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J M Jausseran

Publications and source records attributed to J M Jausseran.

At least 19 recordsLinked to original sources
PubMed1995

In vitro testing of six inferior vena cava filters: filtering efficiency and pressure measurements.

UNLABELLED: The purpose of this study is to compare in standarddised ex vivo conditions the performances of six percutaneous vena cava filters available on the European Market. METHODS: We use a mock circulation with polyethylene beads simulating clots to objectively determine the filtering efficiency of the different devices. We measured pressure at contact points with the wall of the tube simulating vena cava, and also gradient of pressure induced by the empty and full filter. Statistical analysis of the data obtained (at least 100 measurements for each filter) showed great consistency in the response of a given filter to the different conditions of mock circulation. RESULTS: The Greenfield Filter, which served as the reference, was compared to the other models. Its filtering efficiency was acceptable as was that of the L.G. Filter. The Cardial Filter and Vascor Filter were the most efficient. The Antheor Filter and the Filcard Filter performed poorly. CONCLUSION: The mock circulation give reliable and reproducible data on the filtering efficiency for a device but ease of placement and clinical studies must be taken into account for the choice of the filter.

Blood Pressure↗
PubMed1993

[Associated surgery of the carotid and subclavian arteries: indications and results].

Over a 5 year period (1988-1992), 6 patients were treated by combined carotid and subclavian artery surgery, representing 0.7% of carotid interventions practised during this period. The carotid lesion clinical stage was 0 (2 cases), 1 (2 cases) and 3 (2 cases). While for the subclavian artery 4 patients were asymptomatic and 2 had vertebrobasilar syndromes, one associated with ischemia of upper limb. Only one patient was globally asymptomatic but the diagnosis was a prethrombotic carotid restenosis. Radiographs showed that the atheromatous lesion of the cervical trunks was equivalent to 2.83 stenoses per patient. The decision to use the combined interventions was based on either the clinical condition (combined carotid and vertebrobasilar symptomatology) or hemodynamic data (improvement in subclavian flow during carotid surgery). This hemodynamic component could be determined by transcranial Doppler. Operation consisted always of initial subclavian revascularization (1 reimplantation, 5 bypasses), followed by carotid surgery (2 grafts, 4 endarterectomies). The postoperative course was uneventful in 5 patients, the 6th patient requiring recovery surgery for early carotid thrombosis without worsening of the neurologic state. Mean follow up was 9 months (range 1 to 27 months). Combining these two interventions in this small series did not appear to increase carotid surgery complication. Initial revascularization of the subclavian artery in the patient with multiple trunk lesions corrected the posterior hemodynamic supply to the circle of Willis.

Aged↗
PubMed1992

[Vascular endoprosthesis. A new indication in the surgery of the iliac artery].

We have used endoprosthesis (Palmaz Schatz) after balloon angioplasty of iliac arterial stenoses or thromboses, in order to increase the immediate patency and to prevent the recurrence of stenosis. Our series gathers 24 patients operated with endovascular procedures over a period of 2 years: 22 men, 2 women--extreme ages 42 to 78 years, average age 63.5 years--Clinical stage: 22 at stage I, 1 at stage III, 1 at stage IV. Arteriographic findings: 8 primary iliac lesions (6 stenoses and 2 thromboses), 11 external iliac lesions (stenoses). All these lesions were atheromatous. One of them had recurred after angioplasty. Usual technique: balloon angioplasty of the stenosis, assessment on a fluoroscopic screen and angioscopy of the result, decision to insert the Palmaz Stent if defects are seen on the image. Repatency of impassable lesions with a YAG laser was carried out in 2 cases. The indication of an endoprosthesis was established on the basis of the radiological image in 17 cases, of the angioscopic image in 4 and systematically in 10 cases of recurrence of stenosis, iliac thrombosis or associated surgery. Associated surgery: 2 femoropopiteal bypass grafts, 3 femorofemoral bypass grafts, 1 deep plasty, 1 superficial femoral recanalization with laser, 1 lymbar sympathectomy. Postoperative results: 1 death due to MI (78-year-old diabetic woman), 1 thrombosis treated with femorofemoral bypass. Middle-term results: after 6 to 24 months, average time lapse 13 months. The comparison of the ankle pressure indices and of the pre- and postoperative sonographic findings shows an indisputable hemodynamic improvement.

