References of "Van Damme, Hendrik"
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See detailFemoral Anastomotic Aneurysms: Pathogenic Factors, Clinical Presentations and Treatment. A Study of 142 Cases
Demarche, Martine; Waltregny, David ULg; Van Damme, Hendrik ULg et al

in Cardiovascular Surgery (1999), 7(3), 315-22

In this study, the files of 112 patients with a total of 142 femoral anastomotic aneurysms were reviewed. Eighty-five patients (76%) were initially operated upon for obstructive aorto-iliac disease, while ... [more ▼]

In this study, the files of 112 patients with a total of 142 femoral anastomotic aneurysms were reviewed. Eighty-five patients (76%) were initially operated upon for obstructive aorto-iliac disease, while the remaining 27 (24%) had abdominal aortic aneurysms repaired. The majority of the patients (104/112) were male and their mean age was 64.5 years (range 45-88). Ninety-three per cent of the subjects were smokers prior to the first operation and 43% continued to smoke at the time of their femoral anastomotic aneurysms operation. The mean delay between the initial surgery and the repair of the femoral anastomotic aneurysms was 74.5 months (range 1-228). The diagnosis was made because of a painless pulsatile mass (91/142), acute leg ischaemia (27/142), a painful pulsatile mass (12/142), haemorrhage (10/142), pseudo-post-phlebitic oedema (1/142) and microemboli of the toes (1/142). The operative mortality was 2.7% (3/112) of which two-thirds were patients with infected grafts. Two subgroups were distinguished: 10 patients with an infected femoral anastomotic aneurysm and 12 patients with recurrent femoral anastomotic aneurysms, 11 with a single recurrence and one with a double recurrence. In the infected group, the time to development of anastomotic aneurysm was shorter than for the group with non-infected femoral anastomotic aneurysms (41 versus 74.5 months) and the operative mortality was 20% (2/10). One patient developed a recurrent femoral anastomotic aneurysm and another was lost to follow-up. Two subsequent deaths occurred, which were unrelated to the femoral anastomotic aneurysms. In the group of recurrent femoral anastomotic aneurysms one patient was lost to follow-up and two patients died, but not as a result of recurrent femoral anastomotic aneurysms. A total of 122 cases underwent interposition of a new prosthetic segment between the proximal prosthesis and the distal artery (89 at the common femoral, 21 at the femoral profundis, eight at the superficial femoral and four at an existing femoro-popliteal graft). [less ▲]

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See detailLe cas clinique du mois. Diagnostic et traitement du kyste adventitiel de l'artere poplitee.
Zeaiter, R.; SakalihasanN, Natzi ULg; VAN DAMME, Hendrik ULg et al

in Revue Médicale de Liège (1999), 54(6), 514-6

The authors report the case of a 66-year-old patient with unilateral intermittent claudication, in whom no evidence of intravascular occlusive disease was found. Surgical approach revealed an ... [more ▼]

The authors report the case of a 66-year-old patient with unilateral intermittent claudication, in whom no evidence of intravascular occlusive disease was found. Surgical approach revealed an intraparietal cystic adventitial disease of the popliteal artery. An excision of the affected segment and bypass grafting with the internal saphenous vein was done. [less ▲]

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See detailFibromuscular dysplasia of the internal carotid artery. Personal experience with 13 cases and literature review.
VAN DAMME, Hendrik ULg; SakalihasanN, Natzi ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (1999), 99(4), 163-8

From January 1990 to December 1997, the authors observed 13 cases of fibromuscular dysplasia of the internal carotid artery. Four patients presented transient ischemic attacks, one amaurosis fugax, two ... [more ▼]

