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Biomedical subjects

F Alachkar

Publications and source records attributed to F Alachkar.

18 recordsLinked to original sources
PubMed1997

Pulsed transthrombotic fibrinolysis: technique and results in the management of occluded lower limb bypass grafts.

Between March 1987 and March 1993 we used pulsed transthrombotic fibrinolysis to treat 58 symptomatic thrombotic occlusions of lower limb bypass grafts in 45 patients. There were 17 suprainguinal grafts and 28 infrainguinal grafts. Treatment consisted of pulsed infusion of fibrinolytic agents into the thrombus followed by continuous infusion using an electric pump. Minor percutaneous or surgical procedures were often associated. The mean delay to treatment was 7 days. The mean duration of treatment was 150 +/- 66 minutes. Immediate patency was achieved in 88% of cases with no significant difference between suprainguinal and infrainguinal grafts. The clinical success rate was 55%. Actuarial patency at 1 year was 54% +/- 11% for suprainguinal grafts and 26% +/- 7% for infrainguinal grafts. The probability of patency was much lower in patients whose grafts had been implanted within 3 months before occlusion and in patients in whom an adjuvant procedure had not been performed. This study demonstrates that, in cases not requiring immediate surgery, pulsed transthrombotic fibrinolysis can achieve durable patency by treating both the bypass and distal arterial network. This technique allows identification of lesions causing thrombosis and adaptation of treatment specifically to these lesions.

Actuarial Analysis↗
PubMed1992

[Impotence of vascular origin. Techniques of exploration and therapeutic orientations].

Vascular problems of arterial and/or venous origin are often found as the cause of erectile dysfunction. Clinical examination alone is insufficient and must followed up by a number of non or minimally invasive tests in order to confirm the etiology. Such testing should include: Doppler measurements or, better, duplex sonography, nocturnal penile plethysmography, psychological status, clinical biochemistry and intracavernous injection of vasoactive drugs. Occasionally, it may be necessary to complete these tests by more invasive examinations: pharmacoarteriography and/or pharmacocavernosography. Several novel therapeutic approaches have been developed in recent years and have given rise to encouraging improvements.

Adult↗
PubMed1992

Dynamic digitized cerebral parenchymography.

Aortic arch injections centred on the head have been performed routinely in patients with cerebral ischaemia. Digital angiograms with modified windowing (low and narrow) have been used. This "cerebral" arch injection allows much improved analysis of the cerebral parenchymal vascularization, giving better understanding of hemispheric ischaemia and making the decision about revascularization more rational.

Angiography, Digital Subtraction↗
PubMed1990

[Intravascular technics of cerebral revascularization].

Two techniques of cerebral revascularization have been developed: angioplasty of the brachiocephalic vessels (204 cases) and local intra-arterial fibrinolysis in the carotid region (26 cases). Angioplasty appears to be the treatment of choice for inflammatory and atherosclerotic stenoses of the main trunks arising from the aortic arch (82 cases). Stenoses of the origin of the vertebral artery are not often ulcerated and may also be treated by angioplasty (42 cases) as long as the stenosis has been recognized as the cause of vertebral insufficiency symptoms. Among the stenoses of the carotid bifurcation, recurrent postsurgical ones are rather easily treated by angioplasty, particularly when they are recognized early by Doppler examination. Postsurgical and inflammatory stenoses do not require cerebral protection during angioplasty. Conversely, cerebral protection is mandatory for treatment of atherosclerotic stenoses because of the risk of embolic detachment of particles in to brain circulation. A new triple coaxial catheter system has been designed which seems so far to be very efficient. Local intra-arterial fibrinolysis in the carotid region is selected on the basis of clinical signs, the delay after onset and results of CT and complete cerebral angiographic workup. A classification into three topographic groups is proposed. The group at highest risk of post-fibrinolysis hemorrhage is the one with occlusion of the lenticulostriate arteries. It would seem hazardous to undertake fibrinolysis in a patient of this group unless it can be started no later than 4 or 5 hours after clinical onset. Rapid transportation of stroke patients is recommended so that CT and complete arteriography may be performed before deciding whether to use fibrinolytics.

