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Biomedical subjects

P Tournigand

Publications and source records attributed to P Tournigand.

At least 19 recordsLinked to original sources
PubMed1992

Fibromuscular disease of the renal artery: a new histopathologic classification.

To evaluate the relationship between clinical, radiologic, and histopathologic features in various types of renal artery fibromuscular disease, the records of 37 patients operated upon for a total of 44 lesions of the renal artery (30 unilateral and seven bilateral) were retrospectively reviewed. Of these, 36 had hypertension associated with stenosis or aneurysm of the trunk or branches of the renal artery; one had aneurysm of the renal artery without hypertension. The histopathologic study included 38 arterial segments retrieved from 33 patients and underscored the difficulties in using topographic criteria to classify lesions. While all arterial aneurysms were associated with involvement of the media, more than one layer of the artery was involved in 65.7% of cases. Topographic forms, such as the perimedial type, were difficult to classify. Based on the study results, it appears essential to distinguish patients with fibrosis and smooth muscular hyperplasia (type I: 19 patients, 23 arteries) from patients with isolated fibrosis (type II: 14 patients, 15 arteries). In group II, preoperative hypertension was more long-standing (p less than 0.04), more lesions were extended distally (p less than 0.05), and the probability of recovery from hypertension at 52 months follow-up was lower. We have distinguished two different evolutive stages of fibromuscular disease of the renal artery, one characterized by fibrosis with smooth muscle hyperplasia and the second, associated with more severe prognosis, characterized by isolated fibrosis.

Anastomosis, Surgical↗
PubMed1990

Occlusive disease of the renal arteries and chronic renal failure: the limits of reconstructive surgery.

In order to investigate the value of renal revascularization in patients with chronic renal failure and associated occlusive lesions of the renal arteries, the long-term results of 48 revascularizations in 43 patients operated upon between January 1980 and May 1988 were analyzed. There were 36 men and 7 women whose mean age was 61.8 years (range 36 to 79 years). The diagnosis of kidney failure was based on serum creatinine levels greater than 120 micromoles/L on two consecutive determinations. Patients were divided into four groups: Group I (23 patients) had a creatininemia between 120 and 200 mumoles/L, Group II (16 patients) between 200 and 350 mumoles/L, Group III (2 patients) between 350 and 800 mumoles/L and Group IV (2 patients) who had chronic renal failure requiring hemodialysis. Hypertension was found in 37 patients. Renal artery restoration was unilateral in 38 patients, 12 of whom had a solitary kidney. Restoration was bilateral in five patients. In 24 patients, renal artery surgery was associated with reconstruction of the infrarenal aorta. Three patients undergoing associated aortic procedures (7%) died after surgery. Thirty-nine patients were followed for a mean of 35.1 months; one patient was lost to follow-up. Improvement or stabilization of renal function was noted in 24 patients (62%). Deterioration was found in 15 patients (38%), six of whom presently required chronic hemodialysis. In Groups I and II, 69.5% of patients stabilized or improved their kidney function. Renal function worsened in all patients in Groups III and IV. We conclude that restorative renal surgery can improve renal function in patients whose preoperative serum creatinine levels are less than 350 mumoles/L. In this population of patients, associated aortic restoration should be performed only when absolutely necessary.

Adult↗
PubMed1988

Atherosclerotic lesions of the aorta and renal arteries: results of simultaneous surgical treatment.

Between 1975 and 1985, 43 patients underwent simultaneous aortic and renal artery reconstruction. Twenty-two patients had infrarenal abdominal aortic aneurysms and 21 had aortoiliac occlusive disease. In addition, 40 patients had severe lesions of one or both renal arteries and three patients had a lesion in an accessory renal artery. Hypertension was present in 29 patients, 15 of whom had impaired renal function. Four patients had chronic renal insufficiency without hypertension. Ten patients underwent prophylactic renal artery reconstruction. Infrarenal aortic repair was carried out simultaneously with thromboendarterectomy of one or both renal arteries, or reimplantation of a renal artery into the aorta, in two cases with contralateral nephrectomy. In one patient, the celiac and superior mesenteric arteries were also bypassed. Three patients (7%) died in the immediate postoperative period, two of these from myocardial infarction. Long-term survival was studied in 37 patients. Sixty-seven percent of patients with preoperative hypertension and less than 50% of those with preoperative renal insufficiency had good results.

Aorta, Abdominal↗
PubMed1984

[Coronarography by percutaneous puncture of the axillary artery. Value in arteriopathies of the lower limbs].

Coronary angiography by a percutaneous femoral approach using the Judkins-Bourassa technique with special preformed catheters is widely used. This approach is potentially dangerous or impossible in patients with severe lower limb arteriosclerosis even after operation and so the investigation has to be done by Sones' technique (denudation of the humeral artery). There is, however, another upper limb approach which does not involve arterial denudation: percutaneous right or left axillary artery catheterisation. This paper reports the experience of a multicentre study of this method in 105 patients. This study is of interest as an arterial catheter introducer was used which, does not compress the artery, prevents bleeding when the catheter has to be changed and reduced the risk of thromboses or laceration of the axillary artery. 73 of the 105 patients had lower limb arteriosclerosis 5 had aortic aneurysms and 1 patient had a previous history of femoral artery embolism. There was a primary indication for this approach in 21 cases. The left axillary artery was used in 83 cases (79%) and the right axillary artery in 22 cases (21%). The coronary catheters were those usually used with the femoral approach. The left side was chosen preferentially as it avoided the brachiocephalic trunk and facilitated the catheterisation of the coronary ostia and of aorto-coronary bypass grafts. Selective catheterisation of the left coronary artery was achieved in 21 out of 22 cases (95%) and of the right coronary artery in all 22 cases (100%) by the right axillary route. Both left and right coronary arteries were selectively catheterised in all cases by the left axillary approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Plea for the terminal anastomosis of aortic prostheses. Theoretical and practical impact].

End-to-end anastomosis of an aortic prosthesis was used during reconstructive surgery in 100 patients. The advantages of this method are analyzed and compared with those of end-to-side implantation, the former procedure providing improved hemodynamic and long-term results: absence of anastomotic dilatation, regularity of aortic blood flow distribution, lack of competitive or superfluous flow, a guaranteed pelvic circulation and simplicity of later repeat surgery following thrombosis. Tactical indications for this method of anastomosis are defined and depend mainly upon the type of lesions at the iliac bifurcation. The greater complexity of this method would appear to be acceptable in view of the possible improved long-term permeability when compared with the conventional procedure.

Aorta↗