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Biomedical subjects

H Rousseau

Publications and source records attributed to H Rousseau.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of in-stent restenosis in proximal coronary arteries with multidetector computed tomography (MDCT).

The purpose of this study was to assess the ability of 16-slice computed tomography (CT) to detect in-stent restenosis of proximal coronary arteries. From November 2002 to April 2004, 134 consecutive patients with proximal stents (3.25 +/- 0.47 mm) were prospectively studied. Multidetector CT (MDCT) was performed 24 h (baseline) and 6 months after angioplasty and analysed by two radiologists blinded to the results of the coronary angiography. Sensitivity, specificity, positive and negative predictive values for in-stent restenosis were compared with conventional quantitative coronary angiography (QCA). Stenosis with a diameter >or=50% was considered diagnostic of in-stent restenosis. The CT analysis was performed in 131 and 114 patients at baseline and 6 months, respectively. The in-stent lumen was evaluable in 111 (121 stents) and 99 patients (108 stents) at baseline and 6 months, respectively. The prevalence of in-stent restenosis was 22.5%. Restenoses were correctly identified in 91.7 and 87.5% by the two radiologists. The sensitivity, specificity, positive and negative predictive values for the assessment of significant in-stent restenosis were 92, 67, 43, 97% and 87, 66, 41, 95% for the radiologists, respectively. MDCT is a potential non-invasive technique for the screening of in-stent restenosis of proximal coronary arteries that needs further improvements.

Adult↗
PubMed2006

[Management of severe post partum hemorrhage with embolization: the French experience].

PURPOSE: To gain a better understanding of the management of severe post partum hemorrhage in France. PATIENTS AND METHODS: A national survey of members of the Société Française d'Imagerie Cardio-Vasculaire (SFICV) and angiography units was performed in spring 2004. RESULTS: A total of 465 (2002) and 497 (2003) embolizations were performed in 64 centers: 13 in Ile de France (Paris area), including 8 university hospitals (2002: 45% of all cases, 2003: 42.5%); 51 in the other French regions (24 university hospitals) (2002: 55% of all cases, 2003: 57.5%). In 2002, an average of 7.26 embolizations was performed in each center (0-36); in 2003: 7.77 (0-47). On call coverage was available in 77,6% of centers, with 1 to 8 participating radiologists (mean: 3.5). 98% of embolizations were performed in angio suites, located in the same building as the maternity ward for 53.4%, or 100m to 7km (mean: 1100m) with mean transfer time of 18 minutes (5 to 60 minutes). CONCLUSION: Embolization is accurate and safe. When available, it should be considered as the first line treatment for validated indications. Multidisciplinary management of patients remains essential and protocols established by gynecologists, anesthesiologists and radiologists must be in place.

Embolization, Therapeutic↗
PubMed2006

[Pleural biopsies and pleural drainage: interventional radiology].

Interventional radiography performed for diagnostic and therapeutic purposes enables specific orientation of the diagnostic and/or therapeutic interention under radiographic guidance. This minimally invasive approach reduces intervention related morbidity. Mortality remains exceptional. Pleural biopsies and pleural drainage are two interventional procedures performed as routine practices in many centers.

Biopsy↗
PubMed2005

Acute traumatic aortic rupture: a comparison of surgical and stent-graft repair.

OBJECTIVE: The study's objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture. METHODS: A total of 76 patients (14-76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5-257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up. RESULTS: In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13-90 months). No major complication was observed in group 3. CONCLUSIONS: In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy.

Accidents, Traffic↗
PubMed2005

Stent-graft repair of thoracic aortic aneurysms.

Endovascular treatment of aortic disease has emerged as an alternative mode of treatment that is particularly attractive for patients with severe comorbidities who would not be ideal candidates for open surgery. Actually, short-term morbidity and mortality rates, of large series, compare favorably with those from surgery, and stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic aortic diseases. However, although endoluminal interventions are minimally invasive, they are associated with complications, as are surgical methods. In this article, indications, technical aspects, and results of endovascular TAA repairs will be reviewed. We will also examine the advantages and limitations of stent-graft treatment. Finally, we will discuss the management of complications following aortic stent-graft implantation. We intentionally do not cover the topic of thoracic dissection, as it is being covered in another article in this volume.

Aortic Aneurysm, Thoracic↗
PubMed2005

[Spiral CT scan imaging of the coronary vessels six years after complete repair of a Taussig-Bing malformation].

The Taussig-Bing malformation is a rare form of transposition of the great arteries with a ventricular septal defect. Associated cardiac abnormalities are common: hypoplasia of the aorta and especially coronary anomalies which may complicate surgical repair. The authors report the case of a patient with this malformation diagnosed in utero and who underwent anatomical repair on the 11th day of life. The coronary anatomy described by the surgeon was type E of Yacoub and Radley-Smith's classification. The postoperative course was uncomplicated. At the age of 6, a spiral CT scan was performed routinely under betablocker therapy. The coronary trajectory with a double loop, the patency of the coronary ostia and of the aortic isthmus were accurately demonstrated by this form of imaging.

