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C Laurian

Publications and source records attributed to C Laurian.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Atherosclerotic lesions of the subclavian artery. Indications for subclavian carotid transposition].

PURPOSE: To analyze the clinical and anatomical outcome after subclavian carotid transposition and to compare the results with other surgical procedures. METHODS: The hospital records of 51 patients undergoing subclavian carotid transposition were reviewed retrospectively for preoperative symptoms, Doppler and arteriography findings, preoperative details and postoperative complications. Long-term patency and symptoms were determined by physical and Doppler examination during the follow-up. RESULTS: The indications for subclavian transposition were: vertebrobasilar ischemia (24%), ischemia of the upper limb (45%), asymptomatic occlusion or non-specific symptoms (31%). Subclavian artery transposition was associated with vertebral revascularization (7 cases), and homolateral carotid surgery (11 cases). There were no deaths. Early occlusions occurred in two cases, one required reoperation. Minor complications were observed in 21% of the patients with no permanent morbidity. Overall patency after a mean 54 months follow-up was 96%. CONCLUSION: Subclavian carotid transposition is a good method for the treatment of proximal subclavian occlusive disease. Long-term patency can be achieved. Carotido-subclavian bypass should be limited to cases with extensive occlusive lesions as patency rate is lower.

Adult↗
PubMed1998

[Vascular "tumors" and the rules of their surgical management].

After defining vascular tumors and malformations, formerly called angiomas, the authors adopt the classification of the International Society for the Study of vascular Anomalies. The various groups of malformations, after definition of the subject and the problems raised, are illustrated by a number of clinical cases and the rules of surgical management are discussed. Capillary malformations, formerly called portwine stains, can be treated by dye laser, but sometimes tissue and orthognathic reconstructive surgery in the presence of a skeletal malformation. Lymphatic malformations (lymphangiomas), optimally assessed by CT or MRI, can be treated by a variety of approaches: sclerotherapy, surgery. Venous malformations raise very different problems in the cervicocephalic region and on the limbs and trunk, but always require a multidisciplinary approach with, according to the site, size and repercussions, Ethibloc percutaneous sclerotherapy, embolization, surgery. Arteriovenous malformations require complete surgical treatment, usually preceded by embolization; reconstruction consists of local flaps or skin expansion in simple cases, and revascularized free flaps in difficult cases. If the malformation is cosmetically and functionally acceptable, the authors propose conservative management. The first-line treatment of haemangiomas is pharmacological (corticosteroids, interferon), but surgery may be indicated in two situations: early and late. There is a renewed interest in early surgery, subtended by several factors including cosmetic concerns and the development of new technologies, including the Cavitron. Late surgery retains its classical cosmetic and functional indications. Two key-words dominate the rules of therapeutic management of all types of vascular malformations: a multidisciplinary approach and modesty.

Adolescent↗
PubMed1997

[Arterial lesions of the upper limbs in Horton disease. Surgical revascularization by bilateral carotid-humeral bypass].

BACKGROUND: While external carotid lesions predominate, giant cell arteritis (Horton's disease) involves the arteries of the upper limbs in 7.7 to 16% of the patients. CASE REPORT: We cared for one patient with clinically and biologically proven Horton's disease. The patient was given corticosteroid therapy, but although general health status improved and markers of the inflammatory reaction returned to normal levels, exertion-induced ischemia progressively worsened. Due to the length of the arterial lesions, we performed bilateral carotid-humeral bypass surgery. DISCUSSION: Clinical expression of Horton's disease is often quiescent even in cases with extensive anatomic lesions. When clinical signs do appear, they generally respond well to corticosteroid therapy. In certain cases, as reported here, improvement can only be obtained by surgical revascularization.

Arm↗
PubMed1997

Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Société Française de Cardiologie.