From January 1990 to December 1997, the authors observed 13 cases of fibromuscular dysplasia of the internal carotid artery. Four patients presented transient ischemic attacks, one amaurosis fugax, two suffered from a minor stroke, four had non-focalized ischemic cerebral symptoms and two were asymptomatic. At angiography, all patients showed a typical image of "string of beads". Seven patients were operated on. Six had endoluminal graduated dilatation, with rigid dilators up to 4.5 mm, associated with thrombendarterectomy of the bifurcation in three and to correction of a kink in one case. In one case a venous interposition graft was done to exclude a saccular microaneurysm of the dysplasic internal carotid artery. In another case, backflow was insufficient after endoluminal dilatation, and a long venous patch allowed to restitute a normal vascular lumen. There was neither postoperative mortality nor stroke. Six patients, asymptomatic or with non focalized symptoms, were treated medically. During a mean follow-up of 47 months, only one of the 13 patients developed a transient ischemic attack; the patient had not been operated on and received only medical treatment. Prevalence, etiopathology, diagnosis and management of fibromuscular dysplasia of the internal carotid artery are discussed. Fibromuscular dysplasia is a rare cause of cerebral ischemia. For asymptomatic lesions, a conservative approach seems appropriate. Surgery is only to be considered for symptomatic lesions. Surgical graduated endoluminal dilatation, where necessary combined with standard endarterectomy of the carotid bifurcation, is a safe, efficient and durable operation. Some complex cases of fibromuscular dysplasia may necessitate patch insertion or excision and graft interposition. [less ▲]

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See detailLa dysplasie fibromusculaire
VAN DAMME, Hendrik ULg; Quaniers, Janine ULg; Limet, Raymond ULg

in Revue Médicale de Liège (1999), 54(12), 935-42

Fibromuscular dysplasia is a rare non-atherosclerotic, non-inflammatory arterial disease. It concerns less than 1% of all occlusive artery lesions, but is more common in young female patients, with a ... [more ▼]

Fibromuscular dysplasia is a rare non-atherosclerotic, non-inflammatory arterial disease. It concerns less than 1% of all occlusive artery lesions, but is more common in young female patients, with a prevalence of 3 to 5% of the arterial lesions in that age group. It mainly attains renal and carotid arteries. The authors discuss the etiopathogeny, the prevalence and treatment of fibromuscular dysplasia. Their own surgical experience with 21 renal and 10 carotid lesions of fibromuscular is exposed. [less ▲]

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See detailLes agents antiplaquettaires en chirurgie vasculaire périphérique
VAN DAMME, Hendrik ULg; DAVID, Jean-Louis ULg; Limet, Raymond ULg

in Revue Médicale de Liège (1999), 54(2), 109-17

Prescription of platelet inhibitors after arterial surgery is common use. The major concern of the vascular surgeon is to maintain patency of arterial reconstructions. Major causes of graft failure or ... [more ▼]

Prescription of platelet inhibitors after arterial surgery is common use. The major concern of the vascular surgeon is to maintain patency of arterial reconstructions. Major causes of graft failure or arterial thrombosis are the non-thromboresistant nature of the grafts and of the endarterectomised or balloon-dilated surfaces, restenosis due to intimal hyperplasia and progression of atherosclerotic disease in in- or outflow vessels. Platelet adhesion and intimal injury are the primary causes in both processes of graft thrombosis and intimal hyperplasia. To understand how antiplatelet drugs can interfere with these processes, a brief review of platelet function, and of the main platelet inhibitors (aspirin, dypiridamole, ticlopidine) is given. The pathophysiology of intimal hyperplasia is discussed. From clinical trials of peripheral vascular surgery or percutaneous transluminal angioplasty with or without periprocedural antiplatelet therapy, it appears that platelet inhibitors reduce early failure rate by 50% (thrombosis rate at one year reduced from 40 to 20%). There is also evidence that antiplatelet drugs allow to slow down the progression of the atherosclerotic degenerative process in the outflow vessels and in other vascular territories. For the polyvascular patients with charged passed history, platelet inhibitors reduce the risk of myocardial or cerebral infarction by 30% (secondary prevention). Today, there is a general consensus that antiplatelet drugs, started the day before the procedure, are beneficial for early and late patency of peripheral vascular reconstructions (carotid endarterectomy, infrainguinal bypass grafts or endovascular procedures). [less ▲]