Cardiovascular Surgical Procedures↗
PubMed2005

[Percutaneous embolisation of a iatrogenic fistula between the internal mammary artery and the coronary vein].

Latrogenic fistula between the aorta and coronary vein is a rare complication of coronary bypass surgery due to accidental venous or arterial graft onto a coronary vein. The authors report a case of a patient admitted to hospital 2 months after coronary bypass surgery for cardiac failure due to a iatrogenic fistula by implantation of the left internal mammary artery on the great coronary vein. This presentation led to the choice of percutaneous embolisation of the fistula by the release of 6 coils. Based on a review of the literature, this clinical case illustrates the feasibility and value of percutaneous embolisation of iatrogenic fistulae.

Aged↗
PubMed2004

[Transhepatic percutaneous embolisation of a post-traumatic pseudoaneurysm of hepatic artery].

Pseudoaneurysm of the hepatic artery is a rare complication of blunt abdominal trauma. We report a case of post-traumatic pseudoaneurysm diagnosed several months after the initial traumatism in a 18-year-old man who presented recurrent abdominal pain. This pseudoaneurysm was successfully treated by association of both classical endovascular treatment and transhepatic percutaneous embolization.

Abdominal Injuries↗
PubMed2004

[Indication of endovascular stent grafts for traumatic rupture of the thoracic aorta].

OBJECTIVE: The usual treatment of traumatic aortic rupture (TAR) is surgical. This invasive technique necessitating thoracotomy and ECC is associated with a mortality rate of more than 20% and a paraplegia risk of about 10%. New minimally-invasive techniques (aortic stent-grafting) are emerging as less risky alternatives to surgery. We report our experience in the percutaneous treatment of TAR with stent-graft via a surgical femoral cut-down. PATIENTS AND METHODS: Between 1996 and 2002, 23 patients (16-65-year-old, mean 36 years) were treated by thoracic stent-grafting. An informed consent was obtained for every patients. Thirteen patients had an acute or sub-acute TAR (1-8 months, mean 5 months) and five patients had chronic TAR (13-24 years, mean 17 years). The technique was done under general anaesthesia and each patient received a preoperative blood-pressure reduction treatment. During the procedure, anticoagulation (heparin) was given and hypotension was induced when the stent-graft was deployed. Direct positioning control was obtained by means of TEE. RESULTS: Eighty percent of patients were extubed immediately after the procedure. Bleeding was <150 ml. The primary success rate was 100% with one minor type 2 endoleak that was spontaneously resolved after 2 months. There was no case of mortality or paraplegia. There were three minor complications (17%), two haematomas at the arteriotomy site and one inflammatory syndrome characterised by slight fever, raised biological markers but with negative blood culture. CONCLUSION: Percutaneous aortic stent-grafting for TAR is a minimally-invasive technique, which constitute an interesting alternative to surgery. It only necessitates a femoral surgical cut-down compared to the thoracotomy and ECC associated with surgery. The complication rate is low and no mortality or major complication was encountered in our patients. Eventually, the long-term follow-up will allow a widening of indications.

Adolescent↗
PubMed2004

Extended lower limb venous ultrasound for the diagnosis of proximal and distal vein thrombosis in asymptomatic patients after total hip replacement.

OBJECTIVE: To assess the performance of extended lower limb venous ultrasound (US) for the diagnosis of asymptomatic deep vein thrombosis (DVT) and to estimate a 3-month DVT incidence on repeated US after total hip replacement. DESIGN: Diagnostic performance study and prospective cohort study. MATERIALS AND METHODS: US was compared to phlebography in 70 consecutive patients and interobserver agreement was assessed in the last 48 patients at day 8. US was repeated in these 48 patients at day 13 and day 90. RESULTS: Phlebography demonstrated a DVT in 18/70 (26%) patients, with five proximal and 13 distal and US in 23/70 (33%) patients, with eight proximal and 15 distal. Sensitivity and specificity of US with 95% CI were 94% (73-100) and 89% (76-96), respectively. Sensitivity in isolated distal vein thrombosis was 92% (67-99). The Kappa coefficient for agreement between observers was 0.84 (0.66-1.00). Follow-up showed a DVT in 15/48 (31%) patients on day 8, in 20/48 patients (42%) on day 13. DVT recurred in two patients during follow-up. CONCLUSIONS: The incidence of asymptomatic DVT is still significant despite prophylaxis but most DVTs remain distal and occur in the first 2 weeks. Extended US could replace phlebography for systematic screening in clinical trials using surrogate endpoints in view of its high accuracy and reliability.

Arthroplasty, Replacement, Hip↗
PubMed2004

[Towards a new management of acute traumatic aortic ruptures].

