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Biomedical subjects

R Suy

Publications and source records attributed to R Suy.

At least 19 recordsLinked to original sources
PubMed1991

Graft occlusion following aortofemoral Dacron bypass.

We report on a series of 930 patients who received an aortobifemoral Dacron graft between 1963 and 1988. The operative mortality was 5.6% and the mean follow-up reached 5.45 years (range one month to 23.6 years). Late occlusion was noted in 125 patients and the primary patency rate decreased to 74% and 69%, respectively at 10 and 15 years. Long-term patency was primarily (p less than 0.05) dependent on (1) the date of operation, (2) postoperative smoking habits, (3) distal occlusive disease, and (4) age of the patients at the time of surgery. Vascular reconstruction for late thrombosis was performed for 110 late occlusions in 103 patients. Included were 95 unilateral and 15 bilateral occlusions. The method of choice was graft limb thrombectomy (unilateral occlusion) or anatomical graft replacement (bilateral occlusion or unilateral occlusion when thrombectomy proved to be impossible). Associated outflow reconstructions consisted of profundaplasty in 73.3% of the cases. A mean yearly thrombosis rate of 9.4% (range 4-14%) resulted in a five year patency rate of 59%. Differences between graft thrombectomy and anatomical replacement were not statistically significant. Reconstruction for secondary occlusions was associated with a 25% thrombosis rate. Tertiary occlusion in six cases invariably led to major amputation. A total of 20 patients ultimately needed a major amputation, resulting in an eight year limb salvage rate of 79%.

Aorta↗
PubMed1991

The return of clinically evident ischemia after coronary artery bypass grafting.

Although survival after coronary artery bypass grafting (CABG) is the most serious outcome information, the quality of life in living patients is largely determined by the freedom from ischemic events. The return of angina, acute myocardial infarct and sudden death were studied in a large (n = 5880) population of patients undergoing CABG between 1971 and 1987. The freedom from angina pectoris was 95%, 83% and 63% at 1, 5 and 10 years, respectively, after surgery. Early return of angina was related to both procedure incremental risk factors (incomplete revascularization and non-use of the internal mammary (thoracic) artery (IMA) as a conduit) and patient incremental risk factors (aggressiveness of the atherosclerotic process and severity of preCABG symptoms). Late angina return was related to patient risk factors including coexisting factors (hyperlipidemia and hypertension), preCABG symptom severity and gender (female). The freedom from an acute fatal or non-fatal postCABG myocardial infarct was 99%, 96% and 85% at 1, 5 and 10 years after surgery. The incremental risk factors for early infarction were related to incomplete revascularization, but late infarction was related to lipid levels, coexisting diseases (diabetes, positive family history) and non-use of IMA to LAD. The freedom from sudden death was 99.8%, 99% and 97% at 1, 5 and 10 years, respectively, after surgery. The incremental risk factors were dominated by the severity of the left ventricular dysfunction. The freedom from any ischemic event (any of the previous three) was 93%, 79% and 54% at 1, 5 and 10 years, respectively, after surgery. The incremental risk factors included all those cited above for the specific components. Patient-specific predictions validate the influences of these risk factors. They demonstrate that unlike the profound influence of the use of the IMA on survival, there is little benefit of the use of the IMA on return of ischemic events over and above the effect of revascularization per se. The study demonstrates that most patients will experience return of ischemic symptoms within a period of 15-20 years after surgery, but that this is most likely to be return of angina and rarely sudden death.

Adult↗
PubMed1991

Aortofemoral dacron reconstruction for aorto-iliac occlusive disease: a 25-year survey.

The authors present a consecutive series of 869 patients, who received an aorto(bi)femoral Dacron graft for occlusive disease between 1963 and 1988. The operative indications were grade 1 disease (n = 371), grade 2 disease (n = 408) or grade 3 disease (n = 90). The operative mortality was 4.5% and remained stable over the years of the study. The median survival was 8.2 years and 25% of the patients survived for more than 15 years. Late patency decreased to 74% and 70% after 10 and 15 years, respectively. Fifty-six patients underwent a major amputation in the long run. The amputation rate increased to 3, 8.6 and 12.1%, respectively for grade 1, grade 2 and grade 3 disease. Satisfactory functional results were obtained by 51% and 40% of the patients after 10 and 15 years, respectively. By means of secondary and tertiary operations this increased to 70% and 61%. Long term functional results were primarily dependent on smoking habits postoperatively, the date of operation and the presence of concomitant femoro-popliteal occlusive disease.

