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Biomedical subjects

A Branchereau

Publications and source records attributed to A Branchereau.

At least 55 records · Page 3Linked to original sources
PubMed1994

Surgical reconstruction of the superior vena cava.

Ten patients (eight men, two women) who underwent surgical reconstruction of the superior vena cava using an expanded polytretrafluoroethylene (ePTFE) prosthesis between 1981 and 1991 were reviewed to assess the therapeutic value of such surgery. The mean (s.d.) age was 55(12) years. Obstruction of the superior vena cava was caused by pulmonary or mediastinal cancer in nine patients and chronic mediastinitis in one. Eight patients had superior vena cava syndrome and two had symptoms of lung disease. The diagnosis of superior vena cava obstruction was made before surgery by computed tomography or superior venacavography in eight patients and during the surgical procedure in two. Tumour resection was performed in five patients. Venous reconstruction was achieved by interposition of an ePTFE graft between the proximal and distal end of the vena cava in three patients and between one (four cases) or two (three cases) tributaries of the superior vena cava and the right atrium in seven. No patient died during the perioperative period. Symptoms of superior vena cava obstruction disappeared promptly after operation in all patients. Postoperative patency was assessed by cavography or computed tomography; all the grafts were patent. During follow-up no patients presented with recurrent superior vena cava syndrome. Eight patients died. The cumulative survival rates were 70, 25 and 12.5% at 1, 2 and 5 years, respectively. Surgical reconstruction of the superior vena cava with an ePTFE prosthesis provided immediate and long-term relief of symptoms of superior vena cava obstruction with a low surgical morbidity, even in patients with unresectable malignancy.

Adult↗
PubMed1994

[Intra-arterial thrombolysis using rt-PA for the treatment of occluded infra-inguinal bypasses].

From July 1990 to July 1993, we performed 41 percutaneous intra-arterial thrombolysis procedures for the treatment of obstructed infra-inguinal bypass grafts in 32 patients. There were 27 men and five women with a mean age of 63 +/- 17 years (range 21 to 83 years). The symptoms of occlusion were intermittent claudication in three cases, rest pain in 12 cases, severe ischemia without sensitive-motor loss in 26 cases. Bypasses were achieved using a prosthesis in 18 cases (43.9%), a saphenous vein in 10 cases (24.4%), an arterial allograft in nine cases (21.9%), and a composite prosthesis-vein graft in four cases (9.8%) (table I). The distal anastomosis of the bypass graft was located on the popliteal artery in 26 cases (63.4%) and a crural artery in 15 cases (36.6%). The mean duration of the occlusion was 4.9 +/- 3.4 days (range 1 to 15 days). The percutaneous approach was through the contralateral common femoral artery in 26 cases (63.4%), through the ipsilateral common femoral artery in seven cases (17.1%), through the left humeral artery in eight cases (19.5%). In all cases the thrombolytic agent was the recombinant tissue-type plasminogen activator (rt-PA). Each procedure began with the injection of a five milligram bolus of rt-PA into or onto the thrombus followed by infusion of rt-PA into the thrombus at a dose of 0.05 mg/kg/h. Intravenous heparin was simultaneously administered. Serum fibrinogen, prothrombin time, and partial thromboplastin time (PTT) were measured every three hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Simultaneous one- or two-stage restoration of the vertebral and carotid arteries].

Surgery of the vertebral artery is controversial. Few teams performed this procedure routinely. The usefulness of the vertebral artery surgery is even more questionable when carotid artery lesions are associated. In such cases many surgeons claim that carotid artery surgery alone can relieve symptoms of vertebrobasilar insufficiency. In deciding whether or not to perform vertebral artery surgery three questions are essential. First, is a restauration of one or both vertebral artery necessary in this situation? Second, will combined surgery increase the risk of mortality and morbidity? Third what technique should be used and in what order?

Carotid Arteries↗
PubMed1993

Internal carotid artery surgery: ten-year results.

