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Biomedical subjects

R Courbier

Publications and source records attributed to R Courbier.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

The role of omentopexy in the prevention of femoral anastomotic aneurysm.

In our experience the incidence of anastomotic aneurysms (AA) after prosthetic bypass varied from 0.3 to 0.7% depending on location; it was 5 times higher at aortobifemoral anastomoses (77/3146; 2.44%) than aortic anastomosis (8/2173; 0.37%) (p less than 0.005). In the inguinal region the incidence of femoral AA (FAA) is the same as elsewhere when the prosthesis is placed in front of the inguinal ligament (axillo-femoral anastomoses, 1/200; 0.5%; femoro-femoral anastomoses 1/270; 0.37%). However when the prosthesis is placed behind the ligament, the incidence of FAA rises to 2.44% (77/3746). In our opinion, this difference is due to adherence between the prosthesis and the ligament during hip movement. When the hip is in extension, tension is placed on the prosthesis and the adjacent arterial junction causing the wall of the artery to tear. The sutures almost always remain intact. In an effort to avoid this problem, we have developed a technique that consists of enlarging the passage of the prosthesis by partial section of the inguinal ligament and then wrapping the prosthesis with a free non pedunculated segment of omentum from above the femoral anastomosis down to the healthy segment of the femoral artery which, being elastic, can stretch. The omentum acts as sheath that reinforces the anastomosis. To evaluate this technique we assessed our patients operated upon for aortobifemoral (or aortofemoroiliac) bypass into two groups. Group A included 115 patients operated on by the same surgeon using the new technique (October 1981 and December 1984). There were 111 men and 4 women (mean age: 59.7 years). Mean follow-up was 7.36 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMedDate not supplied

Stroke prevention during carotid surgery in high risk patients (value of transcranial Doppler and local anesthesia).

In a series of 114 cases, carotid surgery was performed under local anesthesia by cervical block in order to assess cerebral status. Preoperative transcranial Doppler was used to select high risk patients for shunting. Intraoperatively brain function was checked by carotid arterial blood pressure monitoring and transcranial Doppler. No stroke occurred during the procedure. Postoperatively two deaths (1.8%) occurred, one due to intracerebral hemorrhage and one to a late myocardial infarct. The predictive value of both transcranial Doppler and stump pressure monitoring for shunting was 97% respectively. In combination, the two methods provided 100% protection. During the same period, 1406 patients underwent carotid surgery under general anesthesia. Carotid surgery stroke can be prevented either by using transcranial Doppler together with carotid stump pressure monitoring when the procedure is performed under general anesthesia or by operating under local anesthesia.

Aged↗
PubMedDate not supplied

Single staged carotid and coronary arteries surgery. Indications and results.

The frequency of associated carotid and coronary stenosis is estimated to be 40% of cases including asymptomatic patients. The risk of death by myocardial infarction during carotid surgery is in the neighborhood of 1%. With Doppler and ultrasonic imaging, it is now possible to recognize carotid stenosis in 11% of these cases. Depending on the extent of the clinical manifestations caused by one or the other of these lesions, there are several therapeutic options: surgery of the carotid with special protection of the myocardium during and after surgery or simultaneous carotid and coronary surgery in high risk cases. Between 1979 and 1986, simultaneous surgery was performed in 18 cases in our department. During the same period, 1194 carotid endarterectomies and 505 coronary bypasses were performed. These 18 cases included 13 males and 5 females with a mean age of 62 years (range: 43 to 78 years). The procedure performed in these cases were 17 carotid endarterectomies, one bypass of the innominate artery and an average of 2 aorto-coronary bypasses per patient. One death from myocardial infarction occurred in the immediate postoperative period and another patient died suddenly 8 months later. The evolution of arterial disease was evaluated in the other patients. Simultaneous carotid and coronary artery surgery is indicated in high risk carotid and coronary patients. Perusal of the results in the literature allows a better appreciation of the indications and risks of this type of surgery. Our series indicates the necessity for a careful preoperative workup in these patients and the need for more accurate screening to obtain better results.

Adult↗
PubMedDate not supplied

Current status of vascular grafting in supraaortic trunks. Personal experience.

