Search PubMed⌕ Search

Biomedical subjects

P Desgranges

Publications and source records attributed to P Desgranges.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Surgery of subrenal abdominal aortic aneurysms. Impact of anatomic factors and of comorbidity on perioperative morbidity and mortality].

PURPOSE: To determine the predictivity of anatomic and co-morbid factors for peri-operative mortality of patients operated for a non-ruptured abdominal aortic aneurysm (AAA). METHODS: Between 1986 and 1996, data had been collected prospectively in a computerized date base. A chi-square test was performed for 5 anatomic, and 8 co-morbid criteria. RESULTS: 25 of 470 patients (5.3%) died within one month after surgery. Aneurysm diameter (P = 0.004) and aneurysmal internal iliac artery (P = 0.019) were associated with an increased mortality whereas upper extension of the disease necessitating a juxta-renal anastomosis, the need for inferior mesenteric artery reimplantation, or a symptomatic ilio-femoral occlusive disease, were not. Age (P = 0.016), obesity (P = 0.03), alteration of left ventricular function (P = 0.0014), and preoperative renal failure (P = 0.0001) were associated with increased mortality. CONCLUSION: Both anatomic and co-morbid factors can predict outcome after elective surgery for non-ruptured AAA. The criteria might help to selection patients who might benefit from endovascular treatment of AAA.

Aortic Aneurysm, Abdominal↗
PubMed1998

[Hypogastric arterial aneurysms associated with abdominal aortic aneurysms].

OBJECT: In a previous study, we have found that an operation for a combination of internal iliac aneurysms and an abdominal aortic aneurysm carries a heavier mortality than an operation for an abdominal aortic aneurysm alone. The object of this review was to define the prevalence of this combination of aneurysms and the results of the different treatment modalities in order to define the therapeutic choices. METHOD: A retrospective study of operations on 426 patients with asymptomatic infrarenal aortic aneurysms. The size of the iliac aneurysm was evaluated in terms of the calibre of the artery above and below the aneurysm and these size were classified as < 2C, = 2C and > 2C relative to that calibre. Three groups were defined: group 1--with at least 1 aneurysm < 2C: group 2--with at least 1 aneurysm = 2C, group 3--with at least 1 aneurysm > 2C. RESULTS: 32 patients had combined aneurysms (9 group 1, 13 group 2 and 10 group 3)--i.e. 7%. Treatment consisted of 23 exclusions by ligation, nearly all proximal, 6 bypasses of which 2 eventually required a ligation and 2 wrappings. Three patients aged 78, 82 and 86 years died, but no death was related to the treatment of the internal iliac aneurysms. On the other hand, massive haemorrhages occurred during the operation in a group 2 patient during an attempt at exclusion by ligation above and below the aneurysm and also in a group 3 patient during an unsuccessful attempt at bypassing. One further bypass proved impossible. Later, 2 group 3 patients developed postoperative complications: one buttock claudication and one invalidating paraplegia. CONCLUSION: It is justifiable not to operate on < 2C and, in some cases, = 2C, internal iliac aneurysms. Embolisation was not used in this series. Exclusion by ligation is a good procedure when the other internal iliac artery is patent. Bypassing is the ideal method in bilateral aneurysms but it is associated with the risk of venous haemorrhage and of thrombosis. When flow must be maintained in an internal iliac artery, our first choice is wrapping when the size is < or = 2C and endoneurysmorrhaphy + wrapping when the size is > 2C and performing a bypass may be risky. Unoperated internal iliac aneurysms should be periodically controlled with Duplex or CT scan.

Aged↗
PubMed1998

[Transluminal treatment of abdominal aortic aneurysms. Might one obstruct the renal arteries?].

