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Biomedical subjects

J M Cormier

Publications and source records attributed to J M Cormier.

At least 19 recordsLinked to original sources
PubMed1997

Proximal arterial dilatation developing after surgical closure of long-standing posttraumatic arteriovenous fistula.

Concomitant discovery of long-standing arteriovenous fistula (AVF) and proximal dilatation is commonplace whereas the disclosure of proximal arterial dilatation several years after closure of AVF is much more surprising and less often described. The goal of this study was to call attention to this late complication, to evaluate its prevalence, and to describe the mechanism and outcome after treatment. Six new observations were added to 11 cases already published in the literature. Most AVF were located in the popliteal or superficial femoral arteries. The mean duration of these AVF was 20 years and 7 months. The mean delay between closure of AVF and the discovery of arterial dilatation was 9 years and 8 months. One patient required emergency operation for rupture. Another patient sustained embolism. All patients were treated by exclusion-bypass. Six years after operation for arterial dilatation, one patient had to be reoperated on for impending rupture of an aortic aneurysm. These facts lead us to advocate 1) closure of all AVF, even when iatrogenic, whenever present for 45 days or longer, 2) careful observation of all patients after operation for long-standing AVF, 3) operation on all patients with arterial dilatation secondary to AVF, and 4) life-long surveillance of the proximal arteries of these patients.

Adolescent↗
PubMed1996

[Emboligenic aortopathies. Cholesterol embolisms: surgical treatment].

Emboligenic aortopathies are defined as lesions of the aortic wall leading to the production of thromboatheromatous material which can migrate in fragments or entirely. Emboligenic aortopathy can occur in all parts of the aorta. Localized lesions are rare and usually involve the subrenal abdominal aorta or the isthma. Diffuse lesions involving several segments of the aorta are encountered more often. There are three anatomic types of lesions: ulcerated plaques, atheromatous ulcerations, an evrysmal disease of the aorta. Therapeutic indications depend on: 1) clinical presentation: fibrinocruoric emboli, distal microemboli, disseminated cholesterol emboli; 2) the unique or multiple nature of the emboli; 3) the anatomic lesion; 4) localization.

Aortic Diseases↗
PubMed1996

[Diabetic arteriopathy of the lower limbs].

Diabetic arteriopathy is a specific entity as it associates macro-angiopathy ischemia factor and micro-angiopathy leading to peripheral neuropathy. This association leads to specific clinical manifestations dues to interplay of ischemic and infectious phenomena. Diffuse occlusive lesions predominate distally with mediacalcosis. Wider surgical indications for revascularization of distal vessels of the leg, the ankle and the foot have reduced the number and extent of amputation. Long-term permeability after salvage surgery is identical to that in non-diabetic patients as shown by our series of 695 distal revascularizations. Endovascular techniques with or without stents or recanalization are alternatives which may be indicated in case of short occlusions or trophic disorders contraindicating surgery. Associating stents with conventional surgery may also be indicated in diabetic patients. One final progress in reducing the number of amputations has been provided by free-transfer micro-surgery techniques which allow both vascular supply and coverage of distal tissue loss.

Aged↗
PubMed1996

[Acute upper limb ischemia in a young adult without cardiac disease. Value of transesophageal echocardiography].

The authors report the case of a 34-year old woman with no previous cardiovascular disease who was admitted to hospital for acute ischaemia of the right arm due to embolism, preceded by two episodes of pain and tingling of the left arm related to subacute ischaemia. After right embolectomy, with no possibility of controlateral disobliteration an effective anticoagulation, no cardiac source of embolism could be found; However, transoesophageal echography showed a large mobile thrombus in the aortic arch implanted just before the origin of the left subclavian artery. The only explanation for embolism to the right arm was a retro-oesophageal subclavian artery which was confirmed by scanner. Doppler and arteriography. These investigations, however, did not allow visualisation of the aortic thrombus. In view of the risk of recurrent embolism, a thrombectomy was performed without cardiopulmonary bypass, associated with correction of the vascular abnormality with no complications. This case shows that oesophageal echography is a useful investigation in the work up of acute arterial obstruction in young patients with no cardiac disease.

Acute Disease↗
PubMed1995

[Arterial disease of the lower limbs in diabetic patients].

