Biomedical subjects

M Lacombe

Publications and source records attributed to M Lacombe.

165 records · Page 10Linked to original sources

PubMedDate not supplied

[Artery stenosis in renal transplantation (author's transl)].

Of 506 transplantations, stenosis of the artery supplying the graft was found in 60 patients (11,9%) three months to two years after they had undergone renal transplantation. The diagnosis was made by arteriography done because of refractory hypertension with or without impaired renal function in 58 patients and as a routine investigation in 2 normotensive patients. The stenosis was corrected surgically in 30 patients, with resultant lasting relief of hypertension in 17 patients and improvement of renal function in 9 out of 12 patients with impaired renal function. Different types of stenosis were recognized: stenosis of the recipient artery, stenosis of the suture line, stenosis of the donor renal artery (the most frequent) and multiple forms. There is no single cause of stenosis: atheroma of the recipient vessels, faulty suture technique, hemodynamic disturbances, trauma, immune mechanism. This complication of renal transplantation may be more frequent than is thought usually; therefore, routine renal arteriography should be performed at repeated intervals in all transplanted patients.

Angiography↗

PubMedDate not supplied

[Reoperations on the renal artery].

Twenty six reoperations on the renal artery were performed upon 19 patients. This represents a 3.6% rate of repeat surgery in the author's series of renal artery repairs. The lesions requiring surgery were 22 repeat stenoses and 4 aneurysms of saphenous vein grafts. The 26 reoperations ended with nephrectomy in 8 cases and repeat repair in 18 cases. The nephrectomies were performed because of major difficulties for a repeat repair. The repairs were performed by conventional surgery in 9 cases and ex situ surgery in 9 cases. One postoperative death occurred (5.2%). Early thrombosis of segmental branches occurred in one patient requiring secondary nephrectomy. Late thrombosis of the repair occurred in one case in spite of normal patency of the repair on early postoperative angiography, and did not require any further surgery. Three repeat stenoses occurred (15.7%): one was not reoperated, the two others underwent one nephrectomy and one repair. On the whole, 12 long term successes out of 18 repeat repairs were obtained (66.6%). The results of successful repairs on renal function and blood pressure control are similar to those of primary repairs. Two reasons explain late alterations of initially satisfactory repairs: in only 3 cases (15.7%) worsening of atherosclerosis was responsible for repeat stenoses; in the majority of cases (16 out of 19, i.e. 84.3%), late alterations of the repair or of the arterial substitute occurred. The former lesions are unavoidable, the occurrence of the latter may be prevented by adequate surgical tactics or technique of the primary operation.

Adolescent↗

PubMedDate not supplied

Surgical versus medical treatment of renal artery embolism.

Seventy four case reports of acute renal arterial embolism were analyzed, to compare operative and non-operative management of this disease regarding survival and kidney salvage. The mortality was the same (25%), whatever the treatment. Surgery allows a much higher kidney salvage rate, especially whenever an embolus obstructs the main renal artery. Thus, apart from critically ill patients or segmental renal embolism, treatment should be surgical, irrespective of the time elapsed since onset. A short medical preparation will precede the operation.

Adult↗