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Biomedical subjects

I Fourneau

Publications and source records attributed to I Fourneau.

At least 19 recordsLinked to original sources
PubMed2006

Hand-assisted laparoscopy versus conventional median laparotomy for aortobifemoral bypass for severe aorto-iliac occlusive disease: a prospective randomised study.

OBJECTIVES: To demonstrate that hand-assisted laparoscopy for aortofemoral bypass for severe aorto-iliac occlusive disease reduces morbidity with earlier recovery of bowel function and shorter in-hospital stay. DESIGN: Randomised controlled trial. MATERIALS AND METHODS: Thirty-six consecutive patients with severe aorto-iliac occlusive disease (TASK C/D) without history of major abdominal surgery necessitating an aortobifemoral bypass were randomised between a hand-assisted laparoscopic (HALS) approach and a conventional medial laparotomy. Operative data, early recovery data, quality of life and vascular outcome were analysed. RESULTS: No significant differences in operative data were found. Fluid and solid diet were resumed earlier (28.8 hrs vs. 76.9 hrs; p = 0.016) (45.6 hrs vs. 105.6 hrs; p = 0.02) and in-hospital stay was shorter (7.5 vs. 8.9 days; p = 0.005) in the HALS group. Six weeks post-operatively social functioning measured by the SF-36 survey score was better in patients randomised to HALS (p=0.023). CONCLUSIONS: HALS is a less invasive approach for aortofemoral bypass.

Adult↗
PubMed2005

Hand-assisted laparoscopic aortobifemoral bypass for occlusive disease. Early and mid-term results.

OBJECTIVES: To evaluate the early and mid-term results of hand-assisted laparoscopic surgery (HALS) for aorto-iliac reconstruction. DESIGN: Prospective survey. MATERIALS AND METHODS: Between February 2002 and January 2004, 46 patients received an aortobifemoral bypass for advanced occlusive disease by HALS. RESULT: There was one conversion to open surgery. Mortality was 4.5%. The median return to solid oral diet took 36 h (24-182), the median hospital stay was 5 days (3-26). Primary patency rate at 1 year was 97.5%. The incidence of incisional hernia was 19.5%. CONCLUSIONS: HALS aorto-iliac reconstruction should be considered as a minimal invasive technique with good early and mid-term results.

Adult↗
PubMed2005

Excimer laser assisted angioplasty for critical limb ischemia: results of the LACI Belgium Study.

BACKGROUND: The purpose of this study was to assess the safety and efficacy of translating into national practice methodology for infrainguinal excimer laser-assisted angioplasty, for the treatment of critical limb ischemia in poor surgical bypass candidates. METHODS: A prospective five centre Belgian registry enrolled 48 patients, who presented with 51 chronic critically ischemic limbs (Rutherford category 4, 5 or 6) and were poor candidates for bypass surgery. Treatment included crossing the occlusion or stenosis by conventional guidewire followed by excimer laser angioplasty with, or without, adjunctive balloon angioplasty or stenting. A step-by-step technique was used in cases where the guidewire could not pass the occluded site. The primary endpoint was limb salvage, at 6 months, of the treated limb. RESULTS: Initial treatment was successful in all 51 limbs. By 6 months there had been six deaths, six minor and four major amputations and further intervention was required in four patients. Among survivors, limb salvage rate at 6 month was 38/42 (90.5%), with freedom from critical limb ischemia in 86%. CONCLUSIONS: This Belgian study of excimer laser assisted angioplasty, in high-risk patients who were poor candidates for surgical re-vascularisation, had a low incidence of surgical re-interventions and limb salvage rate in excess of 90%.

Adult↗
PubMed2005

Hemobahn stent-grafts in the treatment of femoropopliteal occlusive disease.