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See detailAbdominal aortic aneurysms in octogenarians.
VAN DAMME, Hendrik ULg; SakalihasanN, Natzi ULg; Vazquez, C. et al

in Acta Chirurgica Belgica (1998), 98(2), 76-84

The decision on whether to operate or not abdominal aortic aneurysms (AAA) in elderly depends on the relative risk of the operation versus the natural course of the unoperated AAA. From January 1984 to ... [more ▼]

The decision on whether to operate or not abdominal aortic aneurysms (AAA) in elderly depends on the relative risk of the operation versus the natural course of the unoperated AAA. From January 1984 to December 996, 138 patients, aged 80 years and older, were referred to our department for an aneurysm of 40 mm or more (transverse diameter) of the infrarenal abdominal aorta (95 asymptomatic, 15 painful, and 28 ruptured AAA). For 58 patients with asymptomatic AAA, operation was denied at referral because of transverse diameter less than 50 mm (n = 21), patient refusal (n = 10) or unacceptable operative risk or poor general condition (n = 27). Thirty-four of these observed AAA were ultimately operated after a mean delay of 41 months because of aneurysm enlargement (n = 15), aneurysm tenderness (n = 6) or rupture (n = 13). Overall, 52 patients had immediate (n = 37) or delayed (n = 15) elective repair of their AAA, with an in-hospital mortality of 5.7%. Urgent operation was done for 21 patients with a painful AAA. Six patients died at hospital (28% mortality rate). Emergent surgery was applied to 41 patients with ruptured AAA (including 13 AAA who ruptured during surveillance). The operative mortality in this subgroup attained 68%. Follow-up for the 77 survivors and the 24 non-operative patients averaged 43 months. The 5-year survival (operative mortality included) is 47% for electively operated patients, 30% for urgently and 20% for emergently operated patients. For comparison, the 5-year survival of an age and sex matched Belgian population is 63%. For the 24 medically followed AAA, the 5-year survival was 33%. In six cases, the cause of death was rupture of the AAA. Of the 58 patients for whom operation was initially not considered, 19 (33%) presented AAA rupture (13 operated in emergency and 6 who never came to surgery). The operative outcome of AAA repair in octogenarians is less favourable than in the younger age group (3.6% mortality after elective repair, 44% after operation for AAA rupture, according to our institution data). The authors conclude that AAA surgery should not be denied to octogenarians on the basis of advanced age alone. They recommend a straightforward surgery for otherwise healthy octogenarians with AAA of 50 mm diameter, surveillance up to 60 mm for high-risk patients and no surgery for unfit, bedridden or demented patients. [less ▲]

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See detailChirurgie vasculaire chez l'octogénaire
VAN DAMME, Hendrik ULg; SMITZ, Simon ULg; LARBUISSON, Robert ULg et al

in Revue Médicale de Liège (1998), 53(3), 149-57

The prevalence of peripheral vascular disease increases with aging of the population. About 8% of the octogenarians present significant carotid artery stenosis, about 4% have an abdominal aortic anneurysm ... [more ▼]

The prevalence of peripheral vascular disease increases with aging of the population. About 8% of the octogenarians present significant carotid artery stenosis, about 4% have an abdominal aortic anneurysm of 40 mm or more, and 6% suffer critical limb ischemia. Carotid endarterectomy in octogenarians is a valuable tool for stroke prevention, only if the combined perioperative stroke-mortality rate is lower than 3%. Operating an abdominal aneurysm of 50 mm or more in octogenarians is characterized by an operative mortality that is higher compared to that observed in a younger patient group (4.7% vs 2.7%). Aneurysm-surgery remains nevertheless justified, since it is the only way to prevent the evolution to rupture, that is almost fatal. Limb salvage surgery should always be considered for an 80-years patient with critical limb ischemia, since readaptation after major limb-amputation is not evident for octogenarians. An extensive review of literature is presented concerning vascular aging and results of carotid surgery, aneurysm repair and lower limb revascularization in octogenarians. The authors report their own recent experience with carotid surgery and aneurysm repair in patients aged 80 years or older. [less ▲]

