Biomedical subjects
Publications and source records attributed to P Chaillou.
Fibromuscular dysplasia of the popliteal artery is rare. We report a case in a 20-year-old man complicated by aneurysm revealed by recurrent synovial effusion of the right knee. Diagnosis was based on pathology reports which showed severe destruction in the media. Two other cases with histopathological documentation were found in the literature.
The chronic rupture of an aneurysm in the abdominal aorta produces an atypical clinical picture. Computed tomography is the method of choice for diagnosis. This is a therapeutic emergency because of the risks involved by evolution.
We report three cases of fatal retrograde dissection of the aortic arch after exclusion-bypass with metal clamps according to Carpentier's thromboexclusion method. All three patients were male, aged 59, 66, and 73 years. Initial operative indications were chronic dissections in two cases and atheromatous aneurysm of the descending thoracic aorta in the other. Two of these patients were operated on in an emergency setting for a ruptured aneurysm. In all three cases, an extraanatomic bypass between the ascending aorta and abdominal aorta was performed as the first step: The proximal clamp was then placed distal to the origin of the left subclavian artery. Death occurred two hours, 12 hours, and eight days after operation, respectively. Autopsy revealed retrograde dissection initiating in the aortic arch and reaching the aortic ring as the cause of death. Pathological examination of aortic specimens confirmed that the dissections began just proximal to the site of clamping. To explain this complication, two etiologic factors, occurring either alone or together, have been postulated: postoperative hypertension and trauma to the aortic wall from the clamp.
The authors report two cases of duodenal obstruction occurring after insertion of an aorto-iliac prosthesis. This form of mechanical obstruction is much rare than the other forms of post-operative mechanical intestinal obstruction. While the need for surgery is often evident, precise diagnosis before the procedure is seldom obtained. CT scan appears to be the investigation of choice. This complication could be prevented by an epiploplasty covering the graft implant region.
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Tuberculous aneurysm of the descending thoracic aorta is a rare entity. To our knowledge the present case is the sixth on record to have been successfully treated surgically. These aneurysms present the usual difficulties of surgical therapy of the thoracic aorta: spinal cord and renal circulatory protection and the choice between distant or in situ revascularization. This case is of particular interest for its evolution and its treatment: resection of the aneurysm without shunting and insertion of a graft in situ covered by a flap of omentum.
A 40 year old man presented fibromuscular hyperplasia of posterior tibial artery media, a rare lesion, and only exceptionally reported in the calves since a total of 3 cases were found in the literature.
Twelve cases of mycotic aneurysm are reported. These rare lesions (2 to 3% of all aneurysms) may affect all arteries. Primary aneurysm is currently the most frequent type observed in France, with onset being related to a bacteremia or septicemia with development on an atheromatous lesion (8 of the 12 cases in this series). Manifestations are often misleading or diagnosis delayed in relation to the infectious process, apart from in rupture, which is the commonest cause of detection of aneurysm (half of the present series). Ideal surgical treatment is exclusion with extra-anatomic revascularization: but revascularization in situ has been reported by many authors (6 of the 12 cases in this series). Localization of aneurysm determines surgical procedure and also very variable mortality rate: 4 of the 12 patients in this series.
114 patients aged over 75 underwent surgery for aneurysm of the infra-renal abdominal aorta in the University Teaching Hospitals in Nantes and Angers between 1979 and 1988. A retrospective study of these patients was performed to evaluate the immediate and long-term results. The mean age of the patients was 79 (+/- 4) years, the oldest being 94. 70% were men. Half of the patients underwent emergency or semi-emergency surgery (52 cases). Cardiovascular factors (in particular coronary insufficiency in 17% of cases) were the most common risk factors. In all cases grafting after laying open the aneurysm was performed, with an aorto-aortic graft in 32% of patients, an aorto-iliac graft in 37% or an aorto-bifemoral graft in 27% of patients. Combined intestinal revascularisation was performed in 10% of case either involving the inferior mesenteric artery or at least one internal iliac artery; renal revascularisation was performed in 3.5% of cases. 75% of patients underwent simple grafting. The mean duration of hospitalisation was 14 days (+/- 6), including a mean period of 7 days in ICU. 36 patients (31%) died in the first post-operative month. The mortality rate in patients who underwent emergency surgery for a complication of the aneurysm (essentially rupture) was 61% versus 6' for elective surgery. 96% of the patients who survived the first post-operative month were independent at the end of the study or at the time of their death.(ABSTRACT TRUNCATED AT 250 WORDS)
The indications for supra-articular prosthetic bypass is still a controversial subject in cases where the internal saphenous vein can be used, or in stage II cases. These bypasses cannot be performed unless they are as permeable as venous bypasses and do not greatly increase the risk of exaggerating the symptomatology in case of thrombosis. In order to evaluate the outcome of these bypasses, we evaluated retrospectively our series of 81 surpa-articular femoro-popliteal prosthetic bypasses performed between 1987 and 1989. The man age of the patients was 64 years and 38% of them had coronary artery disease. Forty-six bypasses (57%) were performed in advanced stage II patients, 20 in stage III patients (25%) and 15 in stage IV (18%). Mean follow-up is 42 months. At 36 months, primary overall permeability was 65%. This level of permeability is in agreement with the data in the literature and is independent of the initial clinical stage, the downstream arterial network and the size of the prosthesis. The outcomes observed in our series would favour use of P.T.F.E. in the first intention operation to save the vein for possible subsequent use at stages III and IV. Inversely, for stage II, prospective randomized studies should be conducted in order to compare endovascular techniques and medical treatments.
Gritti's amputation was performed in 35 patients, mean age 71 years, with vascular disease of leg. There was no immediate postoperative mortality. Of twenty patients fitted with an appliance using a specific technique, only one had a poor functional result. The results obtained in this preliminary series were compared with those after amputations and knee disarticulations. They showed that Gritti's amputation should be considered for patients with arteritis when a functional knee is impossible to conserve.