The twofold purpose of this study was to compare the immediate results of surgery for lesions of the internal carotid artery in two series of patients operated on at 10-year intervals and to assess long-term results in the earliest series. Series I comprised 242 reconstructions in 220 patients (160 men and 60 women, mean age 64.4 years) performed between 1980 and 1982. Seventy patients (35%) were asymptomatic, 113 had monocular or hemispheric symptoms, and 30 had nonhemispheric symptoms. Contrast arteriograms revealed internal carotid artery stenosis of < 30% in 74 cases (30.6%), between 30% and 70% in 49 (20.2%), and > 70% in 119 (49.2%). Reconstruction was achieved by endarterectomy in 164 cases (67.8%), by vein graft in 75 cases (31%), and by other methods in 3 cases (1.2%). Postoperative mortality was 5% (11/110). Nonfatal postoperative stroke occurred in 1.8% (4/220) and transient ischemic attack in 0.5% (1 patient). All reconstructions were patent on postoperative control. The combined mortality/morbidity rate in patients in series II operated on between 1990 and 1991 was significantly lower, that is, 2.4% (4/170) vs. 6.8% (15/220) (p < 0.05). In series I, 11 patients (5%) were lost to follow-up and 124 were still alive at the beginning of the tenth postoperative year. Cumulative survival was 79 +/- 5.6% at 5 years and 60.9 +/- 6.7% at 10 years. The causes of late death were stroke in 7 cases, cardiovascular disease in 30 cases, cancer in 16 cases, and other causes in 20 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Dacron patch/tube graft: a preliminary study.

A Dacron patch/tube graft was developed specifically to avoid technical complications associated with lateral aortic anastomoses of medium-diameter grafts. This new prosthetic device has now been used in 15 patients without complications. It seems to be particularly useful in patients with thick-walled aortas.

Adult↗
PubMed1993

Hemodynamic vertebrobasilar insufficiency caused by multiple arterial lesions: results of surgical treatment.

From 1982 to 1990, 111 of 1013 patients undergoing cerebral artery reconstruction presented with signs of vertebrobasilar insufficiency associated with hemodynamically significant lesions of at least three cerebral arteries. There were 71 men and 40 women whose mean age was 70.3 +/- 8.4 years. Forty patients also had hemispheric symptoms, whereas three had ophthalmic symptoms as well. A total of 191 arteries were reconstructed in 139 procedures. During the first 30 postoperative days there were nine deaths (8.1%) attributable to four neurologic events--one myocardial infarction, two hemorrhages, and one acute kidney failure. There were 18 complications including seven neurologic events (four reversible and three irreversible), one myocardial infarction, and 10 reversible local complications. Mortality and morbidity were not affected if one (87 cases) or several (52 cases) cerebral arteries were reconstructed. Of 179 arteries for which follow-up arteriograms were obtained, two (1%) were found to be occluded. Mean follow-up was 41.2 +/- 27.7 months. Four patients were lost to follow-up, and 28 died: five of cerebrovascular causes in the 21 who died of cardiovascular causes and seven secondary to noncardiovascular events. Actuarial 5-year survival and patency rates were 63.3 +/- 10.9% and 97.3 +/- 2.8%, respectively. Functional results were evaluated in 98 patients. At the last follow-up visit 73 were asymptomatic, 13 were improved (80% good results), 5 were unchanged, and 7 were worse. Mortality and morbidity rates were superior to that for isolated carotid or vertebral artery surgery performed during the same period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Simultaneous reconstruction of infrarenal abdominal aorta and renal arteries.

From 1980 to 1990, 48 (4.7%) of 1,002 patients underwent elective aortic reconstruction and simultaneous renal artery reconstruction. Forty-five men and three women (mean age: 66.5 years) had 59 renal artery lesions (51 stenoses, six occlusions, one dysplasia, and one aneurysm) associated with 20 infrarenal aortic aneurysms and 28 aortoiliac occlusive lesions. One nephrectomy and 58 renal artery reconstructions were performed (35 prosthetic bypasses, 11 vein bypasses, six direct reimplantations, five transaortic endarterectomies, and one resection of an intrahilar aneurysm followed by autotransplantation). Operation was always indicated for the aortic lesions. Indication for renal artery repair was hypertension in 33 cases (17 associated with renal insufficiency) and one with isolated renal insufficiency. In the remaining 14 cases, surgery was deemed preventive. One patient died (2%). There were 12 nonfatal complications two of which were kidney failures requiring chronic extrarenal epuration. Routine follow-up arteriograms showed four postoperative renal artery occlusions. Mean follow-up was 35.8 months. Four patients were lost to follow-up; 10 died secondarily. Five year survival was 72.1 +/- 19.1%. Secondary patency of renal artery reconstruction was 89.5 +/- 9.4% at five years. Late results were favorable in 45% of patients with hypertension and in 39% of patients with renal insufficiency. Mortality in simultaneous aortic and renal artery reconstruction is not superior to that of isolated infrarenal aortic surgery.