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See detailThrombangiitis Obliterans (Buerger's Disease): Still a Limb Threatening Disease
VAN DAMME, Hendrik ULg; de Leval, Laurence ULg; CREEMERS, Etienne ULg et al

in Acta Chirurgica Belgica (1997), 97(5), 229-36

A series of 29 well-documented and properly analysed patients with thrombangiitis obliterans (Buerger's disease) is presented. The diagnosis of Buerger's disease was based on following criteria: smoking ... [more ▼]

A series of 29 well-documented and properly analysed patients with thrombangiitis obliterans (Buerger's disease) is presented. The diagnosis of Buerger's disease was based on following criteria: smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, absence of atherosclerotic risk factors other than smoking. In the last 10 years (1986-1996), we identified 29 patients who met these rigid criteria. There were 24 men and 5 women, aged 32.4 years at the moment of the disease first clinical symptom. The cumulative tobacco use averaged 16 pack-years for each patient. The initial symptom was limited gangrene of a toe (n = 9) or a finger (n = 2), foot claudication (n = 6), calf claudication (n = 3), rest pain (n = 3), migratory superficial phlebitis (n = 4), and Raynaud phenomenon (n = 2). Angiography and/or Doppler ultrasound revealed digital, pedal and calf artery involvement in all patients, with proximal extension in ten patients (femoropopliteal in ten, including three cases with external iliac artery involvement). Seven patients had also evidence of upper limb involvement. Histologic proof was available in only seven patients. Only nine patients completely stopped smoking. Treatment was exclusively medical in five cases. Twenty-four underwent sympathectomy (20 at lumbar, and four at thoracic level), with good immediate result in 16. In 11 patients a vascular reconstruction was done (eight femorocrural and three iliofemoral bypasses), with a patency rate of only 36% at two years. Amputation was required in 16 patients (a mean of 2.7 amputations per patient) at one or more levels: toe (n = 19), forefoot (n = 5), below knee (n = 8), above knee (n = 2), finger (n = 3). Two patients ended up with bilateral leg amputation. Overall, 23% (7/30) of the patients required major leg amputation during the course of the disease. Disease progression was moderately related to continued tobacco use. Buerger's disease still entails considerable risk of major amputation. Complete abstinence from tobacco use is crucial to expect stabilization of the process. However, in advanced stages of the disease and despite cessation of smoking recurrent episodes of ischaemia or tissue loss are not excluded. [less ▲]

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See detailThrombolysis of Occluded Infrainguinal Bypass Grafts
VAN DAMME, Hendrik ULg; TROTTEUR, Geneviève ULg; Dongelinger, R.F. et al

in Acta Chirurgica Belgica (1997), 97(4), 177-83

From January 1993 to December 1995, intraarterial catheter guided urokinase infusion was used as an initial approach in the management of 29 episodes of infrainguinal graft thrombosis (12 venous and 17 ... [more ▼]

From January 1993 to December 1995, intraarterial catheter guided urokinase infusion was used as an initial approach in the management of 29 episodes of infrainguinal graft thrombosis (12 venous and 17 prosthetic grafts) in 27 patients. The infusion catheter was embedded inside the occluding clot which was infiltrated by 225.000 U urokinase from distal to proximal. Local low-dose urokinase (1.000 U/kg/hr) was continued for a mean of 39 hours. By this regimen, prompt relief of ischaemia was achieved in 69% (20/29) of cases. Complete recanalization was obtained in 79% of cases. In six cases, the graft remained totally (n = 3) or partially (n = 3) occluded. Two of these patients benefited from secondary surgery, two improved clinically by conservative treatment, and two required amputation. In the 23 successful cases, thrombolysis unmasked an underlying flow-limiting stenosis in 83% (19/23), that was subsequently corrected by percutaneous balloon angioplasty (n = 15), by surgery (n = 3), or by a combination of both (n = 4). One early rethrombosis resulted in an amputation. The immediate limb-salvage rate was 89% (26/29). Surgical intervention was avoided in 17 cases (58%). The main hospital stay was 13 days. The short-term follow-up (mean of 17 months) reveals a high early rethrombosis rate (8/23 or 35%) within one year. Four of these repeated graft failures evolved to amputation. At one year, the overall limb salvage rate dropped to 79%. Thrombolytic management of infrainguinal occluded bypass grafts gives excellent initial technical results (79%), minimizing the need for major surgical revision. It is however characterized by a high procedure-related morbidity (21%). These immediate favourable results are not longstanding. Diffuse graft disease, limited outflow and high recurrence rate of anastomotic stenoses after balloon angioplasty explain poor long-term results after thrombolysis of failed grafts. [less ▲]