Adult↗
PubMed1991

Secondary aortoduodenal fistulas: value of initial axillofemoral bypass.

Between January 1970 and April 1989, 20 patients underwent operation for secondary aortoduodenal fistulas. When the preoperative diagnosis was certain and emergency control of bleeding not required, initial axillofemoral bypass was performed before ablation of the infected aortic prosthetic graft during the same operation. When diagnosis was uncertain or severity of bleeding required emergency laparotomy, the therapeutic plan varied over time. Until 1980, we performed either a direct repair (three cases) or the ablation of the aortic graft followed by secondary axillofemoral bypass (four cases). After 1980, the order of procedures was 1) control of bleeding whenever necessary, 2) axillofemoral bypass, and 3) ablation of the aortic graft. Postoperative mortality was two of 13 in patients undergoing initial axillofemoral bypass, compared with six of seven patients undergoing direct surgery or initial ablation of the aortic graft. Of the 12 patients surviving the postoperative period, three died of aortic stump hemorrhage, four, 12, and 14 months after operation. Two patients had a new aortic graft inserted. Repeat replacement of the abdominal aorta graft was performed in one case and ascending thoracic aortobifemoral bypass in the other because of secondary thrombosis of the axillofemoral bypass. We conclude that initial axillofemoral bypass before dealing with the aortic graft improves the immediate prognosis in operations for secondary aortoduodenal fistulas. This procedure does not, however, preclude the possibility of aortic stump infection which can lead to recurrent aortoduodenal fistula. The risk of infection or secondary occlusion of axillofemoral bypass is minimal. Secondary prosthetic replacement is not systematically necessary.

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PubMed1991

Pre- and intraoperative transcranial Doppler: prediction and surveillance of tolerance to carotid clamping.

We report 91 patients (mean age 70 years) operated upon, prospectively for a total of 100 carotid revascularizations (nine bilateral). Eighty-five of these patients had pre-, intra-, and postoperative transcranial Doppler investigations. Preoperatively, these 85 patients (92 procedures) were classified into two groups based on the results of their Doppler examinations: Group A (65 patients, 72 procedures), those who did not require an intraoperative indwelling shunt and Group B (20 patients, 20 procedures), those who did. The shunt was inserted only when the mean stump (back) pressure was less than 50 mmHg after cross-clamping. Group A all had satisfactory collaterality with a functional anterior and one or two posterior communicating arteries. Group B had no communicating arteries (anterior or posterior) identified by transcranial Doppler. In 17 of 20 patients in this group, the stump pressure was less than 50 mmHg and a shunt was placed. The overall prediction based on Doppler examination of whether or not patients would need a shunt during operation for the two groups A and B (i.e., 92 procedures) was correct in 95.6% (88/92) of cases. Moreover, six hemodynamically significant stenoses (four in the cavernous portion, two in the middle cerebral artery) were disclosed. Sensitivity and specificity of transcranial Doppler as correlated with arteriographic findings were 70 and 90%. Preoperative transcranial Doppler can measure the velocities of the principal cerebral arteries and the collateral capacity of the circle of Willis, and can forecast tolerance to carotid cross-clamping. Intraoperatively, the velocity of flow in the middle carotid artery was correlated with stump pressure, which allowed for surveillance of the shunt.

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PubMed1991

[Early angiographic assessment of coronary revascularizations using the internal mammary artery. Apropos of a consecutive and prospective series of 180 bypass grafts].

