[Ultrasonographic control during surgery on congenital arteriovenous fistulae in the limbs (author's transl)].
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Arteriovenous Malformations↗
Biomedical subjects
C Laurian
Publications and source records attributed to C Laurian.
[Subscrotal bypass. Technique and indications. A report on twelve cases (author's transl)].
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Aged↗
[Occlusion of vertebral artery. About 33 cases. Therapeutic implications (authors' translation)].
33 occlusions of the vertebral artery on 29 patients were observed from 44 vertebro-basilar strokes and 20 sylvian infarcts (respectively 17 and 5 cases). 7 other cases were related to tumour, trauma or surgical ligation and were asymptomatic. In 10 out of 13 strokes could be related to a reduction of flow because of bilateral lesions onr on dominant artery. In 7 out of 9 occlusions without controlateral lesion embolism could be evoked. These results are analysed with the aim of defining indications for anastomosis on the vertebral artery.
Adult↗
[Partial occlusion of the inferior vena cava by clips. Indications and results about 95 cases (author's transl)].
Vena cava clips were applied in 95 patients between October 1975 and October 1979, without mortality directly related to the surgical intervention. One patients died early after operation due to an associated thoracic aorta aneurysm. The 10 deaths occurring at a later stage were not related to the insertion of the clips or its consequences. One patient developed a pulmonary embolism during operation, as a result of a concomitant juxtarenal thrombectomy. Postoperative extension of a femoropopliteal thrombosis or bilateralization of an iliac phlebitis was observed in 31 p.cent (30 out of 95) of cases. Permeability of the inferior vena cava was confirmed in 32 patients, 65 p. cent of the clips remained patent. Lower limb venous sequelae, related to the insertion of the clip or its consequences, were noted in 34 p.cent (24 of 69) but caused little inconvenience. Severe venous disorders, due to the thrombo-embolic disease, were always present before the insertion of the clips. Postoperative morbidity was low, the clip causing extension of previously existing venous thrombosis, without significant distal sequelae. The absence of recurrence of pulmonary embolism demonstrates the efficacy of this method. The employ of a caval filter to preserve improved permeability of the inferior vena cava (IVC) is discussed.
Adolescent↗
[Surgery of the descending thoracic aorta. Partial derivation between the pulmonary and femoral arteries: 29 cases (author's transl)].
The authors report on 29 surgical operations on the descending thoracic aorta, where partial extra-corporal circulation was established between the pulmonary and femoral arteries, using a straight Rigg's cannula inserted into the pulmonary artery. The blood flow rate in the shunt was of the order of 1,5 l/min. Owing to the ease with which the cannula is inserted and removed and to the possibility of switching to total extra-corporeal circulation the authors prefer this technique to all other types of partial derivation.
Aorta, Thoracic↗
[Replacement of the ascending aorta and aortic valve with re-implantation of the coronary arteries. Long-term results in 20 cases (author's transl)].
Total replacement of the ascending aorta and aortic valve using Bentall's technique was carried out in 20 patients with dystrophic (13 cases), chronic dissecting (4 cases) or acute dissecting (3 cases) aneurysm. Five patients died in the first month following surgery, but all patients operated upon for dystrophic aneurysm survived. The mean follow-up period for the 15 survivors was 39 months, and there was no late death. Thirteen patients are leading a normal life. Nine out of 14 control aortographies were performed 48 months on average after the operation. They showed normal and stable anatomical restoration of the aorta and coronary system. Total replacement of the ascending aorta seems to be the operation of choice for dystrophic aneurysm.
Adult↗
Surgical approach to the whole length of the vertebral artery with special reference to the third portion.
