Venous Allografts for Critical Limb Ischaemia

in Acta Chirurgica Belgica (1995), 95(1, Jan-Feb), 14-20

In as many as 25% of the patients with critical lower limb ischaemia, a suitable autogenous vein graft is not available. Patency rate of prosthetic grafts is disappointing at the infrageniculate level ... [more ▼]

In as many as 25% of the patients with critical lower limb ischaemia, a suitable autogenous vein graft is not available. Patency rate of prosthetic grafts is disappointing at the infrageniculate level. Recently, there is renewed interest in the use of preserved venous allografts as an alternate conduit in patients with threatened ischaemic limbs. From 1991 to 1993, the authors revascularized 12 ischaemic limbs with venous allografts (10 preserved at 4 degrees C, 2 Varivas grafts). The indication for operation was rest pain in five patients and tissue necrosis in seven. Nine patients had one or more previous ipsilateral revascularizations. The at 4 degrees C preserved venous allografts were conserved for a near period of 2 months. In only half (5/10) of the cases ABO isocompatibility could be respected. Distal anastomosis was always below the knee. In 6 patients, the anastomosis was at tibial level. There was one rupture of a Varivas graft on the fifth postoperative day, necessitating ligation of the graft and subsequent amputation. All other grafts remained patent for a mean period of 10.6 months. Actually, 6 grafts are still open. Most patients were given aspirin. Only three patients were under oral coumarin anticoagulation in an effort to prevent early graft failure. The limb salvage rate is 67% (8/12) (mean follow-up of 13 months). The authors discuss the clinical experience with venous allografts as published in recent literature. Use of venous allografts for arterial reconstruction in humans was met with limited success so far. The one year patency approximates 50%. Venous allografts progress in an ineluctable way to a fibrous conduit.(ABSTRACT TRUNCATED AT 250 WORDS) [less ▲]

Le pied diabétique: etiopathogénie, prévention et traitement

in Revue Médicale de Liège (1994), 49(1), 1-13

-Le pied diabétique est la conséquence des altérations dégénératives du système vasculonerveux observées dans un diabète de longue durée. La neuropathie diabétique est le facteur essentiel dans la plupart ... [more ▼]

-Le pied diabétique est la conséquence des altérations dégénératives du système vasculonerveux observées dans un diabète de longue durée. La neuropathie diabétique est le facteur essentiel dans la plupart des cas, responsable d'hypoalgésies, microtraumatismes et ulcérations, déformation du pied (amyotrophie), et d'une eutosympethectomie (peau sèche, fissurée). Une macroangiopathie (médiacalcinose, occlusions artérielles périphériques) n'est retrouvée que dans 30 % des cas. Une microangiopathie compromet la trophicité des tissus et ralentit leur cicatrisation. Enfin, tout diabétique présente une susceptibilité élevée aux infections. Cette multitude de facteurs en cause impose des mesures de prévention. Un équilibre du profil glycémique retardera les atteintes vasculo-nerveuses. L'hygiène du pied consistera en bains de pieds, soins d'ongles et d'hyperkératoses, chaussures adaptées. En cas de troubles trophiques, une décharge d'appui sers nécessaire. Une désinfection rigoureuse, associée à une antibiothérapie (après prélèvement, si possible) aidera à éviter l'évolution vers l'abcès profond. La moindre collection sera drainée, après excision large des tissus nécrotiques. Les nécroses sèches (talons, orteils) traduisent souvent une artériopethie, pour laquelle un geste de revascularisation (protondoolestie; pontage distal) pourra être pris en considération. Parfois, l'état septique du patient, ou l'étendue de la gangrène, imposera une amputation. L'approche du pied diabétique doit toujours être multidisciplinaire (diabétologue, dermatologue, orthésiste, orthopédiste, chirurgien vasculaire), et doit commencer par des mesures préventives. [less ▲]

Anevrysme femoral superficiel rompu dans le cadre d'une neurofibromatose. A propos d'un cas

in Journal des Maladies Vasculaires (1994), 19(1), 62-5

The authors observed the spontaneous rupture of a dysplastic superficial femoral artery in a 47 years old patient with Von Recklinghausen disease. The patient presents a gigantism of his right lower limb ... [more ▼]

The authors observed the spontaneous rupture of a dysplastic superficial femoral artery in a 47 years old patient with Von Recklinghausen disease. The patient presents a gigantism of his right lower limb. On angiography, the femoropopliteal axis is polyaneurysmal and there is evidence of rupture at mid-thigh. The diseased artery is excluded by interposition of a dacron prosthesis, with reimplantation of the deep femoral artery. Histology shows fibrohyalin thickening of the intima. Dysplasia of large limb arteries is excessively rare in Von Recklinghausen disease. [less ▲]

L'age: un facteur limitant pour la chirurgie carotidienne?

in Revue Médicale de Liège (1993), 48(4), 195-206

Dissections spontanées de la carotide interne. A propos de 10 cas.