Lower limb arterial disease in diabetics resembles that in non diabetics. However, some important differences include the vessels involved and the extent of the involvement. In the diabetic, the arteries most frequently involved are those below the knee. Arterial occlusions are bilateral, multisegmental, and involve unusual vessels such as the internal iliac artery, the deep femoral artery, the small branches and the collateral circulation. Arterial disease in the diabetic appears at a younger age, advances more rapidly, is more diffuse, and is almost as common in women as in men. Interaction of arterial disease, neuropathy and infection produces a wide away of clinical findings, including callus formation, foot ulcers, cellulitis, osteomyelitis and patchy areas of gangrene. Foot abscess and cellulitis require emergency debridement and drainage. Arterial reconstruction, including endovascular procedures, lessen the rate of amputation, allow partial foot amputation, and prevent from recurrent foot ulcer. Soft tissue repair, and especially fasciocutaneous flaps or musculocutaneous flaps, provide the means to heal most of the patients without infection, and avoid below-knee amputation.

Arterial Occlusive Diseases↗
PubMed1995

Infrapopliteal polytetrafluoroethylene and composite bypass: factors influencing patency.

Between January 1, 1979, and December 31, 1988, 149 infrapopliteal polytetrafluoroethylene (PTFE) bypasses were performed in 145 patients with chronic, critical, limb-threatening ischemia. These operations represented 27.9% of 534 infrapopliteal bypasses performed during the same period. There were 92 males and 53 females. Mean age was 71.8 +/- 12.3 years. Signs and symptoms of critical ischemia were gangrene, ulceration, and isolated rest pain in 101 (69%), 23 (15.3%), and 25 (16.7%) cases, respectively. A composite (PTFE-saphenous vein) graft was used in 53 (35%) cases. In 96 prosthetic bypasses the distal anastomosis was performed using vein patch angioplasty in 65 (44%) cases and directly in 31 (21%). The in-hospital mortality rate was 3.3%. Patency, limb salvage, and patient survival rates were plotted according to the actuarial method and the curves obtained were compared using the log-rank test. Actuarial survival rates were 68% +/- 5% and 57% +/- 7% at 3 and 5 years, respectively. Primary patency and lower limb salvage rates were 41% +/- 5% and 68% +/- 6% at 3 years and 35% +/- 9% and 65% +/- 10% at 5 years, respectively. There was no statistically significant difference noted in primary patency rates at 3 years according to the type of bypass (composite or all-prosthetic: 36% vs. 44%), the type of distal anastomosis (direct or vein patch angioplasty: 43% vs. 45%), the site of distal anastomosis (upper or lower half of the leg: 38% vs. 46%), lateral or medial placement of the bypass (39% vs. 43%), or according to whether or not it was a repeat operation (40% vs. 44%). In conclusion, patency rates using infrapopliteal PTFE bypasses are low. Certain technical approaches, although they do not seem to improve patency, definitely increase the feasibility of bypass and in our opinion decrease the risk of early failure in unfavorable anatomic settings. The limb salvage rates following infrapopliteal PTFE and composite bypass are encouraging and justify the use of routine distal revascularization, even in the absence of autogenous vein graft.

Adult↗
PubMed1995

Nondysplastic saccular aneurysm of the internal carotid artery.

An unusual case of nondysplastic saccular aneurysm associated with elongation of the extracranial internal carotid artery is reported. The artery was normal except for a punch-hole defect in the media, which distinguished it from true fibromuscular dysplasia. Although neurologic symptoms and treatment were not specific, this case is interesting in that the exact cause of the aneurysm remains unknown.

Aged↗
PubMed1995

Outcome of infrainguinal endovascular revascularization procedures for limb-threatening ischemia.

