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ABSTRACT: To analyse perioperative and midterm outcomes of carotid artery stenting (CAS) for symptomatic >50% and asymptomatic >70% restenosis after open carotid surgery (OCS).
A multicentric retrospective study.
Outcome measures 30-day death, neurologic and anatomic (thrombosis, restenosis) events. Univariant and multivariant logistic regression analyses were performed to identify predictive factors for neurologic and anatomic events.
A total of 249 patients with a mean age of 69 years (range, 45-88) were treated for asymptomatic (86%) or symptomatic (14%) restenosis. The 30-day combined operative mortality and stroke morbidity was 2.8% in asymptomatic patients and 2.9% in symptomatic patients. Events during follow-up (mean duration, 29 months) included stroke in four cases, TIA in two, stent thrombosis in four and restenosis in 21. Kaplan-Meier estimates of overall survival, neurologic-event-free survival, anatomic-event-free survival and reintervention-free survival were 95.4%, 94.7%, 96.7% and 99.5%, respectively, at 1 year and 80.3%, 93.8%, 85.1% and 96%, respectively, at 4 years. Multivariant analysis showed that statin use was correlated with a lower risk of anatomic events (odds ratio (OR) = 0.15 (95% confidence interval (CI) 0.03-0.68), p = 0.01) and that bypass was associated with a higher risk of anatomic events than endarterectomy (OR = 5.0 (95% CI 1.6-16.6), p = 0.009).
CAS is a feasible therapeutic alternative to OCS for carotid restenosis with acceptable risks in the perioperative period. Restenosis rate may be higher in patients treated after bypass.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 08/2011; 42(6):742-50. · 2.92 Impact Factor
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ABSTRACT: This study aims to describe the endovascular management of abdominal-aortic- or common-iliac-artery injuries after lumbar-spine surgery.
Patients treated for abdominal-aortic- or common-iliac-artery injuries after lumbar-spine surgery during a 13-year period were identified from an endovascular database, providing prospective information on techniques and outcome. The corresponding patient records and radiographic reports were analysed retrospectively.
Seven patients were treated with acute (n = 3) or subacute (n = 4) injuries of the common iliac artery (n = 6) or abdominal aorta (n = 1) after lumbar-spine surgery. Vascular injuries included arterial lacerations (n = 3), arteriovenous fistulas (n = 2) and pseudo-aneurysms (n = 2). The mean age of the patients was 51.7 years (30-60 years), 71.4% were women. These lesions were repaired by transluminal placement of stent grafts: Passager (n = 3), Viabahn (n = 1), Wallgraft (n = 1), Zénith (n = 1) and Advanta V12 (n = 1). Exclusion of the injury was achieved in all cases. Mortality was nil. There were no procedure-related complications. During a median follow-up of 8.7 years (range 0.3-13 years), all stent grafts remained patent.
Sealing of common iliac artery or abdominal aortic lesions as a complication of lumbar-disc surgery with a stent graft is effective and is suggested as an excellent alternative to open surgery for iatrogenic great-vessel injuries, particularly in critical conditions.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 05/2011; 42(2):167-71. · 2.92 Impact Factor
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ABSTRACT: Endovascular aneurysm repair (EVAR) has been suggested as a technique to improve outcome of ruptured abdominal aortic aneurysm (AAA). Whether this technique becomes an established treatment will depend, in part, on the anatomy of ruptured AAA.
The anatomy of intact and ruptured AAA seen in a university department of vascular surgery over 5 years was reviewed. Aneurysm anatomy was assessed with spiral computed tomographic angiography. Suitability for EVAR was assessed from the dimensions of the proximal neck and common iliac arteries. Neck length less than 15 mm, neck width greater than 30 mm, and common iliac artery diameter greater than 22 mm were declared unsuitable for EVAR.
Three hundred sixty-three patients with intact AAA and 46 with ruptured AAA were identified. Larger intact aneurysms were significantly associated with longer renal artery-bifurcation distance and more complex proximal neck architecture. In this sample, patients with ruptured AAA were more likely to have larger aneurysms with shorter and narrower proximal necks. Significantly more intact aneurysms were morphologically suitable for endovascular repair compared with ruptured AAA (78% vs 43%; P <.001).
Ruptured AAA are less likely to be suitable for endovascular repair than are intact AAA, most probably because of larger diameter at presentation. Open repair will likely remain the treatment of choice in most patients with ruptured AAA, because of current morphologic constraints of endovascular repair.
