injuries↗
PubMed1980

[Chlormetiazole in anaesthesia (author's transl)].

The use of a vitamin derivate (chlormethiazole) in anaesthesia. Owing to its hypnotic properties and its wide margin of safety, "chlormethiazole" (a derivate of vitamin B1) was used in 30 patients which underwent varying surgical procedures. Since the drug exhibits no analgetic effect, fentanyl was added to maintain a sufficient depth of anesthesia. The patients were artificially ventilated with N2O/O2 at a rate of 3/1. Chlormethiazole, even when used in large doses (2400 mg) over a long period of time (5 hours was well tolerated. The technique therefore offers another opportunity to replace droperidol in classical neuroleptanaesthesia, which is often the cause for uncomfortable neurovegetative side-effects in the post-operative period.

Adolescent↗
PubMedDate not supplied

Persistent hypoglossal artery.

During embryological development, the hypoglossal artery serves as a transient anastomosis between the internal carotid artery and the vertebro-basilar system. This artery occasionally persists into adult life. Two cases of persistent hypoglossal artery we have recently encountered are reported here. The embryology, diagnosis and potential problems for carotid surgery are discussed.

Aged↗
PubMedDate not supplied

Hydronephrosis after aortofemoral bypass graft. A prospective study.

This prospective study was designed to determine the frequency and natural history of hydroureteronephrosis (HUN) after placement of an aortobifemoral vascular graft. A total of 30 patients were evaluated by the study protocol, which included: pre and postoperative biological kidney function tests, preoperative and early postoperative (14th day) intravenous pyelograms and a late (mean 18th month) urologic examination by renal ultrasonic tomography. Four asymptomatic, early cases of HUN were observed in the 57 ureters examined (7%); all four complications regressed in less than 30 days. No cases of symptomatic early or late HUN were observed in this series. Asymptomatic early HUN was a frequent complication in our series (7%) but its benign course does not justify systematic screening. These asymptomatic complications contrast with the symptomatic cases of early or late HUN reported in the literature which necessitated urologic and vascular investigations.

Aged↗
PubMedDate not supplied

Synchronous reconstruction for combined aortoiliac and femoropopliteal occlusive lesions. The role of proximal bypass.

Between January 1984 and December 1986, 31 patients underwent synchronous revascularization (SR) because of the serious clinical condition of a lower limb and presence of arteriographically visible lesions. Average follow-up was 30 months. Operative mortality was 10%. Two patient populations were identified: Group I (N = 13): patients who underwent ilio-femoral or aorto-femoral proximal revascularization (PR); Group II (N = 18): patients who had axillo-femoral PR. Group I patients were younger than those in Group II (64 yr versus 72 yr; p less than 0.01). An association of pre-operative risk factors (arterial hypertension; coronary, renal or respiratory insufficiency) was twice as frequent in Group II as in Group I (p less than 0.02). The rate of SR compared to PR alone was 15%. However, there was no statistically significant difference between Groups I and II. Comparison of the actuarial survival curves for patients ahd the patency rates of SR in Groups I and II failed to reveal any statistically significant differences. Axillo-femoral bypass can be used for PR when SR is necessary in high risk patients.

Aged↗