Biomedical subjects

J P Gournier

Publications and source records attributed to J P Gournier.

At least 19 recordsLinked to original sources

PubMed1998

Bypass to the perigeniculate collateral vessels. A useful technique for limb salvage: preliminary report on 22 patients.

PURPOSE: We describe our initial experience with the use of perigeniculate vessels as outflow tracts in infrainguinal revascularizations for critical limb ischemia. METHODS: Twenty-two such reconstructions were carried out in 20 patients over a 2-year period. Indications for surgery consisted of tissue loss in 9 patients and rest pain in the other 13 patients. Inflow was obtained from the femoral vessels. A variety of graft materials were used, including saphenous vein (16 patients), polytetrafluoroethylene (2 patients), composite (1 patient), and arterial homografts (3 patients). The perigeniculate vessels used were the medial sural artery to the gastrocnemius (arteria suralis) in 16 patients and the highest genicular artery (arteria genu suprema) in the other 6 patients. These vessels were approached via a medial above-the-knee popliteal-type exposure. RESULTS: There were three postoperative deaths. Mean follow-up for the other 17 patients averaged 12 months (range, 3 to 37 months). Three grafts failed (thrombosis) during follow-up, leading to two above-the-knee amputations. One graft stenosis was treated with percutaneous angioplasty. The average postoperative increase in the ankle-brachial index was 0.20. CONCLUSION: These early results appear promising with a 1-year primary patency rate of 77%, assisted primary patency rate of 85%, and a limb-salvage rate of 90% according to the Kaplan-Meier life-table method. This technique is particularly useful when adequate length saphenous vein is not available, no other outflow vessels are available, or other outflow vessels are very calcified and not safely clamped. The continued study of the long-term effectiveness is warranted.

Aged↗

PubMed1997

[An unusual cause of aorto-bronchial fistula: tuberculosis aortitis].

The aortic rupture in the pulmonary parenchyma or the bronchi rarely results in an haemoptysis. It means in most of the cases the rupture of an aortica aneurysm. We relate the observation of a aorto-bronchial fistula from a tuberculosa origin in an old woman case. Although the tuberculosa aortitis is becoming very exceptional, it still remains the cause of aorta rupture, with the formation of a false aneurysm which is rapidly fatal and so, it is important to search for it before any capricious haemoptysis.

Aged↗

PubMed1996

Mechanical characteristics of fresh and frozen human descending thoracic aorta.

In this study, mechanical characteristics of descending thoracic aorta were evaluated after preservation at +4 degrees C in EuroCollins solution or after programmed cryopreservation with 15% dimethylsulfoxide and compared to control segments. Arterial allografts were procured from multiple organ harvesting over a period of 2 years. All the segments were allowed to incubate in EuroCollins enriched antibiotics solution for 18 to 24 hr after harvest and were then tested as a control group or preserved at +4 degrees C in EuroCollins solution for 4, 7, 21, and 31 days or cryopreserved for 2 or 4 months. Each aorta was cut into parallel blades either in the radial or in the circumferential direction and mounted over a traction-compression apparatus for mechanical testing. Stress-strain characteristics indicated that no discernible differences were found between cryopreserved aorta and the control group. For those preserved at +4 degrees C a greater high strain modulus was noted for graft preserved for 21 and 31 days; however, this difference was not statistically significant. The authors concluded that cryopreservation did not alter the mechanical characteristics of arterial allografts procured from multiple organ harvesting.

Aorta, Thoracic↗

PubMed1996

Results of transluminal angioplasty of infra-popliteal arteries.