During transluminal treatment of an aneurysm of the abdominal aorta, the proximal part of the stent may sometimes lay over the ostia of the renal arteries. Animal studies have shown various scarring patterns depending on the type of stent used and its duration of implantation. The Gianturco and Wallstent appear to be better tolerated than the Palmaz stents. The AA have shown that, with the Strecker stents, a neointima developed between the meshes of the stent over a surface of 43% +/- 30% in 6 weeks. May and Parodi report some occlusions in their clinical series. In the AA's series using Vanguard, no renal artery was thrombosed despite the fact that the stent lay over the artery on 2 occasions in 105 patients. In conclusion, the consequences of the proximal part of a stent laying over the ostium of a renal artery depend mainly on the type of stent used. "Wide mesh" stents are probably the best to use to prevent serious renal complications.

Animals↗
PubMed1997

Management of radiation-induced occlusive arterial disease: a reassessment.

BACKGROUND: The goal of this study was to evaluate the operative hazards, therapeutic procedures, and late results of arterial reconstruction for radiation-induced occlusive disease. METHODS: Twenty-five patients were referred to our institution for radiation-induced occlusive arterial disease. Group 1: carotid artery stenosis or occlusion was encountered in seven patients. The nine procedures employed included percutaneous transluminal angioplasty (PTA) (n = 2), carotid endarterectomy (n = 3), vein or prosthetic bypass (n = 4). Group 2: four patients presenting with subclavian and axillary artery occlusion were treated with a common carotid to brachial artery vein bypass, one after unsuccessful PTA. Group 3: Thirteen patients had aorto-iliac occlusion. Initial management included medical treatment (n = 1), PTA (n = 2), aorto-bifemoral bypass (n = 4), aortofemoral and iliofemoral bypass (n = 1 each), axillofemoral bypass (n = 3), femorofemoral bypass (n = 1). Group 4: One patient had femoral artery occlusion treated with PTA. RESULTS: Group 1: One of two PTA was successful. Endarterectomy or bypass were successful in all cases. One late vein bypass stenosis was treated by venous patch angioplasty. Group 2: All vein bypasses were successful. Group 3: Limb salvage was achieved in all patients but eight required repeat operations for prosthetic sepsis (n = 3), restenosis (n = 3), or thrombosis (n = 12). Two patients died of late sepsis. Group 4: Outcome after PTA was successful. CONCLUSIONS: 1) Surgery for radiation-induced arterial lesions is difficult because of arterial, periarterial, and cutaneous sclerosis. Some patients, however, are amenable to PTA or endarterectomy. When bypass is necessary, anastomosis should be performed in healthy arteries, for instance, the thoracic aorta for the proximal anastomosis, or the brachial artery approached through a lateral mid-arm incision. 2) The risk of early or late graft infection is enhanced by the presence of tracheostomy, colostomy, or ureterostomy and by repeat operation for thrombosis. PTA, endarterectomy, or vein bypass should be preferred whenever feasible. When prosthetic material is unavoidable, prevention of infection should include the use of omentoplasty, remote bypass, antibiotic-bonded grafts or, in the case of major sepsis, allografts. 3) As restenosis remains a frequent complication, annual clinical and Duplex-scan surveillance is mandatory.

Adolescent↗
PubMed1997

Simultaneous endoluminal dilatation and conventional surgery. Importance of programmed revascularization of the legs.

OBJECTIVE: evaluate the benefit of synchronous arterial reconstruction and endoluminal balloon dilatation for occlusive arterial disease during non-urgent procedures. METHOD: late results of forty arterial reconstructions combining open surgery with simultaneous endoluminal dilatation have been reviewed. Balloon dilatation was performed on iliac (N = 18), femoral (N = 18), popliteal (N = 3) and infra-popliteal arteries (N = 2). Reasons were rapidity in 31 cases, local reasons in five cases (such as brievity of available vein for bypass), heavy operative risk in two cases and partial failure of transluminal angioplasty in two cases. RESULTS: during the first post-operative month, there were one death (due to sepsis) and two reocclusions (one of the dilated artery and the other of the bypass). They were successfully reoperated. At the moment of the study, the mean follow-up being thirty months, seven patients are deceaded (six of them from intercurrent disease), one has been amputated, three suffer intermittent claudication and twenty-nine are cured (but eight of them have been reoperated). CONCLUSION: synchronous arterial reconstruction and transluminal dilatation are a good option in case of multiple arterial occlusive disease particularly in poor risk patients and when inflow or outflow of bypasses should be improved. Associated balloon dilatation is very useful in case of too short vein graft or arterial stenosis due to a clamp injury. Nowadays in our department, these combined procedures are more and more frequent One stage procedure is associated with less complications, shorter length of hospitalization and lower cost.

