[Image of the month. An unusual case of acute aortic insufficiency].
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Acute Disease↗
Biomedical subjects
J Quaniers
Publications and source records attributed to J Quaniers.
Abdominal aortic aneurysm due to Brucella melitensis.
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Aged↗
[Prevention of secondary mortality after type B aortic dissection].
Only few dissecting aneurysms type A survive without surgery. Opposingly, the dissecting aneurysms type B are successfully managed by the medical treatment "anti-impulsion". A personal series is reported, that evidence important cardiovascular mortality in the follow-up in chronic dissecting aneurysms type B; one part of this late mortality is linked to rupture of the thoracic descending aorta. Thus, the prevention of this late mortality depends on a strict follow-up of the characters and dimensions of descending aortic thoracic aorta.
Aortic Dissection↗
[Resurgence of vein perforation surgery: SEPS (subfacial endoscopic perforator surgery)].
The treatment of venous ulcers is a challenge even in this era of modern medicine. The role of incompetent perforating veins in the pathophysiology of venous ulcers has been well documented. Open surgical interruption of incompetent perforating veins (Linton's procedure) may be complicated by important wound healing problems, and has never gained widespread acceptance as a first choice treatment. Recently, an endoscopic technique of subfascial interruption of perforating veins has been developed. This new procedure, with smaller scars and faster recovery, gives promising midterm results. The authors summarize their initial experience with subfascial endoscopic perforating surgery (SEPS) during the last three years (25 cases). They obtained ulcer healing in all cases. At 16 month follow-up, 88% of patients remain ulcer free. Three patients developed a new minor ulceration in the era of lipodermatosclerosis. This less invasive technique is a promising tool in the management of patients with venous ulcer disease.
Endoscopy↗
[Should we correct stenosis of the superficial femoral artery in a patient with claudication?].
Infrainguinal arterial occlusive disease is very common at the age of 60 years or older. It remains often asymptomatic. In one third of cases, it results in claudication. Claudication is a benign symptom that rarely necessitates surgery or endovascular intervention. Physical training and control of risk factors are sufficient in most cases to improve the walking performance. Nowadays, the authors do no longer perform femoropopliteal bypass grafting as a first choice treatment for intermittent claudication. Conservative treatment has gained widespread acceptance for infrainguinal atherosclerosis with moderate ischemia. What is the fate of the claudicant? How effective is exercise therapy? Should we broaden the indications for percutaneous angioplasty? What is the place of femoropopliteal bypass graft for claudication? The authors investigate these different questions by means of an extensive review of recent literature. Based on this review and on international consensus documents, they justify their conservative approach to claudication secondary to occlusive disease of the superficial femoral artery.
Aged↗
[Fibromuscular dysplasia].
Fibromuscular dysplasia is a rare non-atherosclerotic, non-inflammatory arterial disease. It concerns less than 1% of all occlusive artery lesions, but is more common in young female patients, with a prevalence of 3 to 5% of the arterial lesions in that age group. It mainly attains renal and carotid arteries. The authors discuss the etiopathogeny, the prevalence and treatment of fibromuscular dysplasia. Their own surgical experience with 21 renal and 10 carotid lesions of fibromuscular is exposed.
Adult↗
Outlook of non operated type B aortic dissection with special reference to the incidence of degenerative abdominal aortic aneurysm (AAA). One center study.
OBJECTIVES: to determine the value of pharmacological treatment of type B aortic dissection (B AD) in face of new forms of treatment. DESIGN: this is a retrospective study of the period from 1990 to 2000. Files of 81 patients have been reviewed and completed by questionnaires. RESULTS: Two B AD died after admission without any treatment, 10 were operated on with 7 discharged alive (group I); 69 received hypotensive agents and beta-blockers, 65 were discharged alive (group II). Late mortality of the group I is 3/7, not related with B AD. Late mortality after mean follow-up of 56.8 months is 27/65 with 4/27 related to B AD (4 ruptures, 2 operated on). Non fatal secondary surgery amounts 5 in 4 patients. Total B AD aortic events comprise 8/65 patients. Type A AD were operated on successfully (8 : 4 before B AD, and 4 after B AD). Degenerative abdominal aortic aneurysms were present, operated (9) or not (3), in the history of patients and 3 more appear subsequently. At 10 years, actuarial survival is 40% +/- 18. CONCLUSION: in non-complicated cases of B AD, medical treatment is a reasonable choice, provided that a strict follow-up of the thoracic abdominal aorta is performed.
Adrenergic beta-Antagonists↗
Potential benefits of laparoscopic aorto-bifemoral bypass surgery.
BACKGROUND: This series aims to prove the positive impact of laparoscopic approach in aortofemoral bypass grafting. METHODS: It concerns a retrospective non randomized study comparing 58 consecutive patients treated with laparoscopic procedure (n = 30) and with a standard open procedure (n = 28) in a single center. The different operating times, the complications and the follow-up of these two groups are compared RESULTS: The demographics and angiographic data of the two groups were comparable. Operating time was longer in the laparoscopic group. However, we noticed a significant shorter hospitalisation stay (p < 0.0001) after the laparoscopic procedure with a mean 5.1 days. There was no significant difference of morbidity. CONCLUSION: We suggest that the trans-peritoneal approach is the best way in laparoscopic procedure in term of exposure and ergonomics. Laparoscopic aortofemoral bypass grafting is feasible, safe and effective. Shortening of operating time is observed as surgeon's experience grows.
Anastomosis, Surgical↗
Amputations in diabetic patients: a plea for footsparing surgery.
The authors observed a rather high rate of primary major amputation (above-knee or below-knee) performed for diabetic foot problems as well as an important revision rate for minor amputations (forefoot or toe) in diabetics. They reviewed their experience in order to compare it with more recent data from the literature, pleading for foot-sparing surgery. From 1993 to 1998, 186 amputations were performed on 146 diabetic patients. The cause of foot ulcers was neuropathy in 43 of them (51 episodes of diabetic foot problems) while in the remaining 103 patients (135 episodes of diabetic foot problems), diabetic macroangiopathy (absent ankle pulses) was on cause. For neuropathic foot problems, amputations were almost minor, resulting in a limb salvage rate of 90%. Only five of these patients (12%) had primary major limb amputation versus 43 of the dysvascular patients (42%). The reasons for major amputation by first intention were extensive tissue loss, intractable infection or non-reconstructible occlusive vessel disease, as judged by the surgeon. A foot-sparing surgery was attempted in 92 dysvascular cases. In only 44 of them, a preliminary vascular repair was performed. Twenty eight percent of the primary toe amputations and 24% of the forefoot amputations required secondary revision to a more proximal level. Minor amputations in case of diabetic neuropathy were characterized by a more favourable outcome: only 14% of the toe and 9% of the forefoot amputations failed. During follow-up, only 63% of the major amputations regained an autonomic walking capability with their prosthesis. Wound healing problems in diabetic foot are mainly due to infection and poor tissue perfusion. An aggressive control of the infection and distal revascularization of calf- or foot arteries, whenever possible, could improve the results of diabetic foot surgery. The poor functional recovery after major amputation (only 63% autonomic gait with limb prosthesis) argues for foot-sparing surgery whenever possible.
Aged↗