Transluminal angioplasty is rarely used to treat arterial diseases at leg level. During the last 5 years we have performed 25 distal artery angioplasties in 24 patients. Average age was 70 years, half of them were diabetics. Twenty patients had critical ischemia and 4 asymptomatic patients had critical stenosis distal to a previous patent infra-genicular bypass. Arteriography showed a single leg artery stenosis in 23 cases and a two distal artery stenosis in one case. No material other than guide wire was used to pass through the stenosis. All the dilation was performed in the operating room. Immediate results were good in 20 patients (21 stenosis). Four early failures occurred: one technical, one for progressive limb gangrene with secondary amputation, one postoperative thrombosis and one residual stenosis over 50%. Six patients had recurrent stenosis at mean 9 months. Five of them were treated with a new balloon angioplasty and the last with femoro-distal bypass. The 2 years cumulative primary and secondary patency rates were respectively 46 and 64%. With only guide wire and balloon catheters it is possible to treat distal artery lesions with rather good results.

Aged↗

PubMed1996

Angioplasty of distal venous bypasses: is it worth the cost?

Saphenous vein is the best graft for long term patency infragenicular bypass. During follow-up, stenoses can appear on the graft. Is angioplasty a good solution for the treatment of these lesions? During the follow-up of 612 saphenous bypass with below-knee distal anastomosis, 90 stenoses (over 70%) were discovered. Among them 36 were treated with transluminal angioplasty (34 bypasses). Stenoses were detected at a mean follow-up of 7 months after bypass realization. They were located 17 times on the graft itself and 19 times near the anastomoses and they were never longer than 5 cm. Percutaneous approach was preferred for 11 cases and surgical for the others. Immediate success was obtained in 33 cases (91%). Among the 3 failed cases 2 needed a new bypass. Mean follow-up was 33 months after the initial bypass and 24 months after angioplasty. Graft patency was ensured by a single angioplasty in 18 cases. Assisted primary patency, cumulative patency, limb salvage rate were respectively 65%, 91%, 100% at one year and 53%, 72%, 96% at 2 years. Transluminal angioplasty can be advised for the treatment of short stenosis of infrainguinal vein graft: this technique has a weak risk, little surgical aggressiveness, short hospitalisation. Results are acceptable and not very different with the location of the stenosis.

Aged↗

PubMed1996

[Pros and cons of use of collagenated arterial prostheses].

Use of bovine collagen for collagen arterial grafts raises the problem of possible contamination with the agents causing subacute spongiform encephalopathy. The safety of these products is the confirmed by the manufacturers and the risk of contamination is practically zero. A prospective non-randomized study conducted from January 1991 to December 1992 compared non-impregnated arterial stents with collagen arterial stents. Among the parameters studied, only the amount of blood transfused was significantly different. Collagen arterial grafts generated less blood loss.

Animals↗

PubMed1996

[Medical treatment of arm embolisms].

Emboli in the upper limb occur much less often than in other territories. They usually cause subacute ischaemia due to the importance of the arterial anastomotic network. Medical treatment is thus often sufficient. An analysis of the data in the literature show that medical treatment can give results comparable to surgery. Medical management should only be proposed as a complementary treatment when acute sensitivomotor acute ischaemia threatens the upper limb since priority must be placed on immediate restoration of the arterial flow.

Arm↗

PubMed1995

Do collagen-impregnated knitted Dacron grafts reduce the need for transfusion in infrarenal aortic reconstruction?

The purpose of this study was to evaluate the benefits of collagen-impregnated Dacron grafts in patients undergoing infrarenal aortic reconstruction. We therefore prospectively compared two consecutive series of patients undergoing infrarenal aortic reconstruction with Dacron grafts between January 1991 and December 1992. The first group (group A) included 83 high-density knitted prosthetic grafts (Dialine I), whereas the second included 82 grafts of the same type but impregnated with collagen (Dialine II). The two groups were comparable with regard to age, sex, and operative risk factors. They were also comparable in terms of the proportion of patients with occlusive disease or aneurysms, that is, there were 39 and 36 patients with occlusive disease and 44 and 46 patients with aneurysms in groups A and B, respectively. The type of bypass was similar in both groups with 17 and 19 tubular grafts and 66 and 63 bifurcated grafts being inserted in groups A and B, respectively. Thirteen parameters were studied and compared within each group including (1) number of infected grafts, (2) number of postoperative occlusions, (3) maximum postoperative temperature, (4) number of positive postoperative blood cultures, (5) number of postoperative deaths, (6) intraoperative and (7) postoperative quantities of blood transfused, (8) difference between pre- and postoperative hemoglobin concentrations, (9) difference between pre- and postoperative fibrinogen levels, (10) difference between pre- and postoperative platelet counts, (11) duration of aortic clamping, (12) date of return of intestinal function, and (13) mean duration of pre- and postoperative hospital stays.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