Journal of Vascular Surgery 08/2003; 38(1):88-92. · 3.21 Impact Factor
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ABSTRACT: cross-clamping of the infrarenal aorta is associated with complex haemodynamic disturbances. Several experimental models of aortic cross-clamping (AXC) have been described with heterogeneous results. The main purpose of this study was to establish an animal model in which infrarenal AXC could reproduce similar systemic and renal haemodynamic changes to those observed in humans.
eleven anaesthetised pigs underwent AXC just below the renal arteries. Renal blood flow was measured using clearance of (131)I hippuran. Systemic and renal parameters were collected at 3 consecutive 30-min periods.
AXC did not alter the extraction fraction of (131)I hippuran but was accompanied by significant (13%) decrease in cardiac index (p = 0.005) and a 23% increase in mean arterial pressure (p = 0.005). AXC induced significant 135% increase in renal vascular resistance (p = 0.012) and a 35% decrease in renal blood flow (p = 0.016). This worsened after removal of the aortic clamp, whereas systemic variables returned to baseline levels.
this AXC animal model reproduces the changes observed in humans. It provides a reliable animal model which allows to investigate the underlying mechanisms of renal vasoconstriction and the effect of new drugs.
European Journal of Vascular and Endovascular Surgery 02/2003; 25(1):72-8. · 2.99 Impact Factor
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ABSTRACT: Choice of exposure route for surgical excision of superior sulcus lung tumors depends on involvement at the thoracic inlet. From December 1985 to September 1999, we performed surgical treatment of superior sulcus tumors in 42 patients, including 22 with vascular involvement. Various exposure techniques were used, including a novel technique combining transverse supraclavicular cervicotomy and posterolateral thoracotomy in 11 cases, anterior transclavicular cervicothoracotomy in 7 cases, isolated posterolateral thoracotomy in 3 cases, and cervicosternotomy in 1 case. Vascular procedures consisted of subadventitial dissection of the subclavian artery in 5 patients, arterial resection-anastomosis in 7, and prosthetic bypass in 10. Postoperative mortality was 11.9% in the overall series of 42 patients (n = 5) and 9% (n = 2) in the subgroup of patients with vascular involvement. During follow-up, 13 patients died of tumor recurrence and 1 patient died of respiratory insufficiency. Actuarial 5-year survival was 22.7 +/- 17.5% overall and 18 +/- 17.9% in the subgroup of patients with vascular involvement. This study indicates that the combined exposure route with transverse supraclavicular cervicotomy and posterolateral thoracotomy was useful for treatment of superior sulcus lung tumors requiring lobectomy and pneumonectomy.
Annals of Vascular Surgery 04/2001; 15(2):206-11. · 1.03 Impact Factor
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American Journal of Roentgenology 01/1998; 169(6):1743-5. · 2.78 Impact Factor
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ABSTRACT: The principles of treatment of mycotic aortic aneurysms are not well established and the optimal method of revascularization--extra-anatomic bypass or in situ grafting--is still debated. Infection of the juxtarenal or suprarenal aorta poses an additional challenge in management because of the requirement for visceral revascularization. The case of a 73-year-old man is reported who developed several mycotic aneurysms of the juxtarenal, infrarenal aorta and right main iliac artery following a Candida infection. He was successfully treated with suprarenal aortic ligation, aneurysmal excision, splenorenal bilateral bypass and systemic antifungal therapy. The patient subsequently underwent extra-anatomic revascularization of the lower extremities with a left axillobifermoral bypass involving a polytetrafluoroethylene graft.
Cardiovascular Surgery 07/1996; 4(3):331-4.
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ABSTRACT: We describe the case of a 34-year-old man with blunt abdominal trauma. Initial abdominal computed tomography scan showed retroperitoneal hematoma, pancreatic contusion, multiple fractures of the transverse process in the thoraco-lumbar spine, and infrarenal aortic dissection.
Angiography revealed that the aortic dissection originated proximal to the inferior mesenteric artery and extended down to the left common iliac artery without vascular obliteration. The pancreatic trauma was managed without operation, and the dissection was treated with aortic and left iliac endovascular self-expanding Schneider Wall Stents.
Immediate angiographic and computed tomography scan examination showed the obliteration of the greater part of the dissection with persistence of a short dissected segment at the level of the aortic bifurcation. Examination a week later showed thrombosis of this false lumen and complete obliteration of the dissection.
Intravascular stenting allowed treatment of the dissection without open surgical procedures requiring laparotomy and aortic operation.