This report describes the results of 96 infrainguinal endovascular revascularization procedures performed in 86 patients with limb-threatening ischemia over a 3-year period. There were 41 women and 45 men (mean age 72.9 +/- 11.9 years) including 47 patients (51.1%) with diabetes and 13 (15.1%) with renal insufficiency. All patients had severe ischemia characterized by rest pain (18.8%), ulceration (12.5%), or gangrene (68.8%). Twelve procedures were carried out in association with conventional surgical reconstruction and in eight patients with mixed ulcers a venous procedure was performed during the same session. A total of 143 arterial lesions were treated including 61 occlusions (mean length 5.9 +/- 3.5 cm) and 82 stenoses (mean length 4.6 +/- 3 cm). The following techniques were used: transluminal angioplasty in 99 cases, laser in five cases, Rotablator in 24 cases, and aspiration thrombectomy in 15 cases. Nine patients (10.5%) died in the hospital. Initial failure was observed in 32 patients, of whom 18 underwent subsequent surgical revascularization and 14 required amputation of the extremity within 2 months. Analysis of variance was used to assess the following 12 risk factors for initial failure of endovascular revascularization: sex, age, diabetes, renal insufficiency, associated surgery, treatment of multiple lesions, artery treated, type of lesion, length of lesion, quality of runoff, use of an atherotome, and stent placement. Results showed a significant correlation between initial failure and both quality of runoff (12.9% in patients with two or more patent leg arteries vs. 36.5% in patients with one or fewer patent leg arteries; p < 0.05) and type of lesion (14.5% for stenosis vs. 45.9% for occlusion). Mean follow-up was 9.98 +/- 9.9 months and 4.7% of patients were lost. Restenosis was observed during follow-up of 16 of the 74 initially successful procedures. ANOVA was used to assess the same 12 risk factors for restenosis. Results showed a significant correlation between restenosis and both sex (10.8% in women vs. 32.4% in men; p < 0.05) and age (8% for patients > 80 years of age vs. 28.6% for patients < 80 years; p < 0.05). Primary patency, secondary patency and limb salvage rates calculated according to the actuarial method were 65%, 75%, and 84%, respectively, at 6 months and 47%, 67%, and 81%, respectively, at 1 year. Limb salvage rates for the endoluminal techniques used in this study were satisfactory, especially in elderly patients with either segmental lesions or contraindications for distal bypass.

Adult↗
PubMed1995

[Disabling calf pain in the context of venous angiodysplasia: Contribution of dynamic exploration].

We report the case of a 25-year old woman presenting with disabling pain of the left calf, associated with lower left limb angiodysplasia. Dynamic testing (duplex scan and phlebography) showed a popliteal vein ectasia, with reflux into an incompetent lesser saphenous vein: the venous drainage of this ectasia was an embryonic femoropopliteal vein going to the profunda femoris vein. As long as patency and competence of deep veins and of the superficial femoral vein were confirmed by dynamic testing with compressions, curative surgery was considered: en-bloc resection of lesser saphenous vein and of embryonic femoropopliteal vein combined with lateral suture of the popliteal vein. One-year follow-up confirms the absence of recurrent symptoms. Dynamic testing allows safe surgical therapy of persisting embryonic abnormalities associated with incompetent veins, in cases where such testing clearly demonstrates that a sufficient venous drainage of the affected limb will be provided after surgery.

Adult↗
PubMed1995

[Is it permissible to operate on an asymptomatic aneurysm of the abdominal aorta after the age of 80?].

Whether or not to operate an asymptomatic aneurysm of the aorta in a patient over 80 years of age is a question increasingly facing the surgeon: longer life span (about 7 years), aneurysm discovered on a sonogram or scan ordered for digestive, urologic or pelvic disorders. This discussion is based on a personal retrospective series of 800 patients who underwent elective operation for non-ruptured aneurysms of the subrenal abdominal aorta between January 1985 and June 1990. For the 732 patients under 80, mortality was 1.9% and for the 68 patients over 80, it was 8.8%, emphasising that in this group survival at 6 months was reduced by 10%. The operative risk, as for younger subjects, results from coronary risk (reversible ischaemia), the quality of the heart muscle (ejection fraction < 35%), respiratory and renal function. Increased age raises mortality when one of these factors is severely jeopardized but associated lesions, such as digestive disorders or arterial lesions (severe occlusion of the downstream vessels, occlusion of the mesenteric and hypogastric arteries increases the risk of acute ischaemia of a limb or the intestine), should also be taken into consideration. Indications for operation should be discussed in light of these factors in patients at risk (large aneurysm > 60 mm or increasing in size, "images" suggesting risk of rupture: bleb or bubble ectasia, flotting mural thrombus, "digitiform" lysis of a mural thrombus, rupture of the calcified shell or covered rupture). When there is a high risk of lesion and the operative risk prohibits conventional surgery, other procedures can be discussed: axillo-bifemoral bypass with exclusion of the iliac and secondary embolization or subrenal exclusion, substitution with an endoaortic prosthesis allowing wider indications.

Aged↗
PubMed1994

Vertebral arteriovenous fistulas: a study of 49 cases and review of the literature.

The experience is reported with 50 vertebral fistulas treated by the authors in a joint radiological and surgical team. Of the 28 fistulas that were traumatic, 18 occurred after incidental iatrogenic puncture, and 22 were spontaneous, of which four presented in patients displaying angiographic features of fibromuscular dysplasia. Eleven patients were operated on and 33 had endovascular treatment. In nine patients who were either symptom-free or in poor health, no treatment was advised. The fistula was occluded in 38 (93%) of the treated patients, and the vertebral artery patency was preserved in 32 (78%). A total of 224 published cases were reviewed: 152 were traumatic, most after a penetrating injury; 72 were spontaneous, with three age peaks (at 7, 26 and 52 years). Treatment has evolved considerably and endovascular occlusion is now the treatment of choice, surgery being reserved for specific indications.