Cryopreserved arterial allografts for limb salvage in the absence of suitable saphenous vein: two-year results in 20 cases.

From January 1992 to November 1992, 20 cryopreserved arterial allografts were used as below-knee bypasses for repeated limb salvage in 18 patients lacking saphenous vein grafts. Arteries were obtained during multiorgan harvesting. A scheduled program of cryopreservation with 15% dimethylsulfoxide was used. Mean storage period was 37 days. All cases were matched for blood group compatibility. Patency was checked at 10 and 90 days and twice a year thereafter. Conventional arteriography was routinely performed 3 months postoperatively. Average follow-up was 26.8 months for the 18 patients and 20.8 months for the 20 bypass grafts. No patients were lost to follow-up. Aneurysmal dilation developed in one graft, which was replaced by another homograft. During follow-up 10 grafts occluded: five once, four twice, and one four times. These 10 grafts underwent a total of 16 reinterventions. Thrombectomy with angioplasty was performed 15 times and graft replacement once because of proximal and distal arterial deterioration. Primary actuarial patency was 68% at 1 year and 42% at 2 years. Secondary actuarial patency was 89% at 1 year and 72% at 2 years. Preliminary results of cryopreserved arterial allografts for repeated limb salvage in the absence of available saphenous veins are encouraging. Further studies are needed to determine the long-term deterioration rate of cryopreserved arterial allografts.

Adult↗

PubMed1995

[Acute occlusions of the aorta].

Acute occlusion of the aorta is a vascular emergency with high mortality, greater than 30% after revascularization, due to the extent of the ischaemic territory and the haemodynamic consequences. Over a period of 12 years, 34 patients (22 males, 12 females) underwent surgery for acute occlusion of the aorta. Acute bilateral ischaemia was present in 24, unilateral ischaemia in 6 and sub-acute ischaemia in 4. An embolus of cardiac origin was the cause in 13 cases, disease of the aorta itself in 11 cases and hypercoagulability in 10 including 7 due to allergy to heparin. The delay from onset of ischaemia to revascularization was 9 hours (mean). Revascularization was done by simple bifemoral embolectomy in 19 cases, by aortobifemoral bypass in 9 and by extra-anatomic bypass in 6 (3 supra-pubic, 3 axillo-bifemoral). Six patients (18%) died during the post-operative period. Delay to care had been greater than 12 hours in most of these patients. One or more post-operative complications occurred in 18 patients (53 p. 100) including repeated thrombosis, insufficient revascularization, ischaemic neuropathy. Long-term survival at 3 years was 30%. Prognosis might be improved by three elements: reducing the duration of ischaemia by rapid diagnosis and emergency revascularization, better control of metabolic disorders, screening for heparin allergy before thrombotic events occur.

Acute Disease↗

PubMed1994

[Three-and-a-half years' experience with hemodialysis using 37 Permcaths without infection or definitive thrombosis].

