B. Dona - Academia.edu (original) (raw)
Papers by B. Dona
European Journal of Vascular and Endovascular Surgery, 2016
WHAT THIS PAPER ADDS The association between anatomy and complications after TEVAR seems evident.... more WHAT THIS PAPER ADDS The association between anatomy and complications after TEVAR seems evident. However, objective data defining anatomical criteria that influence outcomes are lacking in the literature. This study focuses on malpositioning after TEVAR, which is one of the early failure modes. The results reveal that global aortic anatomy characterized by tortuosity index was more critical than local anatomy. Adequate pre-operative planning through tortuosity index (TI) calculation to detect patients with a TI >1.68 can be useful to anticipate difficulties during stent graft deployment and thus reduce mal-positioning risk. Objective: The present study aimed at quantifying mal-positioning during thoracic endovascular aortic repair and analysing the extent to which anatomical factors influence the exact stent graft positioning. Methods: A retrospective review was conducted of patients treated between 2007 and 2014 with a stent graft for whom proximal landing zones (LZ) could be precisely located by anatomical fixed landmarks, that is LZ 1, 2, or 3. The study included 66 patients (54 men; mean age 51 years, range 17e83 years) treated for traumatic aortic rupture (n ¼ 27), type B aortic dissection (n ¼ 21), thoracic aortic aneurysm (n ¼ 8), penetrating aortic ulcer (n ¼ 5), intramural hematoma (n ¼ 1), and floating aortic thrombus (n ¼ 4). Pharmacologic hemodynamic control was systematically obtained during stent graft deployment. Pre-and post-operative computed tomographic angiography was reviewed to quantify the distance between planned and achieved LZ and to analyze different anatomical factors: iliac diameter, calcification degree, aortic angulation at the proximal deployment zone, and tortuosity index (TI). Results: Primary endoleak was noted in seven cases (10%): five type I (7%) and two type II (3%). Over a mean 35 month follow up (range 3e95 months), secondary endoleak was detected in two patients (3%), both type I, and stent graft migration was seen in three patients. Mal-positioning varied from 2 to 15 mm. A cutoff value of 11 mm was identified as an adverse event risk. Univariate analysis showed that TI and LZ were significantly associated with mal-positioning (p ¼ .01, p ¼ .04 respectively), and that aortic angulation tends to reach significance (p ¼ .08). No influence of deployment mechanism (p ¼ .50) or stent graft generation (p ¼ .71) or access-related factors was observed. Multivariate analysis identified TI as the unique independent risk factor of mal-positioning (OR 241, 95% CI 1e6,149, p ¼ .05). A TI >1.68 was optimal for inaccurate deployment prediction. Conclusion: TI calculation can be useful to anticipate difficulties during stent graft deployment and to reduce mal-positioning.
European Journal of Vascular and Endovascular Surgery, 2015
WHAT THIS PAPER ADDS The present study is focused on the risk of stent graft malapposition after ... more WHAT THIS PAPER ADDS The present study is focused on the risk of stent graft malapposition after thoracic endovascular repair through an objective and accurate assessment of proximal landing zone anatomy with particular reference to aortic angulation. Objectives: The aim was to analyze the role played by anatomy and stent graft in the incidence of incomplete apposition to aortic arch. Methods: Between 2007 and 2014 data including available and suitable computed tomographic angiography (CTA) imaging of patients who had undergone thoracic endovascular aortic repair were reviewed. The study included 80 patients (65 men, 54 AE 21 years) treated for traumatic aortic rupture (n ¼ 27), thoracic aortic aneurysm (n ¼ 15), type B aortic dissection (n ¼ 24), penetrating aortic ulcer (n ¼ 5), intramural hematoma (n ¼ 2), aorto-oesophageal fistula (n ¼ 2), and aortic mural thrombus (n ¼ 5). Pre-and post-operative CTA images were analyzed to characterize bird beak in terms of length and angle, and to calculate aortic angulation within a 30 mm range at the proximal deployment zone. Results: Bird beak configuration was detected in 46 patients (57%): mean stent protrusion length was 16 mm (range: 8e29 mm) and mean bird beak angle was 20 (range: 7e40). The bird beak effect was significantly more frequent after traumatic aortic rupture treatment (p ¼ .05) and in landing zone 2 (p ¼ .01). No influence of either stent graft type or generation, or degree of oversizing was observed (p ¼ .29, p ¼ .28, p ¼ .81 respectively). However, the mean aortic angle of patients with bird beak was higher in the Pro-form group than that in the Zenith TX2 group (62 vs. 48 , p ¼ .13). Multivariate analysis identified the aortic angle of the deployment zone as the unique independent risk factor of malapposition (HR ¼ 1.05, 95% CI 1e1.10, p ¼ .005). The cutoff value of 51 was found to be predictive of bird beak occurrence with a sensitivity of 58% and a specificity of 85%. Conclusions: Assessment of proximal landing zone morphology to avoid deployment zones generating an aortic angle of over 50 can be recommended to improve aortic curvature apposition with the current available devices.