Angioplasty, Balloon↗
PubMed1988

[Cervical chemodectoma disclosed by coma. Pathogenic hypotheses].

The authors reported a case of cervical paraganglioma. Patient had a coma suggesting secretary activity of the lesion or cerebral venous thrombosis. Angiography showed an hypervascular lesion characterized by venous reflux into the contro-lateral sinus. After neurological stabilization by tumor embolization, the tumor was surgically removed.

Coma↗
PubMed1988

[Anterior ethmoidal dural fistulae. 3 new cases].

The authors report three new cases of anterior ethmoidal dural fistulae: a pure pial and two dural and pial fistulae which presented in the form of rupture. The emphasise the computed tomographic features, revealing a unilateral frontopolar haematoma and the need for angiographic assessment including study of the internal and external carotid arteries. Carotid angiography of the fistula defines the therapeutic modalities which are generally surgical.

Adult↗
PubMed1986

[Peritumoral edema in intracranial meningiomas. Angiographic and computerized tomographic correlations].

On computerized tomography the intracranial meningiomas are surrounded by a more or less extensive peritumoral oedema. Twenty patients presenting with a supratentorial meningioma have been studied by angiography and computerized tomography. A constant correlation between the presence of oedema and the type of vascular supply of the tumor has been demonstrated. When there is no oedema, the whole vascular supply of the tumor is provided by the meningeal branches of the external or the internal carotid arteries. When there is a peritumoral oedema, the vascular supply of the portion of the tumor adjacent to the oedema is provided by leptomeningeal branches of the internal carotid. No constant correlation has been demonstrated by the authors between the presence of oedema and the other factors previously described in the literature.

Adult↗
PubMedDate not supplied

Local intraarterial fibrinolysis in the carotid territory.

A series comprising 12 patients who had intraarterial local fibrinolysis in the carotid territory is reported. A classification is proposed that divides the different types of occlusions into three groups on the basis of angiographic location. Group 1 (two cases) comprises occlusion of the extra- and/or intracranial carotid artery with patency of the circle of Willis and the lenticulostriate arteries. In this group, there is no brain infarction, the CT findings are normal, and the clinical signs are mainly hemodynamic and intermittent. Fibrinolysis may be performed late and rather safely and completed by surgery or angioplasty of the neck vessel stenosis responsible for the occlusion. Group 2 (five cases) comprises occlusions of the cortical arteries without involvement of the lenticulostriate arteries. The mechanism of the occlusion can be hemodynamic or embolic. Group 3 (five cases) comprises occlusions of intracerebral arteries involving the lenticulostriate arteries. In groups 2 and 3 with brain infarction, fibrinolysis will only be able to restore viability of the area of cerebral tissue surrounding the infarction (penumbra). The time factor is particularly critical in group 3 because lenticulostriate arteries are terminal vessels whose revascularization may induce hemorrhages with increasing frequency as the occlusion time is prolonged. The time factor is less critical in group 2 because collaterals make the ischemia less severe in the infarcted area and the vital and functional consequences of hemorrhage are not as serious as in group 3 because of the location. In this series, all the symptomatic complications of hemorrhage (two cases) occurred in group 3, in patients treated later than 6 hr after clinical onset. Given the time delay inherent in performing CT and angiography and in making the medical decision, it is considered dangerous to undertake fibrinolytic therapy in group 3, unless it can be started before 4 or 5 hr after clinical onset.

Adult↗
PubMedDate not supplied

[Correction of erectile impotence of venous origin using detachable balloons and coils].

The authors review a radiological classification of venous impotence and report their therapeutic approach. 13 patients with a venous insufficiency of Santorini's plexus were treated by detachable balloons and coils. This technic was convenient in 11 of the 13 cases. 5 patients with a superficial venous insufficiency were treated by embolization by coils. The results in this group appear to be good in 4 cases.

Embolization, Therapeutic↗