Conference (1993, March 20)

Echographic Characterization of Carotid Plaques

in Acta Chirurgica Belgica (1993), 93(5), 233-8

The histology of the endarterectomy specimen was compared with the preoperative echopattern of 154 plaques. Thirty-four ultrasound images were of poor quality. The 120 adequate echographies revealed 22 ... [more ▼]

The histology of the endarterectomy specimen was compared with the preoperative echopattern of 154 plaques. Thirty-four ultrasound images were of poor quality. The 120 adequate echographies revealed 22 dense hyperechogenic homogeneous plaques, 28 soft hypoechogenic homogeneous plaques, 53 inhomogeneous plaques, and 13 mixed plaques. According to the surface, lesions were subdivided as smooth (n = 63) or irregular (n = 57). Echography recognized fibrous plaques (dense homogeneous hyperechogeneous lesions), with a specificity of 87% and a sensitivity of 56%. Recent intraplaque haemorrhage is echographically apparent as a hypoechogenic area in 88% of cases, what corresponds to a specificity of 79% and a sensitivity of 75%. Echography proved to be more accurate than angiography in determining the presence or absence of ulceration. The ability to characterize the pathology of carotid atheroma by duplex scan make the clinicopathologic correlation of carotid plaques of practical importance. [less ▲]

Mycotic aneurysm of the upper abdominal aorta ruptured into the stomach

in Archives of Surgery (1992), 127(4), 478-482

We report a case of primary aortogastric fistula with erosion of a mycotic aneurysm of the upper abdominal aorta into the stomach. The patient was successfully operated on with an in situ aortoaortic tube ... [more ▼]

We report a case of primary aortogastric fistula with erosion of a mycotic aneurysm of the upper abdominal aorta into the stomach. The patient was successfully operated on with an in situ aortoaortic tube graft, incorporating the splanchnic vessels, and direct suture of the gastric erosion. [less ▲]

Brachiocephalic Arterial Reconstruction

in Acta Chirurgica Belgica (1992), 92(1), 37-45

From 1980 to 1990, 18 patients underwent trans-sternal repair for occlusive disease of the brachiocephalic artery. The mean age was 57 years (43-72). Most of the patients were women (n = 10). All but two ... [more ▼]

From 1980 to 1990, 18 patients underwent trans-sternal repair for occlusive disease of the brachiocephalic artery. The mean age was 57 years (43-72). Most of the patients were women (n = 10). All but two patients had one or more symptoms related to the stenosis of the brachiocephalic trunk: right-sided upper limb ischemia (n = 7), transient ischemic attacks (n = 8), vertebrobasilar insufficiency (n = 6), left sided minor stroke (n = 1). Only two patients were asymptomatic before operation. Angiography revealed a tight stenosis (n = 14) or an occlusion (n = 3); in one patient it concerned an ulcerated non-stenotic plaque of the brachiocephalic artery. Eleven patients had coexistent involvement of other supraaortic vessels. Angiographically, clinically and intraoperatively, there was evidence of Takayasu arteritis in three female patients. All patients had direct repair by trans-sternal approach. Six patients with short lesions had thromboendarterectomy with patch angioplasty of the innominate artery. In eleven cases, aorto-brachiocephalic bypass grafting was performed. In one patient, aortic calcification precluded proximal anastomosis, and a carotid-to-carotid bypass was done. In five patients, simultaneous revascularization of subclavian (n = 3), left common carotid (n = 2) or internal carotid artery (n = 2) completed the procedure. In one patient, concomitant coronary revascularization was done. There was no operative mortality. Postoperative morbidity was limited to pulmonary infection (n = 2), transient neurologic deficit (n = 1) and renal insufficiency (n = 1). All patients had relief of symptoms. Duplex echo scan confirmed patency of all reconstructions at a mean follow-up of 46 months.(ABSTRACT TRUNCATED AT 250 WORDS) [less ▲]

Des angiopathies non athéromateuses

in Revue Médicale de Liège (1992), 47(11), 545-53

Blowout of Carotid Venous Patch Angioplasty

in Annals of Vascular Surgery (1991), 5(6), 542-5

Two cases of vein patch blowout were observed five and seven days after carotid bifurcation endarterectomy with patch angioplasty. Both patients died in spite of emergency reoperation. One patient ... [more ▼]

Two cases of vein patch blowout were observed five and seven days after carotid bifurcation endarterectomy with patch angioplasty. Both patients died in spite of emergency reoperation. One patient developed respiratory failure with subsequent fatal cardiac arrest seven days after reoperation; the other died of extensive hemispheric infarction on the fifth postoperative day. At reoperation both ruptures were found to be located in the middle of the patch whereas the suture lines were intact. Both patients were hypertensive. In the first case, an accessory saphenous vein retrieved from the calf had been the only venous material available for the patch, while the other patient had varicose veins in the contralateral leg. Pathology revealed central transmural tissue necrosis in one of the disrupted patches. A review of the literature regarding morphologic alterations of free vein grafts placed within the arterial circulation as well as hemodynamics in patched arterial segments may provide additional insight as to the inherent benefits and risks of vein patch angioplasty after carotid endarterectomy. When considering vein patch angioplasty, particular attention should be directed to the gross aspect of the vein to be used as well as to any antecedent history of phlebitis. [less ▲]