Adolescent↗
PubMed1994

[Distal arteritis of the legs: endovascular treatment].

Femoro-tibial bypasses are not always feasible in patients presenting with "critical" chronic ischemia. The results of endovascular therapies carried out over a 2-year period are analyzed. Twenty-three patients with critical ischemia (rest pain 13%, gangrene 87%) had 25 procedures on 29 leg arteries: percutaneous transluminal angioplasty in 17 arteries, rotational atherectomy in 10 arteries, laser recanalization (1 artery), directional atherectomy (1 artery). The hospital mortality rate was 4.3%. The cumulative patency and limb salvage rates were respectively 51% and 77% at 6 months, 34% and 71% at 12 months. Candidates for tibial-peroneal endovascular techniques should have a threatened limb, as long as the consequences of failed procedures on patients presenting with claudication can be disastrous, and as long as mid-term patency rates reported in the literature are not fair enough. In localized stenosis or short occlusions with adequate runoff, endovascular techniques are a good alternative to femorotibial bypasses for limb salvage. In diffuse lesions with no possibility of bypass, endovascular techniques can facilitate limb salvage, even if the mid-term arterial patency rate is poor. When conventional therapies cannot face critical ischemia, endovascular therapies can provide a fair limb salvage rate.

Aged↗
PubMed1994

[Internal carotid artery surgery using a venous graft].

Thromboendarterectomy is the most popular technique of carotid restoration for atheromatous lesions. In some cases, endarterectomy may be difficult or hazardous to perform, when atherosclerotic lesions involve the proximal common carotid artery and/or the distal internal carotid artery, when they are radiation induced, and when they are associated with fibromuscular dysplasia, loops or kinking. In other cases, result of endarterectomy may be unsatisfactory, because of a traumatic lesion of the arterial wall during endarterectomy, or a stenosis of the arteriotomy closure. Postoperative and late restenosis and occlusion rate range between 10 and 50% after primary closure of the carotid arteriotomy. Some of these complications may be reduced by alternative techniques such as eversion endarterectomy or patch angioplasty closure. Reversed saphenous bypass may also be performed. In our experience, only suitable autologous greater saphenous vein shall be harvested, including adequate length, absence of valves, diameter greater than 4 mm, and excellent wall texture. Distal anastomosis on the internal carotid artery shall be performed end-to-side with ligation of the internal carotid stump, and not end-to-end. Thus, in that location, venous grafts have excellent long-term patency with less than 5% late restenosis or occlusion rate. Thus, venous graft bypass may be an alternative technique to carotid endarterectomy, especially in young patients and women, who are more often exposed to late complications.

Carotid Artery, Internal↗
PubMed1993

[Arterial aneurysms in Behçet's disease. 4 cases].

Four cases of Behçet's disease with aortic and peripheral lower limb lesions illustrated the characteristics of the disease: multifocal lesions, false aneurysms suggesting infectious perforation and iterative false aneurysm in 1 case. The symptoms of Behçet's disease must be looked for stubbornly. In the presence of any arterial abnormality of this type, this cause must be seriously considered.

Adult↗
PubMed1993

[Surgery of aneurysm of the subrenal abdominal aorta in patients over 80 years of age].

In patients aged over 80 years infrarenal aortic aneurysmectomy is controversial because of reduced life expectancy and multiple risk factors and associated vascular or non-vascular lesions. Our personal experience of 984 operations performed for unruptured abdominal aortic aneurysms over a 6-year period showed a significantly higher perioperative mortality in patients aged more than 80 years (15.4 versus 2 percent). In contrast, for ruptured aneurysms, the difference of perioperative mortality was not significant (71 percent in the over 80 group versus 37 percent in other groups), but the number of patients (17 and 52 respectively, to a total of 69) was too small. In patients over 80, it seems reasonable to restrict elective surgery to aneurysms that are symptomatic or complicated, or to those which carry higher risks of rupture in view of their diameter and gradual enlargement. The best treatment, in fact, is early diagnosis and surgery before the age of 80, when perioperative mortality is much lower, less than 2 percent. Less aggressive treatments, including endoluminal aortic graft placement, are very promising but still experimental.

Age Factors↗