Journal des maladies vasculaires, 2008
To determine whether access to extra-corporal circulation (ECC) is necessary to treat acute desce... more To determine whether access to extra-corporal circulation (ECC) is necessary to treat acute descending thoracic aorta disease. From January 2004 to May 2006, 16 patients underwent endovascular stent-graft repair of the descending thoracic aorta, among them 13 (81%) were treated in an emergency setting (nine men, mean age: 75.4 years, range 30-94 years). The indication was traumatic aortic rupture (n=3, 23%), complicated acute type B dissection (n=4; 31%), symptomatic or ruptured thoracic aortic aneurysm (n=4; 31%), aorto-esophageal fistula (n=1; 7,5%) and aortic intramural haematoma (n=1; 7,5%). Computed tomography showed hemomediastin and/or hemothorax in five patients (38%). Transesophageal echocardiography and angiography were performed in two (15%) and one patients respectively. Cerebrospinal fluid drainage was performed for two patients (15%). Endovascular repair was successfully completed in 92.3% of cases. The 30-day mortality was 7.5% (n=1). There was one case (7.5%) of dela...
Annals of Vascular Surgery, 2010
We report a case of renal artery thrombosis resulting from a stent fracture in a patient with a s... more We report a case of renal artery thrombosis resulting from a stent fracture in a patient with a solitary functional kidney. It was successfully revascularized by surgical repair despite renal ischemia lasting more than 48 hours. This article illustrates the danger of generalizing endovascular stenting in renal artery disease regardless of the etiology. Renal artery entrapment must be kept in mind as a possible cause of renal artery stenosis. Treatment of compressive pathologies with stenting can lead to stent failure. Surgery remains the best approach for the treatment of this type of lesion.
Journal des Maladies Vasculaires, 2012
Annals of Vascular Surgery, 2011
In hemodynamically unstable patients, the management of retroperitoneal vascular trauma is both d... more In hemodynamically unstable patients, the management of retroperitoneal vascular trauma is both difficult and challenging. Endovascular techniques have become an alternative to surgery in several trauma centers. Between 2004 and 2006, 16 patients (nine men, mean age: 46 years, range: 19-79 years) with retroperitoneal vascular trauma and hemodynamic instability were treated using an endovascular approach. The mean injury severity score was 30.7 ± 13.1. Mean systolic blood pressure and the shock index were 74 mm Hg and 1.9, respectively. Vasopressor drugs were required in 68.7% of cases (n = 11). Injuries were attributable to road traffic accidents (n = 15) and falls (n = 1). The hemorrhage sites included the internal iliac artery or its branches (n = 12) with bilateral injury in one case, renal artery (n = 2), abdominal aorta (n = 1), and lumbar artery (n = 1). In all, 14 coil embolizations and three stent-grafts were implanted. The technical success rate was 75%, as early re-embolization was necessary in one case and three patients died during the perioperative period. Six patients died during the period of hospitalization (37.5%). No surgical conversion or major morbidity was reported. In comparison with particulates, coil ± stent-graft may provide similar efficacy with regard to survival, and thus may be a valuable solution when particulate embolization is not available or feasible.
Annales de Chirurgie Vasculaire, 2010
Nous rapportons un cas de thrombose de l'art ere r enale r esultant d'une rupture de stent chez u... more Nous rapportons un cas de thrombose de l'art ere r enale r esultant d'une rupture de stent chez un malade avec un rein fonctionnel unique. Il etait revascularis e avec succ es chirurgicalement en d epit d'une isch emie r enale de plus de 48 heures. Cet article illustre le danger de g en eraliser le stenting des l esions de l'art ere r enale ind ependamment de l' etiologie. Un pi ege de l'art ere r enale doitêtre gard e a l'esprit comme cause possible de st enose de l'art ere r enale. Le traitement des pathologies compressives par stenting peut mener a l' echec du stent. La chirurgie demeure la meilleure approche pour le traitement de ce type de l esion.
