Biomedical subjects
Publications and source records attributed to M C Riche.
On the basis of long-term study on embolization for severe epistaxis, the authors show the different indications and results of this relatively new method; and 54 cases are presented including Rendu-Osler diseases, primary and traumatic epistaxis, or those due to vascular malformation and benign or malignant tumors. Embolization can prove a very effective method in most cases.
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When performed by a team who are experienced in the use of embolization of the external carotid region, this procedure is nowadays a safe and extremely effective method for treating severe, massive, uncontrolled, recurrent epistaxis. Arteriography shows the site of bleeding, the nature of the lesion, and the arteries affected. When carried out by the femoral or common carotid route, this method was effective in 52 cases of severe epistaxis of various origins: essential epistaxis, or from hypertension, trauma, Rendu Osler's disease, vascular malformations, carotidocavernous fistulae, benign or malignant tumors, hematological affections, or hemostatic disorders. To avoid risk it is essential that a perfect technique be used and a certain number of principles respected. The method is effective in cases were surgical hemostasis is insufficient, and its rapidity of action allows removal of packs immediately after embolization. This clearly underlines the value of constantly available vascular radiology units for treatment in this region as well as in other parts of the body.
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On the basis of one case of colonic sub-mucosal cystic pneumatosis explored by double contrast enema, the authors emphasise the pathognomic diagnostic value of the "puzzle" appearance. This appearance is made by precise adaptation of the opaque colonic mucosa depressed in the form of a "cupola" over the intraparietal gas bubble which results in the deformity. Endoscopy failed to reveal the disorder in the case reported here.
Between 1980 and 1990, 150 patients with cervicofacial vascular malformations were studied at the authors' institution with computed tomography, plain radiography, and angiography. Since 1989, 34 of these patients have also undergone magnetic resonance (MR) imaging. Capillary-venous hemangiomas seem to be the best indication for the adjunctive use of MR imaging. The venous pouches, characteristic of this type of lesion, cause elevated signal intensity, well seen on the T2-weighted images. Excellent fat and muscle differentiation with MR imaging allows appreciation of the depth of extension of these lesions and their delimitation from normal tissue. Arteriovenous malformations (AVMs) are characterized by serpentine signal voids, indicative of the high flow rate of these lesions. Delimitation of the AVM nidus in the midst of the afferent and efferent dilated vessels is often difficult. Study of immature angiomas with MR imaging should be restricted to lesions in specific locations (eg, orbital, laryngeal). Lymphatic malformations showed either tissular or cystic signal intensity changes. MR imaging does not replace other studies but represents an important complementary study for the delineation and diagnosis of deep extensions of vascular malformations, allowing better planning of therapy.
PURPOSE: The goal of this study was to evaluate the role of endovascular techniques in the treatment of arteriovenous fistulas (AVFs) in the subclavian region. PATIENTS AND METHODS: Since 1984 six patients with AVFs arising from branches of the subclavian artery have been treated. All AVFs were of iatrogenic origin (five venous punctures and one pacemaker insertion). Two patients had cardiac insufficiency, three had a bruit, and one had upper extremity venous hypertension. Angiographically, four of the AVFs were located on the thyrocervical trunk and two were on the internal mammary artery. RESULTS: All fistulas were treated by means of endovascular occlusion with a detachable balloon, with full resolution of symptoms. One AVF recurred after a balloon deflated prematurely. The patient was treated again and was subsequently cured. No other complications were associated with treatment. CONCLUSION: Endovascular balloon occlusion of AVFs in the subclavian region is a simple, effective, and safe method that eliminates the need for surgery. It should be the method of choice for treatment of these lesions.
Through the aid of developments in the neuroradiological sciences, great attention has been given to the diagnosis and treatment of vascular malformations of the spinal cord. Some of these are congenital, such as intramedullary vascular malformations and arteriovenous fistulae supplied by the spinal cord. Others are rather frequent and appear in old age. Due to their poor prognosis when not treated, precise determinations and sufficient knowledge are of the utmost importance.
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Following exploration by angiography , 45 patients with cervical spine malformations ( out of 220 cervicocephalic examinations for vascular malformations), were treated by embolization. The 45 cases included 13 facial lesions, 4 pharyngolaryngeal lesions, 2 cervical venous ectasias, 4 arteriovenous fistulae of the vertebral artery, 19 medullary lesions, and 3 pseudomalformations (hemangiopericytomas). Though embolization is difficult it is of value in definitely vascular occlusions (follow-up for 3 years), and miniaturization of catheters and balloon sounds enables very selective occlusion of vascular tumors or malformations to be carried out, micro-emboli of 30 to 500 mu have been obtained.
It is well known that proximal arterial ligations have no curative effect on arterio-venous malformations, unfortunately however they are still employed. The immediate and late consequences of such ligatures have been studied by analysing 36 out of 142 cases of arterio-venous malformations. These ligatures interfere with ulterior treatment. At present such a treatment relies on a combination of radio-surgical treatment associated with embolization and complete surgical excision of the malformation, whenever it is possible.
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The development of the detachable balloon allows treatment of many neurological lesions, both congenital and acquired. We describe here a device that may be used easily. Complications and main indications are discussed on the basis of our experience with 114 cases.
A system employing a micro-balloon catheter is proposed for the introduction of catheters for intra-arterial chemotherapy.
Seven patients with arteriovenous fistulae of the internal iliac artery are reported. Ages varied from 6 to 50 years (mean 32 years). Cutaneous angiomata , leg oedema and pain was present in 4 cases each, bleeding in 2 cases whilst only one was asymptomatic. Only 1 patient had cardiac insufficiency. In six patients the lesion was a congenital malformation but in one it was posttraumatic. Arteriography both global and selective, intravenous pyelography and cardiac output are routine. Recently, pelvic computerised tomography has been most helpful. Embolization is recommended in all cases with surgery within 24 hours unless the lesion is very extensive and considered to be inoperable. Repeat embolization is used for recurrence or very extensive lesions. Results were good in five patients; in two patients the results were clinically good but control angiograms showed a recurrence.