Amputation, Surgical↗
PubMed1991

Routine screening for unsuspected aortic aneurysms in patients after myocardial revascularization: a prospective study.

Ultrasonography of the abdominal aorta was routinely performed in a consecutive series of 100 patients during postoperative reconvalescence after myocardial revascularization. The mean aortic diameter was greater in the male series (n = 80) then in the female population (n = 20) (2.17 +/- 0.85 cm vs 1.6 +/- 0.3 cm). Abnormalities were only seen in male patients over 50 years of age (n = 65). The overall incidence of aneurysm greater than or equal to 4 cm was 6%. The incidence of aortas at least 3 cm was 7/65 (11%). It is suggested that the incidence of unsuspected aortic aneurysm in this subgroup is high enough to justify continued screening programmes by ultrasound.

Adult↗
PubMed1990

Carotid artery endarterectomy in patients over seventy years-of-age.

Carotid artery endarterectomy in the elderly patient has been considered to be a high risk procedure. Recent reevaluation, however, showed that advanced age alone doesn't seem to increase the perioperative surgical risk. We retrospectively reviewed the records for 222 carotid artery endarterectomies, not combined with any other type of surgery, in 195 patients over 70 years-of-age. Twenty-eight patients (14.3%) were asymptomatic, 43% were seen after transient ischemic attacks, 5.1% after reversible ischemic neurologic defects, and 37.4% after stroke. A standard operative protocol was followed. We used a shunt in 45.5% of patients, a standard endarterectomy was performed in 93% of patients, using a patch in 68%. There were three perioperative deaths and seven perioperative strokes in the series; total combined morbidity and mortality was 5.1%. In the 73 patients operated after previous stroke, three died and five suffered a perioperative stroke; total combined morbidity and mortality was 10.9%. In the 122 patients operated after previous transient ischemic attack or asymptomatic, two suffered a perioperative stroke; total combined morbidity and mortality was 1.6%. Late survival was identical to the survival of a normal Belgian control population, and stroke and death-free ratio at five years was 65%, 52% for patients operated after previous stroke and 69% for asymptomatic patients or patients operated after transient ischemic attack. Carotid artery endarterectomy can be performed in patients over 70 years-of-age with perioperative results equal to those of younger patients.

Age Factors↗
PubMed1990

Internal mammary artery: methods of use and their effect on survival after coronary bypass surgery.

Hazard analysis of total and cardiac mortality after isolated primary coronary artery surgery was performed using univariate and multivariate methods with special emphasis on the importance of the use and method of use of the internal mammary artery (IMA) as a bypass graft. The clinical data of 5880 consecutive patients were studied. The sum of the real follow-up periods studied was 27,948 years. The hazard of total and cardiac mortality could be defined in three-phase parametric models with an early, a constant and a late phase. The total survival was 82% +/- 1% at 10 years and 59% +/- 3.6% at 15 years. The construction of a single IMA distal graft (using left or right IMA) had a positive influence on the hazard (P = 0.0004) in the late phase after surgery with a high estimate (-1.6). The cardiac survival was 89% +/- 0.8% at 10 years and 74% +/- 3.5% at 15 years. The use of the left IMA had a positive influence (P = 0.001) in the late phase after surgery with a very high estimate (-2.3). The generated simulation of the total survival of a median patient with an IMA graft is 97% at 5 years and 94% at 10 years; for a median patient without an IMA graft, it is 97% at 5 years and 88% at 10 years. If a patient has other risk factors reducing his life expectancy, the influence can be dissipated because of lower survival rates at 5 years after surgery, when the effect of the IMA becomes most apparent.(ABSTRACT TRUNCATED AT 250 WORDS)

Belgium↗
PubMed1990

Aorto-femoral reconstruction and sexual function: a prospective study.

The influence of aorto-femoral (AF) Dacron reconstruction on sexual function and pelvic circulation was studied prospectively in 62 male patients with aorto-iliac occlusive disease. Erectile function remained unchanged in 77%. Improvement or deterioration was seen in 11.3% and 20.5% of the cases respectively. Impotence occurred in only one patient (6%) with normal function preoperatively but in 31% of those presenting with impaired erection. Pelvic circulation, as reflected by the penile brachial index (PBI), was not affected in 74%, increased in 11% and decreased in 15% of the reconstructions. Pelvic circulation was at least preserved in 90% after an end-to-side proximal anastomosis and in 82% after an end-to-end anastomosis. Since fluctuations in sexual function could be related to changes in PBI in only 36% of the cases it is concluded that sexual disorders after AF surgery are due to a combination of disturbed pelvic haemodynamics and interruption of the preaortic autonomic plexus. Patients with impaired erectile function are especially at risk of a deterioration and the possibilities of restoring erectile function in patients with aorto-iliac stenosis by isolated AF reconstruction are limited.

