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Biomedical subjects

G Etienne

Publications and source records attributed to G Etienne.

87 records · Page 5Linked to original sources
PubMedDate not supplied

Severe injuries resulting from operations for thoracic outlet syndrome: can they be avoided?

Surgery for thoracic outlet syndrome (TOS) is claimed to have a low risk of severe complications. To re-evaluate this, a questionnaire was sent out to the French vascular surgical community. There were 66 replies. While some surgeons had operated on several hundred patients without any severe complications, others had experienced rare but dramatic complications including wounds or thrombosis of the axillary artery, vein injuries or thrombosis, transient or definitive paralysis of the brachial plexus, long thoracic or phrenic nerves, hemothorax, and chylothorax. Two resulted in the death of young patients. The results of the present study, as well as rare reports in the literature, demonstrate that these complications may occur even with experienced surgeons using either the supraclavicular or transaxillary approaches. We conclude that: (1) operation for TOS should be considered only when the diagnosis is certain and when operative decompression is the sole solution; (2) the choice of an adequate approach, good vision during operation, and meticulous technique are all mandatory for full security. Surgical guidelines are suggested.

Arm↗
PubMedDate not supplied

Should all spontaneous popliteal aneurysms be operated on?

Operative treatment of spontaneous popliteal aneurysms (S.P.As) is occasionally disappointing. In order to determine the criteria for operation we analyzed retrospectively the fate of 77 S.P.As in 52 patients (mean age, 66 +/- 10 years). S.P.As were divided into 3 groups according to initial symptoms: group I, asymptomatic or mild symptoms, group II, rest pain or toe gangrene, group III, severe ischemia or foot gangrene. Patency rate of arterial reconstruction in groups I, II, III were respectively 83%, 43%, 36%. The course of S.P.As of group I that were not initially operated was not significantly different compared to those operated on, as long as they were frequently reviewed and operated on expeditionaly in cases of complications. The nature of the arterial substitute was the second contributing factor. Quality of run-off had no influence in groups I and II, but was determinant in group III. A good general condition was essential for survival. Operative indications of S.P.As is considered according to classification into 3 groups. Group I: bypass is mandatory, except when the general condition of the patient is poor or when a bad run-off is associated with an unavailable vein. Group II: bypass should be attempted whenever a distal arterial segment seems suitable. Otherwise lumbar sympathectomy may sometimes save a limb. Group III: bypass should be attempted only when the run-off is sufficient and when the tissue damage seems reversible. In the other cases, primary amputation is safer.

Adult↗
PubMedDate not supplied

Management of arterio-venous fistula due to unusual aorto-iliac aneurysms.

Aorto-caval fistula associated with thoraco-abdominal aneurysm or with multiple segmental aneurysms is a major challenge for the vascular surgeon. We report two patients who were managed successfully. In addition to the classical surgical techniques of aneurysm repair, we used haemodynamic monitoring with a Swan Ganz catheter, an autotransfusion device and interruption of the vena cava, thus avoiding the three main causes of death in such cases, namely, gross haemodynamic disturbances, major bleeding, and pulmonary embolism.

Aged↗
PubMedDate not supplied

[Revascularization of supra-aortic trunks from the femoral artery].

A seventy-year-old woman had an occlusion of the left sub-clavian and left primitive, internal and external carotid arteries, combined with a pre-thrombotic stenosis of the brachiocephalic trunk. Lesions were so diffused that a cross extra-anatomic bypass was impossible at the cervical level. There was contraindication for the implantation of a prosthesis on the aortic arch, due to a much extended calcified atheroma which did not allow clamping. Supra-aortic trunk revascularization was done through right femoral-axillary bypass without any post-operative complication. After a four year follow-up, the bypass is still patent. The purpose of this report is to emphasize that such r revascularization, which is rarely reported, must be better known since the implantation of the bypass on the femoral artery leads to patent and durable results.

Aged↗