Angioplasty↗
PubMed1997

Transmural endothelialization of vascular prostheses is regulated in vitro by Fibroblast Growth Factor 2 and heparan-like molecule.

Endothelialization of vascular prostheses may result from transmural migration of endothelial cells. Angiogenesis is controlled by growth factors like Fibroblast Growth Factor 2 (FGF2) and regulators like heparan-like molecules. To that end, we used heparan-like molecules named RGTA for ReGeneraTing Agent. The RGTA11 used was a chemically derived dextran obtained by successive substitutions with carboxymethyl, benzylamide, and benzylamide sulfonate groups on glucose residues. This agent was further selected for its ability to bind, stabilize and protect FGF2. We defined firstly the angiogenic capability of FGF2 in combination with RGTA11 on bovine aortic endothelial cells (BAEC) cultured on collagen I gels. Secondly, the role of FGF2 and RGTA11 in transmural endothelialization was assessed in a three-dimensional in vitro model using a polyethylene terephtalate prosthesis included in collagen gel. BAEC seeded on the external face can migrate to the luminal face of the prosthesis. Microscopic and histological evaluations were performed at 4 and 7 days. Results showed that the addition of RGTA11 alone did not promote angiogenesis while FGF2 alone did. However, RGTA11 combined with FGF2 produced a significant acceleration in angiogenesis compared to FGF2 alone. This combination magnifies and enhances the angiogenic processes leading to endothelialization of luminal face through transmural cellular migration. Our data demonstrates that in vitro transmural endothelialization of porous vascular prostheses by BAEC cultured on collagen I gels is upregulated by RGTA11 combined with FGF2.

Animals↗
PubMed1996

The management and outcome of critical limb ischaemia in diabetic patients: results of a national survey. Audit Committee of the Vascular Surgical Society of Great Britain and Ireland.

It is generally considered that the outcome from critical limb ischaemia (CLI) in people with diabetes is inferior to that in non-diabetic patients. However, excellent results have been reported in diabetic people with the use of bypass surgery to pedal arteries. Data from a prospective national survey on CLI have been analysed to compare surgical practice and outcome from CLI in diabetic and non-diabetic populations. Of 679 limbs included in the survey, 204 (30%) were in diabetic patients. Thirty-seven (18%) of diabetic limbs were treated by primary amputation compared to 43 (9%) in non-diabetics (p = 0.0013). Revascularization was the primary treatment intention in 127 (62.3%) of diabetic limbs compared to 342 (72%) in non-diabetics (p = 0.01). Bypass to pedal arteries was reported in only 2 (1%) diabetic patients. The limb salvage rate in diabetic patients was 60%, compared to 72.5% for non-diabetic patients (p = 0.0013). The mortality rates were 15% and 12% in diabetic and non-diabetic patients, respectively (NS). These results confirm that in the UK and Ireland diabetic patients with CLI fare considerably worse than do people without diabetes. The results may be improved if more pedal artery reconstructions were performed.

Adult↗
PubMed1996

Polytetrafluoroethylene grafts for carotid repair.