Journal of Vascular Surgery, 2010
To assess the potential benefit of the addition of a covered stent to a subintimal recanalized ar... more To assess the potential benefit of the addition of a covered stent to a subintimal recanalized artery in patients with femoro-popliteal occlusions. Methods: From September 2003 to October 2005, we retrospectively analyzed all patients admitted for severe claudication or critical limb ischemia related to long femoro-popliteal occlusions and treated with subintimal recanalization. Patients were divided into two groups depending on whether they received a stent or not. All patients in the group treated with stent received a stent graft, and the entire length of the recanalized artery was covered in each case. Demographic data, indications, procedure, and outcomes were examined using survival analysis statistical techniques. Results: Fifty-three patients (54 limbs) were treated consecutively for severe claudication (n ؍ 19) or critical limb ischemia (n ؍ 34). Thirty-four (64%) had a stent placed, while 19 (35.8%) did not. The mean length of the lesions treated was 20.11 cm (range, 5-35 cm). Statistically, there was no significant difference in lesion length, Rutherford stage of peripheral-artery disease, Transatlantic Inter-Society Consensus classification, and distal runoff between the two groups. The technical success rate was 94.5%, and two out of the three failures were treated with surgical bypass in one case and major amputation in the other. The third patient received only medical treatment. Combined procedures were required in the treatment of 68.2% of limbs in the no-stent group and 55.8% in the stent group. Mean follow up was 16.9 months (range, 1-35 months). At 1 year, primary, primary-assisted, and secondary patency for the stent vs no-stent groups was, respectively, 61.8% vs 78.9% (P ؍ .49), 70.6% vs 78.9% (P ؍ .78), and 88.2% vs 78.9% (P ؍ .22). The 1-year limb salvage rate for the stent vs no-stent group was 94.1% vs 100% (P ؍ .7). Conclusion: Combining subintimal angioplasty with a stent graft in femoro-popliteal lesions does not improve patency. The limb salvage rate remains high after addition of a stent graft. Rigorous monitoring is recommended to diagnose and treat restenosis early in order to improve patency.
European Journal of Vascular and Endovascular Surgery, 2015
ABSTRACT The aim was to analyze the role played by anatomy and stent graft in the incidence of in... more ABSTRACT The aim was to analyze the role played by anatomy and stent graft in the incidence of incomplete apposition to aortic arch. Between 2007 and 2014 data including available and suitable computed tomographic angiography (CTA) imaging of patients who had undergone thoracic endovascular aortic repair were reviewed. The study included 80 patients (65 men, 54 ± 21 years) treated for traumatic aortic rupture (n = 27), thoracic aortic aneurysm (n = 15), type B aortic dissection (n = 24), penetrating aortic ulcer (n = 5), intramural hematoma (n = 2), aorto-oesophageal fistula (n = 2), and aortic mural thrombus (n = 5). Pre- and post-operative CTA images were analyzed to characterize bird beak in terms of length and angle, and to calculate aortic angulation within a 30 mm range at the proximal deployment zone. Bird beak configuration was detected in 46 patients (57%): mean stent protrusion length was 16 mm (range: 8-29 mm) and mean bird beak angle was 20° (range: 7-40°). The bird beak effect was significantly more frequent after traumatic aortic rupture treatment (p = .05) and in landing zone 2 (p = .01). No influence of either stent graft type or generation, or degree of oversizing was observed (p = .29, p = .28, p = .81 respectively). However, the mean aortic angle of patients with bird beak was higher in the Pro-form group than that in the Zenith TX2 group (62° vs. 48°, p = .13). Multivariate analysis identified the aortic angle of the deployment zone as the unique independent risk factor of malapposition (HR = 1.05, 95% CI 1-1.10, p = .005). The cutoff value of 51° was found to be predictive of bird beak occurrence with a sensitivity of 58% and a specificity of 85%. Assessment of proximal landing zone morphology to avoid deployment zones generating an aortic angle of over 50° can be recommended to improve aortic curvature apposition with the current available devices. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Journal des maladies vasculaires, 2008
To determine whether access to extra-corporal circulation (ECC) is necessary to treat acute desce... more To determine whether access to extra-corporal circulation (ECC) is necessary to treat acute descending thoracic aorta disease. From January 2004 to May 2006, 16 patients underwent endovascular stent-graft repair of the descending thoracic aorta, among them 13 (81%) were treated in an emergency setting (nine men, mean age: 75.4 years, range 30-94 years). The indication was traumatic aortic rupture (n=3, 23%), complicated acute type B dissection (n=4; 31%), symptomatic or ruptured thoracic aortic aneurysm (n=4; 31%), aorto-esophageal fistula (n=1; 7,5%) and aortic intramural haematoma (n=1; 7,5%). Computed tomography showed hemomediastin and/or hemothorax in five patients (38%). Transesophageal echocardiography and angiography were performed in two (15%) and one patients respectively. Cerebrospinal fluid drainage was performed for two patients (15%). Endovascular repair was successfully completed in 92.3% of cases. The 30-day mortality was 7.5% (n=1). There was one case (7.5%) of dela...