BACKGROUND: Atherosclerotic lesions of the aortic arch are potential sources of arterial embolism. Mobile thrombi in the aortic arch in young patients without diffuse atherosclerosis have been reported recently, but such cases remain exceptional. We describe a series of young patients with unexplained arterial embolism in whom transesophageal echocardiography detected mobile aortic arch thromboses. METHODS AND RESULTS: Transesophageal echocardiography files collected between 1991 and 1995 in French academic cardiology centers were reviewed to identify patients who fulfilled the following criteria: (1) an arterial embolic event in the preceding weeks; (2) a mobile pedunculated aortic arch thrombosis, defined as an echogenic mass protruding into the lumen of the aorta and inserted on the aortic arch; and (3) absence of obvious diffuse aortic atherosclerosis or of aortic debris on transesophageal echocardiography. Twenty-three cases were identified from 27 855 examinations. Thromboses were located on the horizontal aorta (n = 4), near the ostium of the left subclavian artery (n = 5), or on the concavity of the posterior segment of the aortic arch (in the isthmus) (n = 14). The insertion site was a small atherosclerotic plaque in 21 patients. The remaining aortic wall always appeared normal or mildly atherosclerotic. The mean age of the patients was 45 +/- 8.4 years (range, 26 to 61 years). All patients were treated with intravenous heparin after the diagnosis of aortic arch thrombosis, and surgical removal of the thrombosis was performed in 10 patients in whom histological examination confirmed an atherosclerotic process at the site of insertion of the thrombosis. The prognosis was mainly influenced by embolic events. CONCLUSIONS: Thromboses of the aortic arch appear to be a variant form of aortic atherosclerotic disease associated with arterial embolism in young patients.

Adult↗
PubMed1997

Extensive pure venous malformations in the upper or lower limb: a review of 27 cases.

BACKGROUND: Extensive pure venous malformations (VMs) involving the entire lower or upper limb and adjacent trunk form a particular group of rare vascular malformations. OBJECTIVE: Our purpose was to review 27 cases of extensive limb VMs and describe their characteristics and management. METHODS: Cases of extensive limb VMs were investigated, treated, and observed for a mean of 7 years. RESULTS: Eleven cases involved the upper limbs and 16 involved the lower limbs. All involved skin and muscle. In 81% of cases in the lower limb there was also knee joint involvement that created severe functional impairment. Ultrasonography with Doppler (duplex scans), computed tomographic scans, and magnetic resonance imaging were helpful noninvasive diagnostic procedures in these patients, whereas arteriography and phlebography were less informative. Muscle involvement was present in 100% of patients and bone abnormalities in 63%. Leg length was either normal or there was slight limb undergrowth, except in three patients who had minor overgrowth of the affected limb. Coagulation profiles demonstrated localized intravascular coagulation in 88% of patients. The majority of patients had conservative management (elastic stockings). In a few, percutaneous sclerotherapy or partial excision of skin and muscle VMs was beneficial. Knee joint involvement required synovectomy and VM excision during childhood in 7 of 16 patients. CONCLUSION: Extensive limb VMs are characterized by diffuse involvement of the skin, muscle, and joints, and by a specific localized intravascular coagulopathy with general consequences. This group of vascular malformations should be separated from the Klippel-Trenaunay and Parkes Weber syndromes.

Abnormalities, Multiple↗
PubMed1997

[Subadventitial cyst of the popliteal artery. Non-invasive explorations. Anatomo-pathologic data].

Subadventitial cyst of the popliteal artery is a well known entity. We report a new case and the diagnostic and therapeutic advantages of noninvasive explorations. Transcutaneous duplex-scan provided diagnosis and showed cystic formations in contact with a segmentary occlusion of the popliteal artery. Magnetic resonance imaging (MRI) evidenced communication between the cysts and the articular capsule of the knee joint. Surgical exeresis confirmed the communication with the synovial fluid. This observation demonstrated: i) the contribution of duplex-scan for the diagnosis of adventitial cysts and arterial consequences; ii) the contribution of MRI in identifying communication with the synovial fluid; iii) the presence of arterial wall lesions (necrosis of the media) would favor no conservative treatment.