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See detailChirurgie carotidienne au-delà de 75 ans
Van Damme, Hendrik ULg; Albert, Adelin ULg; Limet, Raymond

in Revue Médicale de Liège (1997), 52(4), 237-44

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See detailCardiac Risk Assessment before Vascular Surgery: A Prospective Study Comparing Clinical Evaluation, Dobutamine Stress Echocardiography, and Dobutamine Tc-99m Sestamibi Tomoscintigraphy
VAN DAMME, Hendrik ULg; Pierard, Luc ULg; Gillain, Daniel ULg et al

in Cardiovascular Surgery (1997), 5(1), 54-64

Preoperative evaluation for cardiac risk assessment before peripheral vascular surgery remains controversial. Between January and June 1994, a prospective open study was carried out in 156 patients ... [more ▼]

Preoperative evaluation for cardiac risk assessment before peripheral vascular surgery remains controversial. Between January and June 1994, a prospective open study was carried out in 156 patients scheduled for elective vascular procedures (63 carotid endarterectomies, 34 abdominal aortic aneurysms, 29 aortoiliac and 30 infrainguinal reconstructions) to compare the ability of clinical data, dobutamine stress echocardiography, and dobutamine Tc-99m sestamibi tomoscintigraphy to predict postoperative cardiac events. Pharmacological stress testing consisted of incremental dobutamine infusion (+/-1 mg atropine to achieve 85% of age-predicted maximal heart rate, with continuous echocardiographic monitoring, and injection of Tc-99m sestamibi after dobutamine infusion). Dobutamine echocardiography was abnormal in 36 patients (worsening resting wall motion abnormality in 11; new induced wall motion abnormality in 25). Dobutamine Tc-99m sestamibi tomoscintigraphy revealed a reversible perfusion defect in 34 patients, indicating the presence of myocardial ischaemia. As a result, eight patients underwent myocardial revascularization (n = 5) or the proposed operation was cancelled (n = 3). In the remaining 142 vascular procedures, there were eight (5.6%) adverse cardiac events: three myocardial infarctions (two fatal), three prolonged myocardial ischaemia, one acute congestive heart failure and one sustained ventricular arrhythmia in the post operative period. Univariate analysis selected unstable angina (relative risk (RR) 11.6), previous congestive heart failure (RR 6.4), Detsky's score of > or = 15 (RR 3.0), positive dobutamine stress echocardiography (RR 3.7), and positive dobutamine tomoscintigraphy (RR 7.4) as significant predictors of postoperative cardiac events. In patients without clinical markers of coronary artery disease (n = 66), non-invasive cardiac testing did not predict cardiac complications (n = 2; one prolonged myocardial ischaemia; one infarction). In the subset of 76 patients with definite clinical or electrocardiographic evidence of ischaemic heart disease, dobutamine stress testing provided additional information, and optimized risk stratification: five of six patients who suffered a cardiac complication had a pathologic dobutamine stress test. Furthermore, a negative dobutamine stress test was characterized by a high negative predictive value (0.96 for echocardiography; 0.97 for tomoscintigraphy). The study further demonstrated that the cardiac response (ischaemic versus non-ischaemic) to dobutamine stress was concordantly classified by echocardiographic and tomoscintigraphic techniques in 96% of cases. It is concluded that complementary non-invasive cardiac stress testing by dobutamine is indicated only in patients with clinically apparent coronary artery disease. [less ▲]

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See detailComparison of results of carotid artery surgery after either direct closure or use of a vein patch.
Desiron, Quentin ULg; Detry, Olivier ULg; Van Damme, Hendrik ULg et al

in Cardiovascular Surgery (1997), 5(3), 295-303

In order to assess the benefit of vein patching versus direct closure after carotid endarterectomy, a series of 2271 carotid operations were analysed retrospectively. Apart from 114 procedures consisting ... [more ▼]

