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Biomedical subjects

A Branchereau

Publications and source records attributed to A Branchereau.

98 records · Page 6Linked to original sources
PubMedDate not supplied

Subclavian artery stenosis: hemodynamic aspects and surgical outcome.

Ninety seven patients (mean age: 58 years) with lesions involving the subclavian artery were studied to determine the relationship between clinical symptoms, angiographic lesions and Doppler-detected hemodynamic disorders. Ninety patients had vertebro-basilar insufficiency (VBI) and 7 had hemispheric manifestations or upper limb ischemia. Of the 105 lesions of the subclavian artery, we observed 76 stenoses greater than 50% and 29 complete occlusions. Thirty seven patients presented a unilateral subclavian lesion and 63 multiple lesions. Doppler examination of the vertebral artery including an upper limb hyperaemic test allowed classification of the patients into three stages: stage 1 "pre-subclavian steal" (35 patients): sudden decrease in the systolic vertebral flow with complete interruption during hyperaemia; stage 2 "intermittent subclavian steal" (18 patients): transient inversion of vertebral during systole with permanent inversion for 1 or 2 minutes after hyperaemia; stage 3 "permanent subclavian steal" (33 patients): complete inversion of the vertebral flow without diastolic flow and increase of flow during hyperaemia. The clinical, hemodynamic and angiographic findings were compared. In stage 1, 65.7% of the patients presented severe VBI (at least two signs) and 66% had a 50 to 70% stenosis of the subclavian artery. In stage 2, 66.6% of the patients presented severe VBI and 78% had a 75 to 95% stenosis. In stage 3, 72.7% of the patients had severe VBI and 73% had either subtotal or complete occlusion of the subclavian artery. There was no correlation between the severity of VBI and the hemodynamic stages but a strong correlation between the hemodynamic grades and the anatomical lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Arm↗
PubMedDate not supplied

Results of vertebral artery reconstruction.

We summarize here the immediate and long term results of 191 vertebral artery reconstructions. Patient selection criteria included vertebrobasilar insufficiency, appropriate angiographic work up, lack of contraindications, and the availability of a suitable technique. Of the 179 patients who underwent these operations, 170 presented with vertebrobasilar insufficiency that in turn was associated with hemispheric manifestations in 29 cases. Five patients had hemispheric manifestations only, and four were asymptomatic. The operation involved the proximal segment of the vertebral artery in 148 instances and its distal segment in 43 instances. Of the eight deaths recorded in this series (4.2%), one occurred in a group of 118 patients who underwent isolated vertebral artery reconstruction and seven in a group of 72 patients who underwent combined vertebral and carotid surgery. This difference was statistically significant (p less than 0.01). The overall survival rate at seven years was 88.8%, and was higher in the group undergoing isolated vertebral repair. Patency at seven years was 90.4% with better results for proximal vertebral artery repair than for distal repair (94.3% versus 77.3%). With a mean follow-up of 34.6 +/- 19 months, 118 patients are asymptomatic, and 15 are improved, for a success rate of 80.1%. Patients with hemispheric manifestations and associated carotid lesions constitute a high risk population for this type of surgery.

Aged↗
PubMedDate not supplied

[Iatrogenic phlebitis of the upper limb and thoracic outlet syndrome].

Classically, the primary forms of phlebitis of the upper limb due to venous compression in the thoracic outlet have been radically contrasted with the secondary phlebitis, always iatrogenic, occurring after peripheral venipuncture. However, this distinction is perhaps not as clear as all that. In this paper, the authors report 3 cases of iatrogenic phlebitis of the upper limb. In all 3 cases, phlebography demonstrated venous compression at the thoracic outlet. Consequently, the development of phlebitis in the upper limb after a nervous puncture should always suggest the possibility of a thoracic outlet syndrome and is an indication for phlebography. Conversely, a corollary to the diagnosis of thoracic outlet syndrome should be the formal contraindication of intravenous infusion on the affected side. The treatment of these iatrogenic forms of phlebitis involves the use of anticoagulants followed by surgical resection of the 1st rib to decompress the collateral venous circulation.

Adolescent↗
PubMedDate not supplied

[Costo-clavicular syndromes (thoracic outlet syndrome) (author's transl)].

During a 5-year period, 156 patients were followed with symptoms representative of costo-clavicular compression. Surgical treatment has been rejected in 80 patients. One hundred and five (20 bilateral) resections of the first rib were performed according to the technique as described by Roos. The surgical indication depends mainly on the severity of symptoms, clinical signs and the presence of complications (45 major complications). In 88% of the cases, a satisfactory result was obtained at the expense of a small incision, a hospital stay averaging 7 days and a few reversible complications of no significance.

Angiography↗
PubMedDate not supplied

[Current status of carotid surgery].

Introduced in the fifties, reconstructive surgery of the carotid arteries has undergone an extensive development in Europe and the United States. Prospective randomized multicentric clinical trials have clearly demonstrated its effectiveness in stroke prevention for both symptomatic and asymptomatic patients with tight carotid stenosis. The diminution of relative risk secondary to surgery is at least 40%; it is 80% for major ipsilateral stroke. There is no benefit if the vessel narrowing is less than 30%. For the 30 to 70% stenosis a benefit has not yet been clearly established. The prophylactic effect of carotid surgery is highly dependent of a low postoperative morbidity. The 30 day stroke plus death rate should not exceed 3% for asymptomatic patients and 5% for symptomatic patients. Postoperative morbidity-mortality has greatly improved over the last twenty years. Several factors are involved; the main improvement may be related to better surgical technique assessed by intra-operative angiographic control rather than the many methods of monitoring or cerebral protection. Ten years patency of arterial reconstruction is greater than 90%. Stroke protection is effective since the annual rate of cerebral events in an operated population is about 2% while it is about 10% in a control population. Inversely, late mortality is still high, primarily due to cardiac disease.

Carotid Stenosis↗
PubMedDate not supplied

[Phlebitis of effort and venous edema of the upper limbs. Compressions of the subclavian vein].

The authors present a series of 18 cases (13 patients) of a venous syndrome of the arm. Three were cases of phlebitis due to effort and 15 were cases of intermittent or permanent oedema of the arms. Four of the patient also presented homo- or contralateral arterial disorders. Dynamics and multiposition phlebography gave evidence on 18 occasions of a branchial compression syndrome. Twelve patients were operated upon. On 16 occasions resection of the first rib was carried out by the axillary route (in 1 case this was combined with the ablation of one cervical rib). All the patients were cured without complications.

Adult↗