This report describes a consecutive and prospective series of 136 patients, who underwent coronary bypass using the internal mammary arteries. Coronary angiography was routinely performed on all patients 8 days after surgery. A total of 137 operations (1 reoperation) were performed on 180 coronary arteries using 132 left internal mammary arteries and 25 right internal mammary arteries. Direct bypass was performed 133 times (73.8%), sequential bypass 23 times (25.5%) and free graft once. Bypass involved 1 coronary artery 89 times (65.4%), 2 coronary arteries 46 times (33.8%) and 3 coronary arteries in 1 case. The overall early success rate of internal mammary bypass in this series was 94.8% including 2 bypasses which were patent but non-functional. Of the 23 sequential bypasses, only 1 anastomosis out of 46 was not patent for a success rate of 97.3%. These good results are attributed to the large diameter of the mammary artery. Early postsurgical imaging is valuable for several reasons. It allows detection of surgical errors and improvement of the procedure. It enables distinction between residual primary surgical stenosis and secondary stenosis or genuine restenosis. It allows analysis of perioperative complications allows. No correlations between myocardial infarction and bypass obstruction were found. Finally, it permits endoluminal therapies such as thrombolysis (1 case in this series) and dilatation (2 cases). In conclusion, although we do not perform angiography routinely, our policy is to perform imaging in all cases of postoperative complications and after certain procedures such as sequential bypass.

Anastomosis, Surgical↗
PubMed1991

Etiology of prosthetic anastomotic false aneurysms: pathologic and structural evaluation in 26 cases.

To determine the etiology of anastomotic false aneurysms (AFAs), 26 textile graft specimens, removed because of AFA, were studied morphologically, histologically and by scanning electron microscopy. No cases of suture-related failures leading to AFA were found. Nine cases of frayed grafts were documented but were not the cause of AFA formation. In three cases, chemical degradation of the fibres, which may have been secondary to lipid infiltration, may have contributed to AFA formation. There were no cases of overt clinical infection, but the presence of bacteria was documented by scanning electron microscopy in 20 cases. The role of bacteria is not well defined, but they may be a factor in host arterial-wall degeneration as a cause for AFA formation.

Adult↗
PubMed1991

[Revascularization of the distal portion of the deep femoral artery. Indications and results].

Most of the times, the distal part of the deep femoral artery is not affected by atheromatous disease. It constitutes an acceptable alternative, whenever the femoral bifurcation is not usable for bypass. This artery is readily approached directly, at a point removed from Scarpa's fascia. We used this technique on 60 patients. Indications included: multiple reoperations (45 cases, 75%), infection of Scarpa's fascia (2 cases, 3%), calcified or thrombosed femoral bifurcation (13 cases, 22%). Lim salvage for decubital pain, grade-IV or acute ischemic disease involved 49 cases (82%). After a mean 28.5 month follow-up period, arterial permeability was 74% and 53% after one year and 5 years, respectively. These results are compared with literature data. Long-term permeability is related to two factors: proximal bypass implantation site and the state of the popliteal reentry and arterial network of the leg. Utilization of the distal segment of the deep femoral artery via an elective approach is interesting of the deep femoral artery via an elective approach is interesting and sensible, whenever the femoral bifurcation is unusable owing to progressive atheromatous disease, repeated surgery or infection.

Adult↗
PubMed1990

[Digestive arterial bypass. Long-term clinical results].

In the period between September 1966 and December 1988, 69 patients were operated, including 92 cases of restorative surgery on celiac, hepatic or superior mesenteric arteries. This is a presentation, of the detailed retrospective analysis of 12 years' experience with more homogeneously matched indications and technics. Only indirect, venous or prosthetic bypasses and reimplants are discussed; excluded are all other digestive revascularization procedures, as well as acute ischemic surgery cases. 31 patients (28 men, 3 women) of mean age 59.8 years (47-80) have undergone consecutive surgery: 11 presented with symptoms of predominantly digestive origin; 18 had a combined aortoiliac bypass operation; radiological signs of disease occurred in 46 cases. (celiac artery): 22 including 14 stenoses, 5 thrombotic cases and 3 aneurysms; superior mesenteric artery: 21 including 13 stenoses and 8 thrombotic cases; inferior mesenteric: 3 thrombotic cases). A restorative operation was carried out on 45 patients, 6 of whom had had previous surgery. 21 patients had a single artery restored: celiac (3), hepatic (9), superior mesenteric (9). Double artery surgery was performed in 12 cases. The procedures most commonly used on the hepatic and superior mesenteric arteries were indirect reimplantation and bypass surgery, respectively. Evolution showed increased numbers of anterograde constructions. No deaths were recorded in the perioperative period. Two patients had early recurrences of thrombosis at D10, which required new bypassing. During the mean retrospective period of 6.1 years, we recorded 6 cases of blindness, 8 secondary deaths, 1 single case of mesenteric infarction 18 months after a repeated restorative operation on the superior mesenteric artery; 17 patients remained symptom-free.