In order to assess the benefit of vein patching versus direct closure after carotid endarterectomy, a series of 2271 carotid operations were analysed retrospectively. Apart from 114 procedures consisting of saphenous vein bypass (n = 29) and eversion endarterectomy (n = 85), 2157 open endarterectomies were performed. They were closed either directly (n = 837) or using a vein patch (n = 1320). The combined mortality-major neurological morbidity rate was 1.7%, i.e. 1% mortality (0.2% neurological) and 0.7% permanent neurological morbidity (0.5% ipsilateral to the operated artery). Early symptomatic internal carotid thrombosis was documented in six cases (four following direct closure and two after vein patching). A total of 827 carotid arteries were followed up by duplex scanning on an annual basis (244 direct closure and 583 vein patching). The mean follow-up was 44 months; 69 months for direct closure and 35 months for vein patching. In direct closure, there were 21 stenoses (9%) and 10 occult thromboses (4%); in vein patching carotids, there were 17 stenoses (3%), nine thromboses (1.8%) [corrected] and six pseudoaneurysms (1%). Annual incidence of poor results was 2.4% in direct closure, and 0.87% in vein patching. The only other factor responsible for a significant difference was gender (3.4% in women versus 2.1% in men). In this retrospective study, vein patching appears to be beneficial for the prevention of acute postoperative thrombosis and late stenosis or thrombosis. [less ▲]

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See detailUretero-arterial fistula: two observations.
VAN DAMME, Hendrik ULg; KEPPENNE, Véronique ULg; SakalihasanN, Natzi ULg et al

in Acta Chirurgica Belgica (1997), 97(3), 133-6

Two cases of life-threatening haematuria, secondary to an uretero-arterial fistula, are reported. Both cases present predisposing causative factors. One patient had a combination of previous aorto ... [more ▼]

Two cases of life-threatening haematuria, secondary to an uretero-arterial fistula, are reported. Both cases present predisposing causative factors. One patient had a combination of previous aorto-bifemoral bypass grafting, an iliac artery aneurysm (retrogradely perfused), and an indwelling ureteral stent for ureteral compression. The other patient had previous aortoiliac surgery and obstructive uropathy with chronic urinary tract infection. Preoperative diagnosis of uretero-arterial fistula was made in only one patient. He was successfully operated (exclusion of the iliac aneurysm). In the other patient, nephrectomy was attempted to control reno-ureteral bleeding of unknown origin. Fatal recidive of brisk haematuria occurred some days later. Factors contributing to the development of uretero-arterial fistula, their diagnosis and optimal treatment are discussed. [less ▲]

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See detailLa maladie de Buerger: aspects cliniques et pronostiques
VAN DAMME, Hendrik ULg; Deprez, E.; DEFRAIGNE, Jean ULg et al

in Revue Médicale de Liège (1997), 52(10), 675-82

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See detailReversal of Acute Renal Failure by Kidney Revascularisation
Van Damme, Hendrik ULg; Rorive, Georges ULg; Limet, Raymond ULg

in European Journal of Vascular and Endovascular Surgery (1996), 11(2), 134-9

OBJECTIVES: To assess whether acute renal failure, due to total or subtotal renal artery occlusion, can be reversed by kidney revascularisation. DESIGN: A retrospective review of surgery for kidney ... [more ▼]

OBJECTIVES: To assess whether acute renal failure, due to total or subtotal renal artery occlusion, can be reversed by kidney revascularisation. DESIGN: A retrospective review of surgery for kidney salvage in anuric patients at a University Hospital. METHODS: From 1983 to 1993, eight patients were operated on for occlusive renal artery disease as a cause of acute renal failure, requiring preoperative haemodialysis. On admission the mean serum creatinine was 40 mg/l (354 mumol/dl). The oligoanuria lasted from 12 h to 3 weeks. Renal length of 8 cm or more and visualisation of a patent distal renal artery branches on aortography were arguments that return of renal function could be expected after revascularisation of these non-functioning kidneys. RESULTS: Revascularisation restored immediate urine flow in six cases, with no further need for dialysis in four. Two patients remained oliguric despite successful reperfusion. One of them could be weaned from dialysis after 1 month. Two patients died postoperatively. Five of the eight patients left the hospital with restored renal function. CONCLUSIONS: Patients with acute renal function deterioration due to ischemia of a single or both kidneys can benefit from prompt revascularisation, with significant recovery of renal function in most of them. [less ▲]