Actuarial Analysis↗
PubMed1992

Use of descending thoracic aorta for lower limb revascularisation.

From November 1984 to May 1991, descending thoracic aorta to femoral artery bypass was used to revascularise 51 lower limbs in 27 patients. There were 25 men and 2 women with a mean age of 60.2 years. There were four primary indications because of inability to use the abdominal aorta, and 23 secondary indications for late failure of a previous lower limb revascularisation: two aorto-prosthetic false aneurysms, nine infected aorto-bifemoral bypasses and 12 occluded grafts. Three deaths and one paraplegia occurred during the postoperative period, and three prosthetic occlusions and one popliteal embolism were successfully treated. During follow up (6-72 months) five deaths and three graft occlusions were observed; at 5 years, the cumulative life expectancy was 61.8 +/- 26.8%, and the cumulative secondary graft patency was 72.6 +/- 24.7%. One prosthetic infection and one ureteric fistula occurred and both were successfully treated. Thoracic aorta to femoral artery bypass is a simple extra-anatomic technique which can be used in cases of failure of a previous aorta to lower limb reconstruction. The haemodynamic results are good, and late results are better than axillo-femoral or bifemoral bypass.

Aorta, Thoracic↗
PubMed1991

Descending thoracic aorta as an inflow source for late occlusive failures following aortoiliac reconstruction.

From November 1984 to March 1990, 10 descending thoracic aorta-to-femoral artery bypass procedures were performed after failure of one or several aortoiliofemoral reconstructions. All patients were men, mean age 60 years. Indications included noninfected false aneurysm of an infrarenal end-to-side aortoprosthetic anastomosis in one case; one occlusion of an axillofemoral bypass; degradation of an aortobifemoral prosthetic graft; two occlusions of aortofemoral bypass; and five occlusions of aortobiliac or aortobifemoral bypasses. Eight bifurcated grafts, one aortoprosthetic tube graft, and one aortopopliteal tube graft were inserted. One patient died 23 days postoperatively of multiple organ failure. Three patients underwent a successful seconary lower limb reconstruction procedure (prosthetic limb thrombectomy, embolectomy, femoral bifurcation angioplasty in one case each). Mean survival time was 14 months (range 3-48 months). Two patients were lost to follow-up, and one died of myocardial infarction six months postoperatively with a patent bypass. Graft thrombosis occurred in two patients. One was treated by thrombectomy at five months, the other was treated by in-situ thrombolysis at 15 months. Both of these patients had patent grafts at 12 and 21 months, respectively. The four other patients had patent grafts at 48 months. Primary patency was 55.5% (5/9 survivors) and secondary patency was 100% (9/9). This is a relatively simple method for constructing an extraanatomic aortofemoral or aortobifemoral bypass in late failures of aortoiliofemoral reconstructive surgery without having to re-enter the abdomen.

Aged↗
PubMed1991

[Aneurysm of the abdominal aorta and preoperative disseminated intravascular coagulation].

A case of abdominal aortic aneurysm associated with preoperative signs of disseminated intravascular coagulation is reported. The 69-year-old female patient presented with spontaneously appearing petechiae and bruising. She had 0.95 g.l-1 fibrinogen, 105 G.l-1 platelets, and 100 micrograms.ml-1 fibrin and fibrinogen degradation products. Investigations revealed an 80 mm diameter aneurysm of the abdominal aorta, extending from the coeliac trunk to the iliac arteries. Heparin 7,000 IU.day-1 resulted in a biological improvement for a week only. At that time, levels of coagulation factors were: 92% factor II, 88% factor V, 100% factors VII and X, 100% antithrombin III. Surgical cure of the aneurysm was nevertheless carried out. Twenty standard units of platelets, 8 g fibrinogen, four units of fresh frozen plasma, five homologous and two autologous red cell units were transfused during the procedure. No coagulation factors were necessary during the postoperative course, which was uneventful. The management of coagulation factor infusions, before or after aortic cross-clamping, is discussed.

Aged↗
PubMed1991

Etiology of prosthetic anastomotic false aneurysms: pathologic and structural evaluation in 26 cases.

To determine the etiology of anastomotic false aneurysms (AFAs), 26 textile graft specimens, removed because of AFA, were studied morphologically, histologically and by scanning electron microscopy. No cases of suture-related failures leading to AFA were found. Nine cases of frayed grafts were documented but were not the cause of AFA formation. In three cases, chemical degradation of the fibres, which may have been secondary to lipid infiltration, may have contributed to AFA formation. There were no cases of overt clinical infection, but the presence of bacteria was documented by scanning electron microscopy in 20 cases. The role of bacteria is not well defined, but they may be a factor in host arterial-wall degeneration as a cause for AFA formation.