Polytetrafluoroethylene grafts are well established for bypassing occlusive disease in the lower limb but there are few reports which deal with the long-term results of such grafts in the neck. The present study was undertaken to evaluate the immediate and long-term results of polytetrafluoroethylene grafts for carotid repair. Between 1982 and 1991, 591 carotid operations (mostly endarterectomies) were performed by the authors. In 32 cases a polytetrafluoroethylene graft was used to replace (n = 12) or to bypass (n = 20) a stenotic lesion of the internal carotid artery. Postoperative angiography was obtained in all patients and the follow-up extended from 1 month to 9 years (mean 30 months) with clinical and duplex scan surveillance. There were no deaths within the first postoperative month. There was one acute postoperative stroke (3%) caused by plaque dislodgement and one symptomless occlusion demonstrated by routine angiography. During follow-up, seven patients died from other causes. No patient developed new neurological symptoms but routine duplex assessment showed one symptomless graft occlusion. The cumulative survival rate was 96% at 1 year and 91% at 4 years. The cumulative primary patency rate was 93% at 1 month, 89% at 1 year and 89% at 4 years. In specific situations polytetrafluoroethylene grafting is an adequate alternative to carotid endarterectomy but is not recommended by the authors as a routine procedure because of its occlusion rate (> 6.2%).

Aged↗
PubMed1996

Are neurologic events occurring during carotid artery surgery predictive of postoperative neurologic complications?

BACKGROUND: Per- and postoperative neurologic complications occurring during carotid artery surgery may be related to different mechanisms. Nevertheless, recent studies suggest that they are related and that patients who develop reversible neurologic events peroperatively are at risk of postoperative neurologic complications. We, therefore, studied 265 patients operated under regional anaesthesia to assess the incidence and the pathogenesis of per- and postoperative neurologic disorders and their relationship. METHOD: Neurologic function was adequately assessed in 261 patients during surgery. The operation was uneventful in 234 patients, while 27 suffered from transient ischaemic neurologic deficit occurring mainly during carotid artery clamping. RESULTS: Postoperative neurologic complications occurred in 6 (2.5%) of the patients who were symptom-free during surgery and in 1 (3.7%) of the patients who experienced neurologic deficit during surgery (NS). In this group, two additional patients had peroperative neurologic deficit which lasted a few hours postoperatively so that the total incidence of postoperative neurologic deficit (11.1%) was significantly higher than in the other group (P < 0.05). Emboli (N = 3) and carotid artery thrombosis (N = 3) were the main causes of postoperative neurologic deficit. CONCLUSION: We conclude that patients who have suffered from a peroperative neurologic complication were more frequently in an unstable neurologic condition postoperatively. However, the incidence of "new" neurologic deficit, separated by a free interval from the one occurring peroperatively, was not significantly different in this group.

Adult↗
PubMed1996

[Impregnated polyester prostheses: a theoretical advantage].

Leak-proof polyester grafts impregnated with collagen, gelatine or albumin are routinely used in vascular surgery. Theoretically, there are several advantages: no need for pre-coagulation, reduced operation time and graft manipulation, less blood loss during the operative period, better healing with a potentially greater resistance to infection. We analyzed all the publications in scientific journals to verify whether these theoretical advantages are validated by clinical trials. There have been 12 non-comparative series reporting favourable results but the lack of control groups makes it difficult to draw conclusions. Five comparative series with random assignment of patients have been reported. None of these series showed a substantial benefit from impregnation. Thus the use of an impregnated polyester graft would not appear to be justified for routine standard aorto-iliac surgery. Conversely, although no evidence has been provided by a comparative study, the major risk of haemorrhage in procedures such as extra-corporal circulation, the thoracic or abdominal aorta and in patients with a coagulation disorder, impregnated graft probably constitute an important progress.

Albumins↗
PubMed1996

[Antibiotic-impregnated prostheses: eclectic indications].