Journal of Vascular Surgery 02/1996; 23(1):156-61. · 3.21 Impact Factor
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ABSTRACT: This study was designed to determine the influence of changes in intraoperative management on the outcome of ruptured abdominal aortic aneurysm (RAAA).
Retrospective review of our surgical experience of RAAA identified 61 patients and was separated into two periods: 1986 to 1988 (group 1 [n = 21 patients]) and 1989 to 1994 (group 2 [n = 40 patients]). Since 1989 operations have been conducted by two vascular surgeons without systemic administration of heparin and with control of suprarenal aorta if extensive hematoma is present, use of collagen-impregnated grafts, preferential repair with aortoaortic grafting, and routine use of intraoperative autotransfusion.
Factors differing between the groups were use of intraoperative autotransfusion (4.76% in group 1 vs 80% in group 2, p < 0.00001), repair with tube grafting (42.8% in group 1 vs 80% in group 2, p = 0.003), number of packed homologous red blood cells (7.5 +/- 5.2 units in group 1 vs 3.1 +/- 3.6 units in group 2, p = 0.008), postoperative blood loss (365 +/- 705 ml in group 1 vs 133 +/- 351 ml in group 2, p = 0.01). The intraoperative mortality rate was significantly lower in group 2 (5% vs 28.6%, p = 0.016). The only predictive factor was the use of intraoperative autotransfusion with a lower mortality rate in patients undergoing autotransfusion (p = 0.029). The postoperative mortality rate was significantly lower in group 2 (20% vs 52.4%, p = 0.009). Predictive factors were use of intraoperative autotransfusion (p = 0.0009), age of the patients (p = 0.0039), and repair with tube graft (p = 0.039). The odds ratio of postoperative death was 25 times higher without intraoperative autotransfusion and seven times lower when a tube graft was used.
Continuing efforts to achieve improvement in surgical technique and use of intraoperative autotransfusion were important determinants in lowering the postoperative mortality rate of RAAA to 20%.
Journal of Vascular Surgery 12/1995; 22(6):780-6. · 3.21 Impact Factor
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La Presse Médicale 06/1995; 24(19):915. · 0.67 Impact Factor
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ABSTRACT: Descending necrotizing mediastinitis can occur as a complication of oropharyngeal and cervical infections that spread to the mediastinum via the cervical spaces. Delayed diagnosis and inadequate mediastinal drainage through a cervical or minor thoracic approach are the primary causes of a high published mortality rate (near 40%). Between 1985 and 1992, six men (mean age, 49 years) with descending necrotizing mediastinitis were surgically treated at our institution. The primary oropharyngeal infection was peritonsillar abscess (three cases) and odontogenic abscess (three cases). In all cases, occurrence of respiratory insufficiency associated with serious cervical infection suggested the mediastinitis diagnosis. Computed tomographic scans confirmed the mediastinitis, showing mediastinal abscess and mediastinal emphysema. All patients underwent surgical drainage of the deep neck infection combined with mediastinal drainage through a thoracic approach. The outcome was favorable in five patients who had mediastinal drainage through a thoracotomy; the patient who had mediastinal drainage through a minor thoracic approach (anterior mediastinotomy) died of tracheal fistula on postoperative day 18. In our experience, aggressive mediastinal drainage by a thoracotomy approach regardless of the level of mediastinal involvement led to improvement in survival of these patients, with a 17% mortality rate.
Journal of Thoracic and Cardiovascular Surgery 02/1994; 107(1):55-61. · 3.41 Impact Factor
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ABSTRACT: Endovascular treatment of descending thoracic aortic pathologies requires a preoperatively determined interventional strategy. Its feasibility depends mainly on anatomic factors: the morphology of the proximal and distal fixation sites, the diameter and disease state of the access vessels. These factors represent important predictors of success and the most important exclusion criteria. Current diagnostic evaluation of aortic aneurysm for endovascular repair relies primarily on CT scan associated with 3D-reconstruction to assess the anatomical suitability for endograft implantation. In patients with an inadequate length of the proximal or distal neck, the left subclavian artery or the coeliac trunk can be overstented to effectively exclude thoracic aortic lesions. Deliberate coverage of aortic side branches should be decided prior to the procedure (guided by a extensive anatomical assessment) or carefully be avoided in order to reduce major morbidity, especially cerebral embolization, spinal cord ischemia and ischemic abdominal complications.
Acta chirurgica Belgica 109(4):458-64. · 0.43 Impact Factor