Aorta, Abdominal↗
PubMed1990

Autotransfusion during aorto-iliac surgery.

Red blood cell (RBC) quality and function during autotransfusion with the Solcotrans system were studied. Up to 64% (mean 999.5 +/- 310 ml) of the total volume of blood lost (mean 1895 +/- 707 ml) during operation in 10 patients undergoing elective abdominal aortic surgery was salvaged. No patient received homologous blood during surgery. Haemoglobin (Hb) and Haematocrit (PCV) values decreased but within acceptable limits. No evidence of DIC was found and renal function was unaffected. Mechanical and functional damage to the RBC was minimal and erythrocyte oxygen-carrying capacity was excellent. 2,3-DPGRBC concentration and RBC reduced glutathion were normal. The device was easy to handle and technical problems were not encountered. It was accurate in salvaging blood although the need for homologous blood was not entirely eliminated since four patients received homologous blood products in the postoperative period. No adverse clinical events occurred.

Aged↗
PubMed1990

[Angioplasty using a Nd:YAG laser with a sapphire probe].

Laser angioplasty with Sapphire Contact Probes coupled to a Nd:YAG laser followed by balloon angioplasty was performed in 30 patients with 26 femoropopliteal and 4 iliac artery occlusions. Mean length of the occlusions was 4.5 +/- 1.6 cm with a mean duration of occlusion of 7.06 +/- 6.18 months. Initial angiographic success was obtained in 25/30 (83%) procedures, including 3/4 successes in the iliac artery (75%) and 22/26 successes in the femoropopliteal artery (84%). Reason for failure was perforation in 2 patients, and subintimal passage of the probe in 2, and heavy calcification of the lesion in 1 patient. Early rethrombosis in 3 patients reduced the primary success rate to 73%. Peripheral emboli necessitating surgical intervention occurred in 2 patients. Of the 22 recanalized arteries 21 remained patent with a mean follow-up of 8.4 +/- 3.3 months. It remains to be determined whether the angiographic and clinical short and long term success rate of "laser assisted balloon angioplasty" will be greater than after thrombolysis or conventional balloon angioplasty.

Aged↗
PubMed1990

Preliminary results of percutaneous transluminal atherectomy.

Percutaneous transluminal atherectomy with the Simpson atherectomy catheter was performed in 5 patients with severe atheromatous stenoses of the femoropopliteal arteries. In all patients plaque material was removed with successful restoration of vessel patency. Further clinical follow-up will have to determine whether recurrence rate of stenosis will be lower with this method than with conventional balloon angioplasty.

Arteriosclerosis↗
PubMed1990

Outpatient angiography.

Outpatient angiography of the abdominal aorta and the peripheral arteries of the under limbs was performed in 100 patients with complaints of peripheral vascular disease. In all patients small 5F catheters, a low-osmolar contrast medium and intraarterial digital subtraction angiography could reduce the local and general invasiveness of the angiographic procedure. Two complications occurred. In one patient thrombosis at the puncture site was noted. In another patient, an onset of angina pectoris was a minor and transitory complication. In 42 out of the 100 patients, treatment was conservative so that hospitalization could be avoided. With newer technical equipment angiography can be performed safely on an outpatient basis with important costsaving for the community. The late occurrence of some complications though, requires good information of the patient.

Adult↗
PubMed1989

Arterial infection following renal transplantation: successful management using transperineal femorofemoral crossover graft.

Infection of a vascular prosthesis or an arterial receptor site is one of the most challenging situations for the vascular surgeon. In some instances the standard extraanatomic routes to bypass infected areas cannot be used. Two cases of arterial infection following renal transplantation are presented. An infrascrotal perineal approach for a femorofemoral bypass was used to achieve revascularization of a threatened limb.

Adult↗
PubMed1989

Balloon angioplasty combined with vascular surgery.