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PubMed1989

[Axillo-femoral bypass. Long-term results].

182 patients underwent axillo-femoral bypass between April 1974 and December 1981 (29 women and 153 men). Mean survival was 43 months. The mean age was 68 years (range: 40-90). 10.9% of patients were Leriche stage II, stages III and IV accounted for 69.7% of cases. All presented a high surgical risk with cardiac disease present in 43.4% and severe respiratory failure in 36.8%. Depending on the year studied, this procedure represented 10 to 15% of the aorto-iliac revascularisations carried out. Mortality was low (5 cases = 2.7%). Early complications (15%) included 11 cases (6%) of early thrombosis requiring reintervention, and late complications included 48 cardiac problems (26.3%). Analysis of the results in the long term was carried out according to an actuarial method over a period of 10 years. The secondary permeability rate was 86.4% at 5 years and 68.8% at 10 years with a 30% secondary thrombectomy rate (25% long term). Limb conservation at 5 and 10 years was respectively 91.1% and 82.7% while for the same periods survival was 46.7% and 19.7%, confirming the grave condition of the patients. We can conclude that axillo-femoral bypass remains a simple and reliable method with good long term results. When extra-anatomical revascularisation seems indicated, it is particularly suitable for subjects in very poor general health.

Actuarial Analysis↗
PubMed1988

[Cerebral protection in carotid artery surgery. The role of the intraluminal shunt. Results of a national survey].

Clamping of the carotid artery made necessary by surgery of that vessel produces haemodynamic disturbances which may result in a neurological deficit accident at recovery from anaesthesia. Evaluating the patient's tolerance to carotid clamping and using brain protection methods during clamping increase the safety of the operation. The different methods of protection used in France were examined in an enquiry conducted among members of the French college of vascular surgery, with special attention to measurement of residual pressure in the clamped internal carotid artery (performed by 60 p. 100 of surgeons) and its corollary which is intraluminal shunting in case of hypotension. This type of enquiry concerning controverted technical procedures should provide information on the best way of improving surgical results.

Blood Pressure↗
PubMed1988

Expanded PTFE prostheses as arterial substitutes in humans: late pathological findings in 73 excised grafts.

Through collaboration of surgeons, pathologists and bioengineers at five centers in Canada and France, this study analyzed the late pathology and structural changes in 73 expanded PTFE arterial prostheses harvested from patients at autopsies and reoperations. The degree of tissue encapsulation increased with the duration of implantation but was reduced by the presence of infection. In several cases, the fibrous tissue penetrated the wall of the prosthesis and partitioned off the thin outer layer, thus disrupting the delicate microporous structure of the wall. The presence of aneurysms was observed in models that had no external reinforcing layer and among grafts that apparently suffered from surgical trauma. Wrinkling of grafts was noted at areas of flexion and was often associated with thickening of the external capsule and reduced luminal diameters. Endothelialization was found within only a few millimeters of the anastomoses. The luminal surfaces were generally not well healed. The PTFE structure was usually readily visible under a thin covering of loosely adhering thrombotic deposits. Bacteria were observed in 46% of the cases, even though only 29% were considered clinically infected. The incidence of lipid or cholesterol deposits was high. Avoiding iatrogenic trauma to the external wall of the prosthesis during implantation is important. Those features where design improvements are required to provide longer term structural integrity and dimensional stability in future models of expanded PTFE prostheses should be identified.