Two-hundred forty-nine patients underwent prosthesis implantation for supraaortic trunk disease. The most frequently used technique for lesions of the innominate artery was direct repair via sternotomy. Mortality was very low (2.8%) and at 97.3% late patency was excellent (mean follow-up: six years). Extra-anatomical bypasses were reserved for all other lesions of the subclavian and common carotid arteries or contraindications to the direct approach. Patency for carotido-subclavian bypass (81 patients) and subclavio-subclavian bypass (134 patients) was 71% (mean follow-up: 4.6 years) with one operative death. Indications are decided on the basis of the extent and aspect of the lesions.

Anastomosis, Surgical↗
PubMedDate not supplied

Carotid restenosis: should they all be reoperated on?

Restenosis of carotid arteries after endarterectomy is a rare complication; in our series 1.2% (19 patients - 20 recurrences out of 1658 operations - Dec. 1985). It usually occurs early, i.e. in the first months (12 cases) with features of myointimal hyperplasia. Peroperative angiography should be routinely performed to rule out technical errors that might be mistaken for restenosis. At the time of reoperation, 12 patients were symptomatic. The operation consisted of 6 second endarterectomies, 13 saphenous vein grafts and 1 PTFE graft. The postoperative period was uneventful in 14 cases, but in the remaining patients there were 2 transient ischemic attacks, 2 monoplegias and 1 dysphasia (with immediate thrombosis of the bypass in 3 cases). Five patients were lost at follow-up. In the remaining 14 patients, the follow-up period varied between 3 and 84 months (mean: 20 months). Presently 11 carotid arteries are patent. In one case involving a venous patch, the artery is dilated. All 12 of these patients are asymptomatic. One thrombosed bypass is also asymptomatic. The two monoplegias occurred in patients whose bypasses occluded immediately. The recurrence rate varied according to the imaging technique. i.e. pulsed Doppler, B-mode scanning or angiography, used to detect restenosis. Restenosis usually remains asymptomatic even in patients with hemodynamically significant lesions. Restenosis due to myointimal hyperplasia does not carry the risk of embolism and atheromatous stenosis does not have the same prognosis. In our experience immediate and long term results of red are not as good the first endarterectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Influence of the haemodynamic parameters on the repartition of the flow between an artery and its graft.

The aim of this study was to investigate the repartition of the flow between an artery and its graft for several values of the geometric and dynamic parameters (length and severity of the stenosis, Reynolds number and frequency pulse value). The model, fabricated in silicone, was included in an hydrodynamic test bench, allowing to reproduce physiological conditions. Our study showed that the severity of the stenosis was the most influent parameter on the repartition of the flow; in particular, a 75% severity was necessary to obtain a repartition 70-30% between the graft and the artery.

Arterial Occlusive Diseases↗
PubMedDate not supplied

[Indications of intraluminal shunt. In carotid surgery].

The essential clamping during carotid artery surgery requires different procedures for cerebral protection. Most surgeons prefer the use of an intra-luminal shunt allowing conservation of a part of the proximal carotid artery. A study was conducted to compare two statistically similar series of 50 patients (with a residual pressure of less than 50 mmHg) treated or not by intra-luminal shunts. Results showed a significant difference with respect to early postoperative neurologic accidents between the groups operated without (8% accidents) and with (0%) shunts. Precise indications for the use of this procedure are discussed in relation to pre- and peri-operative findings, with the aim of reducing the incidence of postoperative neurologic complications.

Aged↗
PubMedDate not supplied

Carotid stenosis. Surgery after 75 years.

Is it reasonable and useful to perform surgery on carotid lesions after 75 years? ("old man" according to the W.H.O. classification). To answer this question, we re-examined 66 patients aged 75 to 87 years, who underwent 76 carotid thromboendarteriectomies with one post-operative death. The results study showed that morbidity and general complications were not more important than in younger patients. Late results from 2 to 94 months showed a very low percentage of secondary neurologic complications even if patients had a vascular or general surgical intervention in a second period: 13 cases. There were only 2 re-stenoses. Indications were defined, but it was above all the asymptomatic patients or patients who had a TIA who could benefit from them.

Age Factors↗