A lateral route between the SCM and the lateral border of the internal jugular vein is defined from an anatomical study for exposure of the VA. It offers the simplest route for controlling any part or the whole length of the VA, including its intracranial portion. Surgical indications are discussed on the basis of our experience in eight cases with, in all cases, control of the VA in its third segment between C2 and the foramen magnum. Arteriovenous malformations are the most frequent indications; two cases were treated by direct approach and one by exclusion and anastomosis between the internal carotid artery and the vertebral artery at C1-C2. TUmours of the lateral cervical space (one haemangiopericytoma and one jugular glomus tumour) or of the posterior fossa extruding out of the foramen magnum or the jugular foramen (one meningioma) may require control of the VA. Traumatic lesions (one case) or compression by an osteophytic spur are also indications for this approach. Wall lesions of the VA (aneurysm or stenosis) are best treated by exclusion and anastomosis between either the carotid or the subclavian artery and the vertebral artery at C1-C2 level. One case of aneurysmal dysplasia was cured by anastomosis between the subclavian artery and the vertebral artery at C1-C2 with a saphenous vein graft and clipping of the VA proximal to the by-pass. Radiological examinations are fundamental for diagnosis, treatment when embolization is necessary, and choice of surgical treatment, according to the importance of the contralateral VA and the medullary branches.
Arteriovenous Malformations↗
Aortocoronary bypass with homologous saphenous vein: long-term results.
Between February 1973, and February, 1979, 27 homologous saphenous veins were used in 20 patients (mean age, 54 years). Seven fresh grafts were used less than 24 hours after severance. They were kept at a temperature of 4 degrees C in saline solution containing penicillin. Twenty cryopreserved grafts were used within a period of eight days to 2 months from severance. They were preserved in glycerol at a temperature of -40 degrees C. One patient (5%) died postoperatively. A perioperative myocardial infarction developed in 3 patients (15%). Average follow-up is 27 months. No late mortality was registered. Fifteen patients are free from symptoms, and 3 patients have residual angina with exercise. Control angiograms were made in 13 patients 1 to 68 months after operation; 17 homografts were seen. Early occlusion of 1 graft and late occlusion of 8 grafts were registered. The poor late patency rate does not seem to be related to either histocompatibility or technical conditions. Conversely, microscopic examination of several cryopreserved grafts showed that the mode of preservation resulted in deterioration of intimal and medial tissues of the vein. Therefore, it appears to us that the use of homologous saphenous veins should be avoided for coronary bypass.
Adult↗
[Vascular complications after the treatment of carcinoma of the cervix (author's transl)].
Vascular complications after this treatment are rare. Artery stenosis or occlusions, more often iliac, are well recognized complications of postoperative radiotherapy. These segmental lesions, sometimes, are pathological lesions similar to arteriosclerotic changes. These lesions may be corrected later on after the treatment of carcinoma of the cervix. The venous complications often present later and tall within the context of post thrombotic syndrome. Conservative treatment is indicated alone. A well recognized complication, lymphedema is usually mild; a superimposed iliofemoral thrombophlebitis often may be suspected.
Adult↗
[Thombosis of a persistent sciatic artery: a rare cause of severe ischemia in the lower limb (author's transl)].
Persistence of the primitive axial limb artery is an uncommon developemental anomaly. This artery is called sciatic in account of its connections with the nerve. Usually gluteal aneurysms develop and the anomaly is disclosed by a complication : pain, pulsatile buttock mass, thrombosis or release of emboli. Prophylactic surgical repair of such aneurysms seems reasonable.
Aged↗
[Value of surgical approach to the vertebral artery in its extra-cranial segment. A case of aneurysm of the vertebral artery in C3 (author's transl)].
Long considered dangerous, surgical treatment of lesions of the vertebral artery in its extra-cranial course, may be viewed in parallel with angiographic techniques. Approach to the vertebral artery in its different segments, pre-operative arteriographic assessment, are discussed, and operative indications only mentioned. An aneurysm of the vertebral artery in C2-C3 was treated by exclusion and restoration of continuity by a sub-clavian vertebral vein graft in C1-C2.
Aneurysm↗
[Acute dissection of the aorta. A new surgical technique using a biological glue (author's transl)].
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Adult↗
[Exposure of the extracranial portion of the vertebral artery. Anatomical study--Surgical value (author's transl)].