Adult↗
PubMed1988

Unfastening of an Adams-de Weese clip: an uncommon cause of recurrent pulmonary embolism after interruption of the inferior vena cava.

Recurrent pulmonary embolism after placement of a caval clip is uncommon. We report the case of a patient admitted for recurrent venous thrombosis of the lower limbs, 11 years after placement of an Adams-de Weese clip. Severe pulmonary embolism occurred in spite of anticoagulant treatment. After an unsuccessful attempt to insert a Greenfield filter, surgery was performed. The clip was found to have come unfastened; simple repeat closure was performed. We were unable to find any similar reports in the literature. In spite of its rarity, this cause should be considered when faced with recurrent pulmonary embolism in patients having undergone inferior vena caval clipping.

Constriction↗
PubMed1988

[Reliability and perspectives in peroperative flowmetry. An original computer-assisted ultrasonic technic].

To mitigate the lack of reliability of currently used flowmetry technics, an original method was developed based on a single window 15 MHz Doppler flowmeter and an Apple IIe computer with data acquisition system. Eleven successive measurements of instantaneous rate were made in an arterial section. A mean flow was determined by integration of mean rate in section. The reliability of the method was evaluated by an experimental study on a hydrodynamic bench reproducing physiologic flow conditions with an error always less than 8%. An in vivo study in 30 patients provided 100 measurements of arterial flow before and after surgical arterial reconstruction. The mean error value was less than 10%. Among the risks of error, those due to the probe was reduced by specially conceived probes. The most important factor was that of respiration, this latter factor imposing an integration time of rate of signal of 30 seconds to eliminate errors due to respiration. The conventional measurement time for other configurations is 6 seconds but this leads to a mean error of 25% which can attain 60%. The perspective of miniaturization of the apparatus in the near future with acceleration of measurements using a multi-window Doppler should allow flow measurement in 30 seconds and control of surgical reconstructions (on healthy arteries, vein grafts and prostheses but excluding PTFE). Similarly, it should be possible to improve evaluation of so-called vasoactive drugs.

Arterial Occlusive Diseases↗
PubMed1987

[Exploratory hierarchy and surgical indications for carotid surgery in patients with coronary disease].

The major cause of death from carotid artery surgery (1.2% in 1984 in this series) is still coronary disease and myocardial infarct. A series of 50 patients were randomly selected for detailed study of post-operative cardiologic complications and the following sequelae were noted: mortality = 1 myocardial infarct; morbidity = 1 myocardial infarct, 3 documented anginal pains, 8 repolarization disorders, 4 benign ventricular arrhythmias. Analysis of these complications and a literature review demonstrated: the high frequency of combined carotid artery and coronary artery stenosis even in asymptomatic patients (25 to 40% of cases); the elevated percentage of complications in patients with symptomatic coronary disease (mortality risk multiplied by ten), hypertension or arterial disease; the low effect of age taken alone as risk factor. Pre-operative explorations to detect angina, particularly when latent and asymptomatic, should include a questionnaire, strict patient clinical examination and detailed reading of electrocardiogram tracings. An effort test should be performed as a function of results and patients' medical history and when positive should lead to coronarography in patients under 70 in good general condition, and when doubt persists after the effort tests. The indication for surgical treatment is dependent on results of these explorations: Carotid artery surgery (stenosis with high cerebral risk) should be performed under pre- and post-operative myocardial protection in patients with coronary artery disease who are too old or inoperable for cardiac reasons. Simultaneous myocardial and cerebral revascularization in the presence of severe lesions and at equivalent risk of progression. First intention carotid artery surgery for bilateral stable lesions with subsequent simultaneous myocardial and cerebral revascularization. First intention carotid artery surgery in case of cerebral ischemia with coronary artery shunt surgery at a later stage. Improved exploration of patients and close cooperation between cardiologists, anaesthetists and surgeons should allow patients at high risk to be operated upon under improved conditions of safety.

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