Humans↗
PubMed1997

[Iatrogenic intra-arterial injection during sclerotherapy of the external saphenous vein].

Inadvertant intra-arterial injection is a rare complication of sclerotherapy of varicose veins. We report one case of accidental popliteal injection complicated by acute ischemiae of the posterior compartment of the leg who needed fasciotomy and Achillus tendum elongation. There is no practical "step-by-step" guide of these complications and the best treatment is the prevention by respect of contraindications and the injection of sclerosing agent under ultrasonographic control.

Adult↗
PubMed1996

[Surgical treatment of superficial vascular malformations. Indications for tissue expansion].

The aim of this work was to demonstrate the feasibility of surgical exeresis of superficial vascular malformations using tissue expansion. A retrospective analysis of data from 15 patients who underwent surgery over a 9 year period for arteriovenous (n = 6) and venous malformations of the trunk and limbs was made. Indications for treatment were pain in six patients or complications of an arteriovenous malformation. Twenty-eight expanders were used in 15 patients. Most of the complications observed (25% of the cases) were minor. The program had to be interrupted due to complications in only one case (7%). Mean duration of tissue expansion was 105 days (30-165). Mean delay to cicatrization was 40 days and mean duration of the treatment program was 156 days. Indication for surgical exeresis of superficial vascular malformations can be widened due the contribution of tissue expansion. With acquired experience, the risk of complications has been reduced. The duration of the treatment protocol is the main drawback.

Adolescent↗
PubMed1995

[Revascularization of distal arteriopathies: a new approach].

The diffuse nature of arterial occlusions in Buerger's disease compromises the effect of revascularization. Nevertheless, the muscle branches are quite often unaffected by the occlusive disease making revascularization of collateral arterial branches a promising alternative to conventional procedures. Revascularization by a short autologous venous graft from the grand anastomotic or gastrocnemius artery can be an alternative technique. Advances in microsurgery have made such revascularizations possible.

Arterial Occlusive Diseases↗
PubMed1994

[Rare forms of chronic venous insufficiency of the lower limbs].

Ultrasound examination, digital phlebography, and CT scan have facilitated the diagnosis of unusual forms of chronic venous insufficiency. Congenital anomalies of the deep venous system and vascular malformations are the most common forms. The lesions are more frequent in the deep venous system of the lower limbs than in the vena cava or the iliac veins. Agenesia and traumatic lesions of the inferior vena cava are rare. Occlusion of the iliac veins is often diagnosed during late childhood; they are secondary to the traumatic catheterization of the femoral vein. Valvular incompetence and vascular malformations are localized to the lower limbs. Surgery has some indications. Reconstructive techniques are used for the iliac vein or the inferior vena cava. In the lower limb, valvuloplasty of the femoral vein is proposed only after conservative therapy has failed.

Chronic Disease↗
PubMed1994

Vertebral arteriovenous fistulas: a study of 49 cases and review of the literature.

The experience is reported with 50 vertebral fistulas treated by the authors in a joint radiological and surgical team. Of the 28 fistulas that were traumatic, 18 occurred after incidental iatrogenic puncture, and 22 were spontaneous, of which four presented in patients displaying angiographic features of fibromuscular dysplasia. Eleven patients were operated on and 33 had endovascular treatment. In nine patients who were either symptom-free or in poor health, no treatment was advised. The fistula was occluded in 38 (93%) of the treated patients, and the vertebral artery patency was preserved in 32 (78%). A total of 224 published cases were reviewed: 152 were traumatic, most after a penetrating injury; 72 were spontaneous, with three age peaks (at 7, 26 and 52 years). Treatment has evolved considerably and endovascular occlusion is now the treatment of choice, surgery being reserved for specific indications.

Adolescent↗
PubMed1994

[Study and treatment of varicose veins. Truths and counter-truths].