OBJECTIVE: Infection is a major complication in vascular stents. Stents impregnated with gelatine and dipped in Rifampicin have been shown to resist methicillin-resistant Staphylococcus aureus in both animal experiments and in man. It has been suggested that all aorto-ilio-femoral stents should be treated. To evaluate this method, we reassessed all stent infections observed in our patients who had undergone revascularization of the lower limbs from January 1985 to 1994. We excluded stents implanted for ruptured aneurysms or implanted in patients with a past history of local infection on vascular stents. RESULTS: The rate of septic complications observed during the first year was 1% for all patients in the series, 0% for aorto-aortic and aorto-biiliac stents and 0.7% for aorto- bifemoral stents. These rates are similar to those reported in the multicentric study directed by Goeau Brissonière using antibiotic impregnated stents. The extra cost involved in using such stents for aorto-ilio-femoral revascularization was estimated in this series at 2,180,000 Francs. The costs resulting from the three infections was estimated at 960,000 Francs. CONCLUSION: Based on the findings in this series, antibiotic impregnated stents should be indicated only in selected patients due to the extra cost: past history of local infection, ruptured aneurysms, femoro-tibial stents, cross or axillo-femoral revascularization for which the rate of stent infection is 6.3 - 3.2 and 1.4%, immunodeficient patients, multiple reoperations, post-irradiation arteritis and situations known to involve major risk of infection.

Aged↗
PubMed1996

[Severe limb ischemia due to iatrogenic trauma].

OBJECTIVES: Assess the frequency, severity and technical problems raised by iatrogenic trauma to the arteries. METHOD: A retrospective study of 45 cases of iatrogenic arterial trauma treated over a 25-year period was studied. RESULTS: The most frequent cause was arterial catheterization (n = 32 including 24 of the lower limbs and 8 for the upper limbs) performed for arteriography (n = 16), coronarography (n = 13) or endovascular therapy (n = 3). Thrombectomy was performed in 24 cases, bypass in 4 and endarterectomy in 4. Post-operative period was uneventful in all except two fatal cases. CONCLUSION: In most cases, iatrogenic arterial trauma can be avoided with proper technique. Prognosis is highly dependent on early care.

Adult↗
PubMed1996

[False anastomotic aneurysms after aorto-femoral prosthesis. Detection, prevention and treatment].

OBJECTIVE: The aim of this study was to evaluate screening, prevention and treatment of false anastomotic aneurysms (FAA). METHOD: A retrospective analysis of 95 FAA observed in 72 patients (67 males, 5 females, age range 48 to 93 years was conducted. Mean delay to onset was 7.5 years. RESULTS: Diagnosis was made on the basis of imaging evidence using, since 1978, duplex-scan: 8/15 FAA of the aorta, 4/5 FAA of the iliac arteries and 35/75 FAA of the femoral arteries. Treatment was always difficult due to atherosclerosis. The greatest difficulties were encountered in aortic FAA with 1 death due to septic rupture, 1 nephrectomy by ureteral fistula and 1 graft sepsis successfully treated with an allograft. There were 2 deaths in the iliac FAA, 1 due to ureteral fistula and 1 due to heart failure. For femoral FAA, there were 3 deaths (cerebral hemorrhage, graft sepsis and renal failure after acute aortic thrombosis). Long term results showed 6 recurrent femoral FAA which were reoperated successfully. CONCLUSION: FAA complicates 2 to 5% of graft procedures and can lead to death and amputations: 1.) Clinical surveillance and regular duplex-scan examinations are essential: the diagnosis should also be entertained in case of digestive hemorrhage. 2.) The threshold of dilatation which suggests the need for surgical repair would appear to be a two-fold dilatation but for the aorta, localized dehiscence requires surgery. 3.) A graft procedure is usually used, stents can by used for end-to-end aortic or iliac anastomoses. 4.) Since FAA remains a risk after graft, revascularization should be entertained when other methods have failed. 5.) Patients should be informed of the risk and of movements to avoid in case of femoral anastomoses and also of required regular checkups.

Aged↗
PubMed1995

Conventional versus endovascular surgical procedures: a no choice option.