Exposure of the vertebral artery, in particular in its extracranial course, may be of surgical value. The treatment of lesions affecting this entire artery must be discussed in the context of the revascularisation of the vessels supplying the brain. The anatomical study forms defines the features of this surgical approach. Selective vertebral arteriography and the assessment of tolerance of vertebral clamping are the main features of pre-operative evaluation.
Arteriovenous Fistula↗
The cavaportal shunt in interruptions of the suprarenal inferior vena cava.
Abrupt interruption of the suprarenal inferior vena cava can have dramatic consequences and can be difficult to repair successfully. In the case reported, an excellent result was obtained by a cavaportal anastomosis, with minimal consequences on renal and hepatic functions.
Humans↗
Surgical possibilities in the third portion of the vertebral artery (above C2). Anatomical study and report of a case of anastomosis between subclavian artery and vertebral artery at C1-C2 level.
A reappraisal of surgical possibilities in the third portion of the vertebral artery (VA) above C2, has been done from an anatomical study on twenty autopsy specimens. A route passing between the internal jugular vein and the Sterno-cleido-mastoid muscle allows a simple approach to the transverse process of C1. After division of two muscles attached to this process, 1.5 cm of the VA can be exposed. For larger exposure of the artery, the foramen transversarium of C1 must be unroofed and the artery dissected in the guttering of the posterior arch of the atlas. This surgical route was used in a case of aneurysmal dysplasia at the C3 level. An anastomosis between the subclavian artery and VA at the C1-C2 level was performed with an autologous saphenous vein graft. The key points are the highest possible freeing of the XI nerve and the head position. Rotation and extension move the transverse process and the posterior arch of the atlas superficially and anteriorly.
Cerebral Revascularization↗
[Dissecting aneursym of the ascending aorta after lateral clamping for aorto-coronary by pass (author's transl)].
Four cases of dissecting aneurysm of the aorta after lateral aortic clamping for aorto-coronary bypass are described. These accidents are rare but very serious. They often occur in hypertensive patients, and sometimes an aortic wall with a low elastic fibre content is found on histology. Surgery is that of dissecting aneurysm of the ascending aorta. However the severity of these accidents should lead to routine preventive measures during all aortocoronary bypass operations, in particular aortic anastomosis of the grafts under extra-corporeal circulation.
Aortic Dissection↗
Use of biological glue in acute aortic dissection. Preliminary clinical results with a new surgical technique.
Use of a biological glue (GRF) is common in certain fields such as hepatic or renal surgery, but its use in vascular surgery, especially in acute aortic dissection, has not yet been reported. Our experience has demonstrated many advantages: The glue is very simple and safe to use. The aortic tissues are firmly reinforced and the sutures tighten immediately. The proximal aortic stump is anatomically reconstructed, and generally the aortic valve can be preserved and coronary reimplantation avoided. The preoperative and postoperative bleeding rates are low and the postoperative course generally is simple. The risk of maintenance or recurrence of the dissection process is reduced. Consequently, the hospital mortality rate can be reduced to about 10 percent and the long-term survival rate greatly improved.
Adult↗
[Surgery of acute aortic dissection by use of a biological glue. Experimental study (author's transl)].
The improvement in surgical technic in the treatment of dissecting aneurysm of the aorta should permit a reduction in mortality and secondary complications. With this object, an attempt to stick together the two parts of the aneurysm with biological glue, was submitted to an experimental study. The operative protocol included on the one hand, creation of a dissecting aneurysm in the thorax of the dog, and secondly, repair of the latter with biological glue of variable composition. 27 dogs were thus operated on : -- 4 dissections were treated by simple suture (control group); -- in 23 cases, the two parts of the dissecting aneurysm were stuck together with gelatin-resorcin glue which was polymerised either by formaldehyde alone, or by a mixture of glutaraldehyde-glycerinaldehyde or by a mixture formaldehyde-glutaraldehyde. The best results of adhesiveness and tissue tolerance were obtained with the latter mixture.
Acute Disease↗