34 patients had 37 Quinton Permcath (PKT), surgically implanted in jugular vein (internal: 29, or external: 8). The first 20 were used for a temporary vascular access (mean: 21 weeks). Then, the next 17 were used for permanent vascular access. 8 could be used for more than 1 year and 2 for more than two years. Anti-aggregant (29 cases) or anticoagulant treatment (8 cases) were systematically prescribed. 6 patients died for unrelated causes (mean delay: 35 weeks). 3 catheters were mispositioned. 2 catheters had to be removed because they were damaged (mean 53 and 69 weeks). Complications were: vein thrombosis (internal jugular vein): 2 cases, vein stenosis (inominate vein): 1 case, heparin overdoses: 3 cases. A partial thrombosis of a single lumen was common but always easily cured by local thrombolysis. Nurses were strongly motivated and followed rigorous educations with help of video-movie. This could be why no infectious (local or generalised) complication was observed. Long-term Permcath dialysis is a precious tool for patient without any peripheral vascular access or in elderly and short-live expectancy.

Adult↗

PubMed1994

[Paradoxical embolism of the aortic arch diagnosed by transesophageal echocardiography. Surgical treatment].

The authors report the case of a woman who presented with a pulmonary embolism followed by systemic embolism. Transoesophageal echocardiography showed a persistent foramen ovale compatible with a possible paradoxical embolism. In addition, a mobile embolism in the aortic arch was demonstrated. This embolism was extracted under cardiopulmonary bypass to avoid a recurrence of embolism. Transoesophageal echocardiography is the only reliable, non-invasive method allowing simultaneous diagnosis of a right to left shunt and visualisation of the thoracic aorta.

Aged↗

PubMed1994

[Aneurysms of branches of the renal artery: surgery ex vivo].

Extra corporeal replacement of the renal artery for the treatment of complex renal artery diseases offers numerous advantages: safe approach for the branches of the renal artery and division of the intra-hilar arteries, easy repair and sutures, excellent quality of intra-operative arteriogram, easy repair of venous damage, excellent renal preservation. These advantages and the excellent long term results justify extra-corporeal surgery as the procedure of choice for the treatment of complex renal artery disease.

Aneurysm↗

PubMed1994

Sequential by-passes for limb salvage.

Direct revascularisation of the foot permits the healing of distal trophic lesions. This is not always possible with a by-pass on a single isolated popliteal segment. When multi-segmental occlusive arterial lesions were found in femoral, popliteal and distal arteries sequential by-pass grafting was used to improve distal runoff. During a 5 year period (1988-1992), 53 sequential by-passes were performed in 52 patients with severe ischemia manifested by rest pain (17) or trophic lesions (36). Autogenous saphenous vein was used in 36 (10 reversed, 26 in-situ), homologous saphenous in 3 and composite (PTFE+saphenous) in 14. Proximal anastomosis was performed on 29 common femoral, 20 superficial femoral and 4 popliteal arteries. Intermediary anastomosis was performed on 6 above-knee and 31 below-knee popliteal arteries and on 16 distal arteries. All distal anastomoses were performed on distal arteries (13 cases on malleolar arteries). The mean follow-up was 18 months. Thirteen patients died during this period (mean 8.5 months after the surgery). Primary and secondary patency were respectively 66 and 79% over one year and 51 and 76% over two years. Limb salvage was obtained in 89% over one year and 86% over 2 years. Sequential by-pass is a useful alternative for limb salvage. This approach offers several hemodynamic advantages and may be the best procedure in patients with poor distal runoff.

Aged↗

PubMed1994

Aortobronchial fistula: report of three cases and review of the literature.

BACKGROUND: Aortobronchial fistula is uniformly fatal if not treated surgically. The aim of this study is to report three new cases and to discuss cause, clinical findings, surgical approaches, and results. METHODS: All three patients with massive hemoptysis underwent operation in emergency situation. The procedure performed were a Bentall operation for a false aneurysm of the ascending aorta 10 years after the correction of an acute dissection, a Dacron graft replacement for a mycotic aneurysm of the descending aorta, and an extraanatomic bypass between ascending and celiac aortas for a false aneurysm 14 years after the correction of an isthmic coarctation. RESULTS: The patient with the mycotic aneurysm died of paraplegia and septicemia after operation. The other two were without symptoms after 2 years of follow-up. CONCLUSIONS: The diagnosis should be considered in any patient with minor or major hemoptysis and prior history of thoracic aortic operation. Aortography and thoracic computed tomographic scan are the main investigations for diagnosis. Direct approach or extraanatomic bypass have the same results with a survival rate of 76% in the recent literature. Early diagnosis and emergency surgery are the two predictive factors for good results.