Seventy-nine intra-operative balloon angioplasties were performed in 72 patients undergoing a vascular reconstructive procedure over a 7-year-period (1981 through December 1987). The primary purpose of balloon angioplasty was either to increase inflow (26 procedures) or outflow (53 procedures) in association with a planned vascular operation and to avoid more extensive operative procedures in high risk patients. Peroperative balloon angioplasty involved atherosclerotic stenotic lesions in 26 iliac, 37 femoro-popliteal and 10 crural arteries. In 6 cases distal graft anastomotic stenoses were dilated. Follow-up ranged from 2 to 78 months (mean 32.4 months). The overall initial success rate was 84.8% and five procedure related complications were seen. One iliac restenosis with distal thrombosis, two superficial femoral artery dissections, one tibial artery thrombosis necessitating below knee amputation and one distal popliteal embolus after superficial femoral artery dilatation. There were no postoperative deaths. Fifty-one patients remained asymptomatic during follow-up. One iliac, eight femoro-popliteal and two tibial arteries restenosed with or without occlusion and thrombosis. The 3-year cumulative patency rate for the iliac and femoro-popliteal angioplasties is 80.2%. Intra-operative balloon angioplasty broadens the surgical therapeutic armamentarium available to correct multiple symptomatic arterial lesions. In addition this technique offers several advantages over a two stage procedure.

Adult↗
PubMed1989

Percutaneous transluminal renal angioplasty versus renovascular surgery: statistical, medical and economical considerations.

Retro- and prospective comparative studies in patients with renal artery stenosis demonstrate that technical results and blood pressure improvement after renovascular surgery or percutaneous transluminal renal angioplasty (PTRA) are strictly comparable. The lesser invasive character of PTRA together with its lower complication rate and the lower cost explain why PTRA is the method of choice in the treatment of renal artery stenosis, with less restrictive selection criteria than used for surgery.

Angioplasty, Balloon↗
PubMed1989

Balloon angioplasty of venous structures.

Percutaneous transluminal angioplasty was attempted in 20 patients with stenoses of venous structures. It concerned one stenosis in a native subclavian vein, 12 stenoses in venous bypass grafts and 7 stenoses in hemodialysis-access fistulas. Primary results were excellent for the procedures in the native vein and the venous bypass grafts with success in all patients (13/13). In the arteriovenous fistulas for hemodialysis, dilatation of the venous stenoses was only possible in 5 out of 7 patients. The subclavian vein stenosis did not recur within a follow-up period of 3 years. Of the stenoses in the venous bypass grafts, two lesions reoccluded within one week and 6 lesions recurred within one year. Two of these lesions were successfully redilated so that 6 lesions remain patent with a follow-up of more than one year. Of the 5 successful dilatations in hemodialysis-access fistulas, two lesions recurred within 2 months. Only 3 veins are still accessible for hemodialysis. It is concluded that attempts at balloon dilatation of stenoses in venous bypass grafts or hemodialysis-access fistulas are meaningful in order to prolong the life of these surgical procedures. Recurrence of stenoses is however likely to occur within one or two years.

Angioplasty, Balloon↗
PubMed1988

Intravenous digital subtraction angiography and Duplex scanning in the detection of late human umbilical vein degeneration.

To define the exact incidence of late degeneration, 32 patients underwent intravenous digital subtraction angiography (IVDSA) and/or a Duplex scan more than 3 years after human umbilical vein (HUV) grafting. IVDSA (n = 26) showed a 23 per cent aneurysmal degeneration rate which increased to 40 per cent with Duplex scanning (n = 25). Although the differences obtained in those patients receiving both examinations (n = 19) were statistically not significant, Duplex scanning appeared to be more sensitive, demonstrating two additional cases of aneurysmal degeneration not detected by IVDSA. Since, moreover, Duplex scanning proved able to detect anastomotic stenosis, it appears to be the examination of choice in long-term follow-up of the HUV graft. Despite this relatively high degeneration rate, the authors consider continued use of the HUV graft in selected patients to be justified, especially when the long-term patency rates, the available alternatives, and the less favourable long-term survival after femoropopliteal reconstruction are taken into consideration.

Aneurysm↗
PubMed1988

Intraarterial embolization in combination with surgery in the management of congenital pelvic arteriovenous malformation.

A case of congenital arteriovenous fistula of the pelvis is described. Arteriovenous malformations of the pelvis are rare and can give rise to problems in diagnosis and treatment. A long history of vague complaints precedes determination of the correct diagnosis. Because recurrence is not uncommon after treatment, intraarterial embolization in combination with surgery is mandatory.

Adult↗