Adult↗
PubMed1990

The albumin-coated knitted Dacron aortic prosthesis: a clinical study.

Between June 1987 and January 1989, a total of 123 albumin-coated, knitted Dacron aortic prosthetic grafts were used in 120 patients. The aim of this study was to determine the degree of graft impermeability to blood as well as short- and medium-term patency of the graft material. Patients were grouped as follows: group I (64 patients), operation for chronic aortoiliac obliteration; group II (45 patients), operation for abdominal aortic aneurysm; group III (14 patients), operation on the thoracic aorta. Ninety-one bifurcated and 32 albumin-coated grafts were inserted. Abnormal bleeding was seen in five cases but did not lead to any adverse clinical consequences and stopped spontaneously. In group I there were two instances of early thromboses thought to be due to hemodynamic compromise, which were successfully treated surgically. In group III, two patients had early thrombosis due to coagulation disorders. These were treated by thrombectomy and medical therapy. One hundred and fourteen patients (95%) were followed for a mean of 8.2 months (range 1-18 months). Three late complications related to the prosthesis were observed: one patient had a false aneurysm occurring at month 14 and was corrected surgically. Two other patients experienced thrombosis of their graft treated by extraanatomical bypasses. Primary patency at the end of the follow-up period was 93% while secondary patency was 98%. There were no early or late infectious complications. We conclude that albumin-coated Dacron prosthesis is a reliable material for aortic replacement. Intraoperative loss of blood is reduced and short- and medium-term patency is comparable to those of uncoated aortic prosthetic material.

Adult↗
PubMed1990

Combined mortality and morbidity of direct surgical treatment of abdominal aortic aneurysm.

Two hundred aneurysms of the abdominal aorta were treated surgically from 1980 to 1987 by the same surgeon. There were 187 men and 13 women whose mean age was 66.1 years. Nine patients were 80-years-old or more. Eighty-seven percent of patients had preoperative risk factors, 30% of which were coronary artery disease. The operative approach was through a transverse laparotomy in 188 patients compared to 11 midline incisions and one lumbotomy. An aortoaortic tube was inserted in 87 patients, a bifurcated prosthesis in 99, and a tube bypass in 14. Five patients (2.5%) died within the 30 day perioperative period. Death was due to colonic necrosis, right heart chamber thrombosis, renal failure after repeat operation for acute lower limb ischemia, and myocardial infarction associated with renal and respiratory failure. The morbidity rate was 15.7% (31 patients) and included seven neurologic accidents, four respiratory complications, five ischemic events of the lower limbs requiring reoperation and one amputation, four cardiac complications, two renal failures, one reversible colonic ischemia, one revision for incomplete hemostasis, one phlebitis, one sliding syndrome, and five minor infections or cutaneous complications. Mean duration of hospital stay was 10.9 days. These results confirm that direct operation on aortic aneurysms can be performed in patients from all age groups and even with associated diseases. A rapid, simple technique based on a transverse approach, minimal dissection and insertion of aortoaortic tubes, whenever feasible, appears to reduce combined mortality-morbidity.

Age Factors↗
PubMed1990

[Digitalized angiography in the study of critical ischemia of the lower limbs].

Twenty three patients suffering from severe chronic ischemia of the lower limbs were explored by conventional and digital angiography. A comparative study of these 2 angiographic techniques was carried out to appreciate the pre-operative distal vascular tree and the surgical indications. In all cases, digital angiography was never found to be less informative than conventional angiography. In 14 cases, the surgical approach was changed as a result of digital angiography in 4 cases the method of revascularization and in 10 cases the surgical indication itself (distal bypass instead of amputation). The authors consider digital angiography to be essential in this surgical indication.

Adult↗
PubMed1989

Extended medial approach to the popliteal artery without muscular division.

This technique allows wide access to the entire popliteal artery by detaching the tendons of the pes anserinus and semimembranosus muscles, without any muscular division. The tendons are reinserted anatomically upon completion of the vascular procedure. This technique was used in 14 patients, without complication. This technique is of particular value when it is necessary to inspect the popliteal artery to determine the etiology of the occlusion in the young subject. It is invaluable when direct access to the midpopliteal artery is required.

Humans↗