AIM: The aim of this study was to determine our results and indications for the Hemobahn stent-graft in femoropopliteal occlusive disease. METHODS: Since 1999, 38 patients with femoropopliteal occlusive disease in 40 legs have been treated by endovascular dilation or recanalisation and additional endografting. All have been followed up prospectively at 6 month intervals by clinical examination, Doppler and duplex. RESULTS: In 40 legs, 15 high grade stenoses were dilated and 25 occlusions needed first recanalization. Additional Hemobahn stent-graft deployment was successful in all cases (total grafts n=60). The median length of the stented segment was 15 cm. Immediate complications during the procedure were stent-graft thrombosis (n=1) and distal embolization (n=3), instantly treated with thrombolysis and thrombus aspiration. The median ankle-brachial index in rest increased from 0.5 preoperatively to 1 postoperatively. With a median follow-up time of 28.2 months (range from 1 to 48 months), there were 4 high grade stenoses and 13 stent-graft occlusions (1 year primary patency rate of 66%). All 4 stenoses were treated with balloon dilation (1 year assisted primary patency rate of 76%) and 4 of the occluded grafts were recovered by thrombectomy (n=1) or thrombolysis (n=3), resulting in a 1 year secondary patency rate of 87%. CONCLUSIONS: The Hemobahn stent-graft can be used in the treatment of femoropopliteal occlusive disease with a low complication rate and acceptable patency rates in the short-term. We had the best results when there was no recanalization needed before.

Arterial Occlusive Diseases↗
PubMed2005

Endovascular stent-graft and first rib resection for thoracic outlet syndrome complicated by an aneurysm of the subclavian artery.

PURPOSE: To report our experience with a combined endovascular and surgical approach for arterial thoracic outlet syndrome (TOS) complicated by an aneurysm of the subclavian artery. METHODS: We treated three consecutive patients suffering from arterial thoracic outlet syndrome complicated by an aneurysm of the subclavian artery by the use of a stent-graft and a first rib resection. These patients were reviewed retrospectively. RESULTS: At a mean follow-up of 37.3 months all patients were free of symptoms without late complications. CONCLUSIONS: Endovascular stent-grafting followed by decompression of the costoclavicular space is an attractive alternative to the conventional surgical approach of complicated arterial TOS.

Adult↗
PubMed2004

Minimal-access aortic surgery: the potentials of hand-assisted laparoscopy.

In analogy with the good results of laparoscopic abdominal procedures minimal-access aortic surgery looks very promising. However, in spite of the many technical improvements that have already been made, totally laparoscopic and even laparoscopically assisted aortic surgery remains technically demanding. This explains the rather slow introduction of minimal-access aortic surgery in the vascular society. In anticipation of increasing surgical experience and better instrumentation that will make the technique feasible for each vascular surgeon, hand-assisted laparoscopy (HALS) can be a valuable intermediate approach. HALS offers an easy to perform and still clearly less invasive approach for all aorto-iliac reconstructions.

Anastomosis, Surgical↗
PubMed2003

Thoracic aorta endoprosthesis: the final countdown for open surgery after traumatic aortic rupture?

From December 1998 through May 2001, seven patients with thoracic aortic isthmus rupture underwent endovascular stent graft repair. Diagnosis was made by chest X-ray, transesophageal echography, CT scan, and aortography. The endoprosthesis was ordered and/or custom made on an urgent basis. During the delay period blood pressure was kept low and the tear closely monitored by means of transesophageal echography and CT scan. The mean delay period was 94 days: three patients were treated within 24 hr, two patients had their treatment postponed because of multiple organ failure, and two patients were diagnosed late. Complete exclusion of the pseudoaneurysmal sac was successful in all patients. One patient underwent a preliminary carotidosubclavian bypass because of a short proximal neck, one subclavian artery was unintentionally partially covered, and a second one was deliberately overstented. None of these patients developed arm ischemia or claudication. One patient died 3 weeks after the procedure because of the severity of associated lesions and comorbidity. Our preliminary results prove that endografting for aortic isthmic rupture is technically feasible and that it represents a safe and potentially valuable alternative to the mortality and morbidity of open surgery. Further evaluation is needed to assess the full therapeutic potential and determine the mid and long-term follow-up.