Electroencephalography and clinical neurophysiology
Motor evoked potentials (MEPs) following magnetic stimulation were recorded in 22 patients comato... more Motor evoked potentials (MEPs) following magnetic stimulation were recorded in 22 patients comatose as a result of head injury (13 cases), stroke (7 cases) or anoxia (2 cases). Somatosensory evoked potentials (SEPs) from median nerve were recorded as well in 19 cases in the same session. Thirteen patients died or remained vegetative (59.1%), 3 were severely disabled (13.6%) and 6 showed a good recovery (27.3%). MEPs were significantly related to the outcome; they appeared to be a more accurate prognostic indicator than the Glasgow Coma Scale (GCS). However, 1 out of 6 patients with bilaterally absent MEPs (16.7%) showed a good recovery. SEPs were significantly related to the outcome as well, but the combined use of SEP and MEP improved the outcome prediction, decreasing the rate of false negatives. Two patients had normal sensorimotor function, 13 a combined sensorimotor dysfunction, while 4 had a pure motor dysfunction. Our results suggest that SEPs and MEPs may improve the assessm...
Journal des Maladies Vasculaires, 2012
Annals of Vascular Surgery, 2011
In hemodynamically unstable patients, the management of retroperitoneal vascular trauma is both d... more In hemodynamically unstable patients, the management of retroperitoneal vascular trauma is both difficult and challenging. Endovascular techniques have become an alternative to surgery in several trauma centers. Between 2004 and 2006, 16 patients (nine men, mean age: 46 years, range: 19-79 years) with retroperitoneal vascular trauma and hemodynamic instability were treated using an endovascular approach. The mean injury severity score was 30.7 ± 13.1. Mean systolic blood pressure and the shock index were 74 mm Hg and 1.9, respectively. Vasopressor drugs were required in 68.7% of cases (n = 11). Injuries were attributable to road traffic accidents (n = 15) and falls (n = 1). The hemorrhage sites included the internal iliac artery or its branches (n = 12) with bilateral injury in one case, renal artery (n = 2), abdominal aorta (n = 1), and lumbar artery (n = 1). In all, 14 coil embolizations and three stent-grafts were implanted. The technical success rate was 75%, as early re-embolization was necessary in one case and three patients died during the perioperative period. Six patients died during the period of hospitalization (37.5%). No surgical conversion or major morbidity was reported. In comparison with particulates, coil ± stent-graft may provide similar efficacy with regard to survival, and thus may be a valuable solution when particulate embolization is not available or feasible.
Electroencephalography and Clinical Neurophysiology, 1990
Neurophysiologie Clinique/Clinical Neurophysiology, 1992
Sununary -Four hundred and tlfirty-nine carotid endarterectomies (CEAs) with routine use of patch... more Sununary -Four hundred and tlfirty-nine carotid endarterectomies (CEAs) with routine use of patchgraft angioplasty were performed in 375 patients; the indwelling shunt was used only in patients showing clamp-related EEG abnormalities. Five patients showed EEG abnormalities just after head positioning, which reversed after removal of head hyperextension; three cases suffered EEG flattening due to severe bradycardia or cardiac arrest before carotid clamping, which promptly reversed after treatment. Clamprelated EEG abnormalities appeared in 106 operations (24.2%) and all reversed after the insertion of the indwelling shunt; patients with occlusion of the contralateral intemal carotid artery showed a 68.8% rate of EEG clamp-related changes. The short term follow-up (one month after the operation) showed six minor strokes with complete recovery (1.37%), one intmoperative stroke (0.23%), three delayed major strokes (0.69%) and three neurological deaths (0.69%). The long-term follow-up over an average of 42 months showed a 3.7% rate of relevant neurological complications (ie permanent deficits + death) and a 3.16% rate significant restenosis or occlusion of the operated carotid artery. Our results show that the routine use of EEG monitoring and patch-graft angioplasty allow to perform CEAs with a very high degree of safety, improving the clinical course of the disease.