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See detailKinking of the Internal Carotid Artery: Clinical Significance and Surgical Management
Van Damme, Hendrik ULg; Gillain, Daniel ULg; Desiron, Quentin ULg et al

in Acta Chirurgica Belgica (1996), 96(1), 15-22

The authors report on 62 surgical corrections for kinking of the internal carotid artery during a 13-year period (1980-1993). This represents 2.8% of all carotid operative procedures (n = 2188) in the ... [more ▼]

The authors report on 62 surgical corrections for kinking of the internal carotid artery during a 13-year period (1980-1993). This represents 2.8% of all carotid operative procedures (n = 2188) in the same period. It always concerned a significant (< 60 degrees) angulation of a redundant internal carotid artery, that in all but 3 cases was associated with atherosclerotic involvement of the carotid bifurcation. The indication to surgery included transient hemispheric or ocular ischaemia in 25.5% of cases, a regressive neurologic deficit in 8%, a minor stroke in 3%, a stroke in evolution in 11%, and non-lateralized cerebral ischaemia in 21%. In 19 patients (31%) it concerned an asymptomatic high degree stenosis. The surgical technique consisted in carotid transposition-reimplantation after eversion endarterectomy in 37 cases, in posterior transverse plication with patch angioplasty in 20 cases, and in segmental excision with venous interposition graft in 5 cases. There was one postoperative death. The morbidity include one ipsilateral non-fatal stroke and 3 transient ischaemic attacks. A complete long-term follow-up (mean duration 3.4 years) is available for 57 patients. The late incidence of stroke is 1.5% per year. The 5-year survival attains 67%. These long-term results are comparable to the outcome of standard endarterectomy in the same institution. The authors discuss the indication, techniques, and outcome of surgical correction of kinked internal carotid artery. They recommend a shortening procedure, often associated with endarterectomy for severely kinked vessels (angulation 60 degrees or less), symptomatic or not. [less ▲]

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See detailRevascularisation rénale pour sauvetage ou préservation néphronique
VAN DAMME, Hendrik ULg; CREEMERS, Etienne ULg; Gillain et al

in Revue Médicale de Liège (1996), 51(2), 175-86

La néphropathie ischémique est une entité de plus en plus fréquente, à cause du vieillissement de la population et du contrôle médicamenteux de l'hypertension. Une ischémie de l'ensemble de la masse ... [more ▼]

La néphropathie ischémique est une entité de plus en plus fréquente, à cause du vieillissement de la population et du contrôle médicamenteux de l'hypertension. Une ischémie de l'ensemble de la masse rénale (sténoses serrées concernant les deux reins ou un rein unique) compromet la filtration glomérulaire et constitue une des rares formes d'insuffisance rénale chronique réversible. Actuellement, 30 à 50% des patients sélectionnés pour une revascularisation rénale ont une fonction rénale altérée. L'histoire naturelle des sténoses rénales (surtout les lésions athéroscléreuses) montre une évolutivité vers l'obstruction progressive avec perte de parenchyme fonctionnel. Une revascularisation rénale envisage soit la protection du capital néphronique (intervention prophylactique), soit un sauvetage néphronique (restauration ou stabilisation d'une fonction rénale déjà altérée). Les critères prédictifs de bénéfice à long terme sont analysés. Les rôles respectifs de l'angioplastie transluminale percutanée et de la chirurgie sont discutés. L'intérêt de la revascularisation rénale sur la fonction rénale a été apprécié chez 23 malades réno-vasculaires et azotémiques (créatinine > 20 mg/l) ainsi que chez 8 patients en oligoanurie d'origine ischémique. [less ▲]

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