Adolescent↗
PubMed2003

Ten-year experience in autogenous reconstruction with the femoral vein in the treatment of aortofemoral prosthetic infection.

OBJECTIVE: to study the short and long term effectiveness of in situ replacement of infected aortic grafts with the lower extremity deep veins. METHODS: forty-nine patients operated on for infrarenal aortic graft infection since 1990 were studied. Diagnosis of infection was based on clinical signs, bacteriological tests and typical findings on CT scan and leukocyte scan. The surgical treatment consisted in harvesting the femoral vein, total graft excision, thorough debridement and in situ reconstruction with the femoral veins. After discharge, the patients were followed at 6 monthly intervals with clinical examination, duplex and/or CT scan. RESULTS: there were four in-hospital deaths (8%). One patient required above-knee amputation (2%) and there were two graft limb occlusions (4%). With a mean follow-up 41 months, another 13 patients died, unrelated to the operation (29%). There were no late amputations and only two late graft limb stenoses (4%). We have a 5 year survival rate of 60%, a 5 year limb salvage rate of 98%, and a 5 year primary patency rate of 91%. There were no cases of aneurysmal dilatation of vein grafts and no incidence of reinfection. CONCLUSION: in situ reconstruction with the lower extremity deep veins is in the long term a safe and attractive alternative in the treatment of infrarenal aortic graft infection.

Aged↗
PubMed2002

Endovascular repair of inflammatory abdominal aortic aneurysms with special reference to concomitant ureteric obstruction.

OBJECTIVES: To study the technical feasibility and results of endovascular treatment of inflammatory abdominal aortic aneurysms (AAA). DESIGN: Prospective study. MATERIAL AND METHODS: Seven patients underwent endovascular repair of an inflammatory AAA. Five patients (8 ureters) were treated with ureteric stents CT scans were obtained one year. RESULTS: The early technical success rate was 100%. Four ureters remained entrapped at one year. Partial regression of periaortic fibrosis was documented in three patients, while four patients showed no regression. CONCLUSION: Endovascular reconstruction of inflammatory abdominal aneurysms is technically feasible. Further study is warranted with regard to the evolution of the periaortic fibrosis and the possible benefits for patients with concomitant hydronephrosis.

Aged↗
PubMed2001

Liver transplantation for polycystic liver disease.

Polycystic liver disease (PLD) may provoke massive hepatomegaly and severe physical and social handicaps. Data on orthotopic liver transplantation (OLT) for PLD are rare and conflicting. Conservative surgery (resection or fenestration) is indicated for large single cysts, but its value for small diffuse cysts is questionable. In addition, conservative surgery is not devoid of morbidity and mortality. OLT offers the prospect of a fully curative treatment, but controversy remains because those patients usually have preserved liver function. Thus, we reviewed our experience with OLT for PLD. Sixteen adult women underwent OLT for small diffuse PLD between 1990 and 1999. Mean age was 45 years (range, 34 to 56 years). Fourteen patients had combined liver and kidney cystic disease, but only 1 patient required combined liver and kidney transplantation, whereas 13 patients underwent OLT alone. Two patients had isolated PLD. Indications for transplantation were massive hepatomegaly causing physical handicaps (n = 16), social handicaps (n = 16), malnutrition (n = 4), and cholestasis and/or portal hypertension (n = 5). OLT caused no technical difficulty in 15 of 16 patients (surgery duration, 6.8 hours; range, 5 to 8 hours), with blood transfusions of 7.9 units (range, 0 to 22 units). One patient who underwent attempted liver-mass reduction pre-OLT died of bleeding and pulmonary emboli. Native liver weight was 10 to 20 kg. Posttransplantation immunosuppression consisted of cyclosporine or FK506, azathioprine, and steroids (discontinued at 3 months). Morbidity included biliary stricture (2 patients), revision for bleeding and hepatitis (1 patient), pneumothorax and subphrenic collection (1 patient), and tracheostomy (1 patient). One patient died of lung cancer 6 years posttransplantation. Both patient and graft survival rates are 87.5% (follow-up, 3 months to 9 years). Of 15 patients who underwent OLT alone, only 1 patient needed a kidney transplant 4 years after OLT. Kidney function has remained satisfactory in the other patients despite the use of cyclosporine or FK506 (last follow-up creatinine level, 1.55 mg/dL; range, 0.80 to 2.85 mg/dL). OLT had a dramatic impact on daily quality of life, enabling these patients to go back to a fully active life style. OLT offers the chance of a definitive treatment in patients with extensive, small, diffuse PLD that has evolved into severely handicapping hepatomegaly. In contrast to previous studies, combined liver and kidney transplantation is rarely needed. Patient symptoms and chances of definitive palliation offered by OLT must be balanced against the risks of transplantation and lifelong commitment to immunosuppression.