Adult↗

PubMed1993

Cryopreserved arterial homografts: preliminary study.

The use of arterial or venous allografts for vascular reconstruction was first reported in 1951, but long-term results have been disappointing. Rejection and inappropriate methods of preservation are the main reasons for failure. A successful solution to this problem could be achieved by programmed cryopreservation with cryoprotectant. Our study had two aims: to define the biomechanical properties of cryopreserved arterial allografts and to study their histologic appearance. Arteries were removed as part of a protocol for multiorgan harvesting for transplantation. Cryopreservation was performed within the first 24 hours after harvesting. Programmed cryopreservation with 15% dimethyl sulfoxide (cryoprotectant) was used. Mechanical testing was done immediately after thawing. Two groups were tested: a control group of fresh aortas and a group of cryopreserved aortas. Axial and circumferential strips were tested. High strain modulus and stress and strain characteristics were calculated for each strip. There was no statistically significant difference between the mechanical properties of fresh and cryopreserved human descending thoracic aortas. Biochemical tests were performed in the preservative solution at 1 and 7 days in both groups. There was no statistically significant difference between the two groups at day 1 or day 7 (p > 0.05). Histologic studies before and after arterial cryopreservation included standard and electron microscopy and showed that arteries had normal structure after cryopreservation. These results confirm that programmed cryopreservation with cryoprotectant does not alter the molecular or geometric configuration of collagen or elastic fibers. Endothelial cells were still present, however, their viability and function were not assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta↗

PubMed1993

Trans-osseous ilio-femoral by-pass. A new extra-anatomical by-pass.

A new extra-anatomical by-pass is described as an alternative procedure to solve complicated vascular problems in the groin. This trans-osseous ilio-femoral by-pass can be use in spite of classical extra-anatomical by-passes (obturator, perineal, supra-pubic, axillo-femoral). The proximal anastomosis can be performed on aorto-iliac homolateral axis by a retro-peritoneal approach. The by-pass is going externally on the psoas-iliac muscle, through the iliac aisle and then between the sartorius and gluteus medius muscle. Distal anastomosis can be performed on the profunda femoral artery or, with sequential by-pass, on multiple arteries of the leg. We have performed such a by-pass in 5 patients for femoral triangle infection (4 cases) or radiotherapeutic complication. One patient died after cardiac surgery, another has had a major amputation. Three by-passes are patent with a follow-up period of 2 years. This by-pass is easy to do, its route is short, deep (without neurological, bleeding or compressive risk) and far from an eventual infected common femoral artery.

Blood Vessel Prosthesis↗

PubMed1992

Dysplastic lesions of renal artery branches: late results of ex vivo repair.

Between November 1980 and July 1989, 29 ex vivo reconstructions were performed in 12 women and five men (mean age: 42 years) for dysplastic lesions of renal artery branches. Fifteen patients had hypertension, associated with advanced renal failure in one case. The internal iliac artery was used routinely for reconstruction. The saphenous vein was used on one side where bilateral repairs were necessary. A total of 52 distal anastomoses were performed, an average of 2.6 per revascularized kidney. Mean follow-up was four years and 10 months. No patients were lost to follow-up. There were no early or late deaths. At least one follow-up arteriogram and technetium99 diethylene triamine pentacetic acid scintiscan was obtained for all patients. Forty-five (86%) of 52 anastomoses remained patent. Eleven of 15 hypertensive patients completely recovered while four were improved. Systolic arterial blood pressure decreased by an average of 42 mmHg (p less than 0.001), and results remained stable with time. For fibromuscular dysplasia occurring in young patients whose life expectancy is usually long, this type of surgery provides excellent long-term clinical and anatomical results.

Adolescent↗