The on-going debates on the competitiveness of endovascular and conventional surgery in the treatment of peripheral occlusive vascular diseases are justified by the fact that endovascular procedures are associated with a lower mortality and morbidity, require a shorter hospital stay, and are less costly than conventional surgery. However, scientific and economic comparisons between the two techniques are difficult because they cannot strictly be applied to the same patients. Patients who may benefit from endovascular surgery are generally at an earlier stage of the disease, they have claudication and short stenoses or occlusion. On the other hand, patients who present with severe claudication or critical ischaemia, in most cases, have long occlusions, multiple segmental disease and often require conventional surgery.

Angioplasty, Balloon↗
PubMed1995

Iliac and femoropopliteal lesions: evaluation of balloon angioplasty and classical surgery.

PURPOSE: The purpose of this study was to compare the characteristics of patients treated for atherosclerotic disease of the lower extremities with balloon angioplasty (BA) or classical surgery (CS) and to assess the outcome of both techniques. METHODS: The records of 1364 patients who were treated with BA or CS for chronic lower limb ischemia between 1986 and 1993 were analyzed. Demographic features of patients, immediate and long-term survival, patency, and amputation rates were compared in both groups according to the level of the revascularization (iliac or femoropopliteal). RESULTS: Patients undergoing BA were slightly younger (62.3 years versus 65.9 years for CS group; p = NS) and demonstrated symptoms consistent with less severe atherosclerotic disease (81% claudication in the BA group versus 48% in the CS patients; p < 0.001). At 30 days post-treatment in the BA and CS groups, respectively, there were 0.7% and 4% deaths (p < 0.01); 13% and 6% primary failures (p = 0.013); 13% and 6% secondary failures (p = 0.01); 0.3% and 12% general complications (p = 0.001); and 3% and 8%, nonvascular complications (p = 0.007). At the iliac level, in the angioplasty (n = 134 limbs) and surgery (n = 721 limbs) groups, respectively, the mean age was 57.6 and 63.7 years (p < 0.01), and claudication was present in 91% and 72%. Perioperative mortality was 0% and 1.9%. The 4-year survival rates were 95% and 88%; patency was 70% and 79%; and the amputation rates were 0% and 5%. At the femoropopliteal level, in the angioplasty (n = 138 limbs) and surgery (n = 656 limbs) groups, respectively, the mean age was 67.8 and 66.8 years (NS), and claudication was present in 69% and 28%. Perioperative mortality was 0.9% and 5.5%. The 4-year survival rates were 95% and 78%; and patency was 44% and 65%. At 2 years, the amputation rates were 6% and 12%. CONCLUSIONS: Patients treated by BA were younger, especially in the iliac group, and had less symptomatic lesions than patients treated with surgery. Surgery achieved a better long-term patency at the cost of a higher immediate complication rate and mortality. Whenever technically feasible, BA may be the better choice for initial therapy in appropriate patients suffering from chronic lower limb ischemia.

Aged↗
PubMed1995

[Patients operated on for aneurysms of the abdominal aorta: risk factors and survival].

Patients requiring radical cure of an aneurysm of the abdominal aorta often have associated conditions increasing the risk of peri-operative complications and immediate or short-term mortality. Detecting such associated lesions is thus of major importance to adapt patient management and treatment strategy. We assessed the following parameters associated with increased risk of peri-operative death in a series of 418 patients who underwent elective surgery for aneurysms of the abdominal aorta between 1986 and 1994: chronic renal failure (with or without dialysis), clinically apparent coronary artery disease, age over 75 years, defective left ventricular function. The effect of the characteristics of the aneurysm on immediate survival was also assessed. Aneurysm larger than 6 cm extending to the hypogastric artery had a higher operative risk. Post-operative survival was 96.5% at one month, 90% at one year and 87% and 69% at 2 and 5 years respectively. The predominant causes of death late in the post-operative period were vascular disease (coronary or neurologic) and cancer. Complications related to the operation were rare (1.5%). In conclusion, detection of operative risks allows 1) better patient selection for surgery, 2) adopting appropriate measures when the indication for surgery is retained, 3) establishing a follow-up and a screening protocol for detecting factors causing late deaths.

Aged↗