Adult↗
PubMed2001

Type of donor aortic preservation solution and not cold ischemia time is a major determinant of biliary strictures after liver transplantation.

The development of biliary strictures (BSs) after liver transplantation (LT) continues to affect 10% to 30% of patients, causing substantial morbidity. The cause of BSs is multifactorial, including technical, immune, and, in particular, ischemic factors. The importance of adequate flushing of the peribiliary arterial tree has been stressed. We hypothesized that high-viscosity (HV) preservation solutions in the donor do not completely flush the small donor peribiliary plexus, leading to inadequate preservation of the bile ducts and posttransplant BSs. To test this hypothesis, we retrospectively compared the incidence of BSs in 2 groups of adults undergoing LT using different types of aortic preservation solution in the donor: group 1 (n = 24), low-viscosity (LV) Marshall solution; and group 2 (n = 27), HV University of Wisconsin (UW) solution. All donors in both groups received additional portal flushes with UW. All LTs were performed between November 1995 and August 1998 at 2 centers by the same surgeon, eliminating a technical bias. Terminal duct-to-duct anastomosis was performed in all recipients except 1 patient in group 1, who underwent a bile duct-to-jejunum anastomosis. BSs were first suspected on clinical and biochemical grounds and then confirmed by endoscopic retrograde cholangiopancreatography. Identical medical protocols were used in all patients. One-year patient survival rates in groups 1 and 2 were 92% and 100%, respectively (P =.9). One-year graft survival was identical to patient survival. The incidence of BSs in group 1 was 4.1% (1 of 24 patients), compared to 29.7% in group 2 (8 of 27 patients; P =.02). The BS in group 1 occurred 4 months post-LT and was anastomotic. BSs in group 2 occurred between 1 and 12 months post-LT and were anastomotic, extrahepatic, intrahepatic, or combined intrahepatic and extrahepatic. There were no significant differences in the following factors between groups 1 and 2: donor age, local versus imported liver, split-liver or full-liver transplantation, incidence of multiple vessels in the donor liver, indications for LT, recipient age, T-tube versus no T-tube, post-LT peak aspartate aminotransferase level, and treatment for rejection. There was no hepatic artery thrombosis or primary nonfunction in either group. Interestingly, cold ischemia time (CIT) was longer in group 1, which had the least incidence of BSs (692 +/- 190 v 535 +/- 129 minutes in group 2; P =.001). Follow-up was longer in group 1 (28.9 +/- 8.3 v 15.6 +/- 8 months in group 2; P =.0001). Preservation costs per procurement were 1.9 times greater in the UW group than in the Marshall group. Donor aortic flushing with an HV preservation solution leads to more frequent BSs compared with an LV preservation solution. The impact of preservation solution outweighs the previously described deleterious impact of prolonged CIT. Mixed preservation solution (Marshall solution in the aorta, UW solution in the portal vein) might protect against BS formation while providing optimal liver graft preservation, function, and survival despite a mean CIT longer than 10 hours.