PURPOSE: The aim of this study was to evaluate the feasibility and safety of endovascular repair in acute traumatic aortic rupture on the basis of our experience with 16 patients. MATERIALS AND METHODS: From January 1996 to December 2001,16 patients, with a mean age 36 years, underwent repair of traumatic rupture of the aorta with the use of stent-grafts. All patients presented with coexisting injuries and 9 of 16 patients were hemodynamically unstable because of other injury. After a delay ranging from 9 to 245 days (mean 78 days), aortic stent-grafting was performed by a multidisciplinary team. All patients had regular follow-up with spiral CT and transesophageal echocardiogram. RESULTS: Stent-graft placement was successful in all patients with exclusion of false aneurysm. The duration of the procedure was about 120 min and mechanical respiratory assistance could be removed immediately in 80% of patients. Mean stay in the intensive care unit was 24 hours. One complication was noted: compression of the left main stem bronchus successfully treated with endoprosthesis. Maximum follow-up was 7 years. CONCLUSION: Endovascular stent-graft repair is a valuable technique and is emerging as an alternative technique for treating thoracic aortic injury in patients in whom coexisting injury increases the surgical risk.

Adolescent↗
PubMed2004

[Imaging of the thoracic aorta in adults: when, how and why?].

CT, MRI and transesophageal echocardiography have become the standard of reference for evaluation of the thoracic aorta. Angiography is mainly performed as a presurgical procedure. Congenital pathologies observed during adulthood include coarctation, patent ductus arteriosus, and aberrant retroesophageal subclavian arteries. Imaging plays a major role for diagnosis and management of patients with acute aortic syndromes: intramural hematoma, dissection, penetrating ulcer and nondissecting aneurysms. Cross sectional imaging of the thoracic aortic wall allows evaluation of inflammatory diseases of the aorta or aortitis.

Adult↗
PubMed2003

[The lower limb of elderly patients (venous and arterial diseases)].

Elderly patients frequently suffer from vascular pathologies of the leg. In these more fragile patients, diagnostic work-up must cause as little trauma as possible. The clinical status and morphological appearance of the vessels make vascular investigations sometimes difficult to perform in the elderly. With arterial pathology, vascular imaging relies on numerous non invasive techniques (Duplex scan and vascular imaging techniques by reconstruction: helical CT and magnetic resonance angiography). The clinical exam, the evolution stage of arterial disease and these non invasive investigations must allow to select the patients that should benefit from an arteriography, more or less associated to revascularization. With thrombo-embolic pathology, venography has now been replaced by venous duplex scan of the lower limbs irrespective of the underlying thrombotic etiology.

Adult↗
PubMed2002

Results of a European multicentre iliac stent trial with a flexible balloon expandable stent.

PURPOSE: to determine the 12 months success rate with a balloon expandable, flexible stainless steel stent in iliac artery obstructions. MATERIALS AND METHODS: one-hundred and twenty-six consecutive patients with iliac obstructive disease and who demonstrated an unsatisfactory angioplasty result with a post-dilatation gradient of at least 10 mmHg, or a primary occluded lesion were included in the study. Follow-up was by Doppler sonography, ankle pressures with and without exercise and clinical parameters. RESULTS: after stent placement, the mean percentage diameter stenosis decreased from 79 to 4%, with a mean intra-arterial pressure gradient of 3 mmHg. Primary stent patency was 94% at 6 months and 89% at 12 months. Primary clinical result at 6 months was 88% and at 12 months 81%. Primary assisted clinical result (after re-pta) at 6 and 12 months was 89 and 86%, respectively. The Ankle Brachial Index (ABI) after exercise at 1 month follow-up was reduced from 0.88 to 0.75, with minor deterioration at 6 months to 0.72, and at 12 months to 0.68. The 1, 6, and 12 months follow-up Piek Systolic Velocity (PSV) ratios across the stented lesions remained stable at a mean of 1.4, 1.6, and 1.6, respectively. However, respectively 44, 39 and 34% of the patients still experienced symptoms of claudication. CONCLUSIONS: the results presented here support the suggestion stenting to be an effective device in the treatment of iliac artery obstructive disease. This study also, confirms other study results concerning haemodynamic patency after iliac stenting on the indication of a 10 mmHg pressure gradient after pta and the discrepancy between good haemodynamic patency and clinical result.

Adult↗
PubMed2001

Long-term results of endovascular stent placement in the superior caval venous system.

PURPOSE: To present the long-term results in superior caval stenting for symptomatic obstruction. METHODS: Forty-nine stents were placed in 30 patients: 16 (53%) with malignant lesions, five (17%) with benign lesions and nine (30%) hemodialysis patients. Self-expandable stents were deployed on a first-line basis. Patients were followed clinically as well as by various imaging techniques and survival analysis was performed. RESULTS: Stent deployment was possible in all cases. Reocclusion was seen in 13 patients, of whom eight belonged to the hemodialysis group. Primary and secondary patency rates for malignant, benign and hemodialysis patients were respectively 74%, 50% and 22%, and 74%, 75% and 56% at 1 year. We had 7% complications and one death from iatrogenic superior vena cava injury. CONCLUSION: Primary stenting of superior caval obstruction is a first-choice treatment method achieving good mid-term patency. Patients with hemodialysis shunts must be closely monitored for early reintervention.

Adenocarcinoma↗