Varicose veins are not the only symptomatology of chronic venous insufficiency of the lower limbs, which has other clinical manifestations: purely symptomatic problems, varicosities, edema and trophic skin lesions. The management of varicose veins is base upon thorough clinical examination. Doppler and ultrasonography are useful in cases of varicose veins in which radical treatment is envisaged. Ultrasound investigation is essential in the presence of cutaneous ulceration in order to avoid mistaking a trophic lesion due to incompetence of deep veins, most often of post-thrombotic origin, for a varicose ulcer. The treatment of varicose veins varies according to the precise nature of the preoccupations of the patient concerned. Elastic support is useful regardless of the clinical form of the disease. Vasculoprotective and venotonic drugs can be used when venous insufficiency is symptomatic. Radical treatment of varicose veins, whether by sclerosing injections or surgery, depends upon the anatomical nature of lesions, the degree of venous incompetence and the extent of signs, but also the wishes of the patient, properly informed of the advantages and limitations of each technique.

Edema↗
PubMed1993

[Arterial aneurysms in Behçet's disease. 4 cases].

Four cases of Behçet's disease with aortic and peripheral lower limb lesions illustrated the characteristics of the disease: multifocal lesions, false aneurysms suggesting infectious perforation and iterative false aneurysm in 1 case. The symptoms of Behçet's disease must be looked for stubbornly. In the presence of any arterial abnormality of this type, this cause must be seriously considered.

Adult↗
PubMed1993

Long-term follow-up of positive cultures in 500 abdominal aortic aneurysms.

Routine aneurysm culture is frequently performed as it is thought that a positive culture could be a risk factor for secondary graft infection. Five hundred aneurysms, in a series of 796 patients, had microbiologic examination of the thrombus and/or aneurysm wall. Cultures were positive in 185 cases (37%), mostly due to normal skin flora microorganisms (80%), whereas 16 patients (3.2%) had infectious aortitis. Gram-stained smears were positive in nine of these 16 patients compared with two of the other 169. Of the 185 patients with positive culture, after a mean length of follow-up of 35 months, only one had a graft infection that occurred 6 years later and was not due to the same microorganism. Graft sepsis was diagnosed in six of the 296 patients who did not have a positive culture, and was related to clinically obvious locoregional or systemic foci. In this series, positive cultures from aneurysm without rupture or signs of infection were not a risk factor for secondary graft sepsis. Therefore, in cases of asymptomatic unruptured aneurysm, routine culturing is not necessary as a positive result has no pathogenic significance or therapeutic implication.

Aged↗
PubMed1993

High levels of portal TNF-alpha during abdominal aortic surgery in man.

During shock or multiple organ dysfunction syndrome, translocation of bacteria and/or lipopolysaccharide (LPS) from the ischaemic gut might occur and could explain the excess of cytokine production detectable in plasma. To test this hypothesis, we studied a model of mild gut ischaemia due to bowel manipulation and aortic clamping in patients undergoing abdominal aortic surgery (n = 14). Per-operative levels of LPS and cytokines were measured before clamping and after reperfusion, and compared in systemic and portal blood. Systemic levels of LPS and cytokines were measured in a control group of patients undergoing internal carotid surgery (n = 7). Portal LPS was detectable (i.e., > 12 pg/ml) in 36% of the patients undergoing aortic surgery after bowel manipulation, and in 71% after clamp release. Similar levels of LPS were observed in portal and systemic blood after clamp release. Circulating tumour necrosis factor alpha (TNF-alpha) was observed in all patients undergoing aortic surgery. Levels of portal TNF-alpha were higher than those in systemic blood after bowel manipulation as well as after reperfusion (P = 0.02 and 0.007, respectively). LPS was never detected in control patients and TNF-alpha was detectable in only two out of seven patients. Mean levels of IL-6 were similar in the two groups, with a peak on the day following surgery, confirming that circulating IL-6 is associated with any surgical procedures. Our data indicate that bowel manipulation, aortic clamping and reperfusion lead to similar levels of portal and systemic circulating LPS.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