Adenosine↗
PubMed2000

An improved model of acute liver failure based on transient ischemia of the liver.

HYPOTHESIS: A reproducible and potentially reversible model of acute liver failure in the pig is feasible based on transient ischemia of the liver. DESIGN: To determine the shortest period of liver ischemia sufficient to cause 100% mortality, ischemia of the liver was induced for different lengths of time, starting with 6 hours. If the pig survived, ischemia time was prolonged for 2 hours in the next animal. In the first group, the common bile duct was not tightened. In the second group, the common bile duct was tightened. SETTING: The Laboratory for Hepatopathophysiology, Catholic University, Leuven, Belgium. PARTICIPANTS: Female stress-negative Belgian Landrace pigs weighing 18 to 22 kg. INTERVENTIONS: During preparatory surgery, all ligaments around the liver and connective tissue around the liver hilum were transected and an end-to-side portacaval shunt was made. Vessel loops were placed around the branches of the hepatic artery and bile duct. Three days later, in fully awake pigs, the loops were tightened. MAIN OUTCOME MEASURES: Mortality. Development of acute liver failure was determined based on neurologic, biochemical, and pathological variables. RESULTS: When occluded for 10 hours, all pigs in group 2 (n = 5) [corrected] died between 12 and 17 hours after the induction of ischemia. All pigs developed typical acute liver failure. Tissue specimens showed 90% necrosis of the liver parenchyma. CONCLUSION: A highly reproducible and potentially reversible model of acute liver failure in the large animal has been established.

Animals↗
PubMed1998

Aneurysm of the iliofemoral vein.

In this clinical case we report the use of the superficial femoral vein as an autologous venous interposition graft for the reconstruction of the iliofemoral vein in a 21-year-old female who presented with an asymptomatic primary aneurysm of the left iliofemoral vein. The choice of surgical technique used is discussed.

Adult↗
PubMed1998

Unstable femoral neck fractures in young adults: treatment with the AO 130-degree blade plate.

OBJECTIVE: To evaluate the clinical outcome of the treatment of unstable femoral neck fractures using the AO 130-degree blade plate. DESIGN: Between 1980 and 1994, thirty-four consecutive patients younger than age fifty years with an unstable intracapsular femoral neck fracture (Garden Types III-IV) were treated with internal fixation. SETTING: University Hospital Gasthuisberg, Leuven, Belgium. INTERVENTION: The AO 130-degree blade plate with an antirotation, 6.5-millimeter, partially threaded cancellous lag screw was used. RESULTS: Nineteen (63.3 percent) patients had an excellent result, seven (23.3 percent) had a good result, three (10 percent) had a fair result, and one (3.3 percent) had a poor result. Delayed union was observed in one case, and avascular necrosis was observed in two cases. Two implants perforated the subchondral bone. CONCLUSION: Stable fixation with the AO 130-degree blade plate avoids damage to the adjacent blood supply to the femoral head and appears to guarantee a good final outcome of unstable intracapsular femoral neck fractures in young adults.

Adult↗
PubMed1998

Pathologic fractures due to metastatic disease. A retrospective study of 160 surgically treated fractures.

Orthopaedic surgeons are increasingly confronted with metastatic fractures. As the majority of metastatic fractures never heal, surgical treatment is required. The goals of surgical therapy are to achieve early mobilization, relief pain and improve quality of life. One hundred twenty nine patients with 160 metastatic fractures of a long bone, completed or impending, were retrospectively analysed with regard to the type of treatment, effect on pain relief and mobility. Seven of the patients (4.4%) died postoperatively, a good functional result was obtained in 86.9% of the cases and for all patients a good analgesic effect was achieved. In 3.75% of the cases a mechanical complication was seen which needed reintervention. In general, the only indication for endoprosthesis is an intracapsular or very proximal lesion. In almost all other cases, intramedullary nailing is preferred.

Aged↗