Journal of Vascular Surgery, 2010
To assess the potential benefit of the addition of a covered stent to a subintimal recanalized ar... more To assess the potential benefit of the addition of a covered stent to a subintimal recanalized artery in patients with femoro-popliteal occlusions. From September 2003 to October 2005, we retrospectively analyzed all patients admitted for severe claudication or critical limb ischemia related to long femoro-popliteal occlusions and treated with subintimal recanalization. Patients were divided into two groups depending on whether they received a stent or not. All patients in the group treated with stent received a stent graft, and the entire length of the recanalized artery was covered in each case. Demographic data, indications, procedure, and outcomes were examined using survival analysis statistical techniques. Fifty-three patients (54 limbs) were treated consecutively for severe claudication (n=19) or critical limb ischemia (n=34). Thirty-four (64%) had a stent placed, while 19 (35.8%) did not. The mean length of the lesions treated was 20.11 cm (range, 5-35 cm). Statistically, there was no significant difference in lesion length, Rutherford stage of peripheral-artery disease, Transatlantic Inter-Society Consensus classification, and distal run-off between the two groups. The technical success rate was 94.5%, and two out of the three failures were treated with surgical bypass in one case and major amputation in the other. The third patient received only medical treatment. Combined procedures were required in the treatment of 68.2% of limbs in the no-stent group and 55.8% in the stent group. Mean follow up was 16.9 months (range, 1-35 months). At 1 year, primary, primary-assisted, and secondary patency for the stent vs no-stent groups was, respectively, 61.8% vs 78.9% (P=.49), 70.6% vs 78.9% (P=.78), and 88.2% vs 78.9% (P=.22). The 1-year limb salvage rate for the stent vs no-stent group was 94.1% vs 100% (P=.7). Combining subintimal angioplasty with a stent graft in femoro-popliteal lesions does not improve patency. The limb salvage rate remains high after addition of a stent graft. Rigorous monitoring is recommended to diagnose and treat restenosis early in order to improve patency.
Annals of Vascular Surgery, 2010
We report a case of renal artery thrombosis resulting from a stent fracture in a patient with a s... more We report a case of renal artery thrombosis resulting from a stent fracture in a patient with a solitary functional kidney. It was successfully revascularized by surgical repair despite renal ischemia lasting more than 48 hours. This article illustrates the danger of generalizing endovascular stenting in renal artery disease regardless of the etiology. Renal artery entrapment must be kept in mind as a possible cause of renal artery stenosis. Treatment of compressive pathologies with stenting can lead to stent failure. Surgery remains the best approach for the treatment of this type of lesion.
European Journal of Vascular and Endovascular Surgery, 2016
WHAT THIS PAPER ADDS The association between anatomy and complications after TEVAR seems evident.... more WHAT THIS PAPER ADDS The association between anatomy and complications after TEVAR seems evident. However, objective data defining anatomical criteria that influence outcomes are lacking in the literature. This study focuses on malpositioning after TEVAR, which is one of the early failure modes. The results reveal that global aortic anatomy characterized by tortuosity index was more critical than local anatomy. Adequate pre-operative planning through tortuosity index (TI) calculation to detect patients with a TI >1.68 can be useful to anticipate difficulties during stent graft deployment and thus reduce mal-positioning risk. Objective: The present study aimed at quantifying mal-positioning during thoracic endovascular aortic repair and analysing the extent to which anatomical factors influence the exact stent graft positioning. Methods: A retrospective review was conducted of patients treated between 2007 and 2014 with a stent graft for whom proximal landing zones (LZ) could be precisely located by anatomical fixed landmarks, that is LZ 1, 2, or 3. The study included 66 patients (54 men; mean age 51 years, range 17e83 years) treated for traumatic aortic rupture (n ¼ 27), type B aortic dissection (n ¼ 21), thoracic aortic aneurysm (n ¼ 8), penetrating aortic ulcer (n ¼ 5), intramural hematoma (n ¼ 1), and floating aortic thrombus (n ¼ 4). Pharmacologic hemodynamic control was systematically obtained during stent graft deployment. Pre-and post-operative computed tomographic angiography was reviewed to quantify the distance between planned and achieved LZ and to analyze different anatomical factors: iliac diameter, calcification degree, aortic angulation at the proximal deployment zone, and tortuosity index (TI). Results: Primary endoleak was noted in seven cases (10%): five type I (7%) and two type II (3%). Over a mean 35 month follow up (range 3e95 months), secondary endoleak was detected in two patients (3%), both type I, and stent graft migration was seen in three patients. Mal-positioning varied from 2 to 15 mm. A cutoff value of 11 mm was identified as an adverse event risk. Univariate analysis showed that TI and LZ were significantly associated with mal-positioning (p ¼ .01, p ¼ .04 respectively), and that aortic angulation tends to reach significance (p ¼ .08). No influence of deployment mechanism (p ¼ .50) or stent graft generation (p ¼ .71) or access-related factors was observed. Multivariate analysis identified TI as the unique independent risk factor of mal-positioning (OR 241, 95% CI 1e6,149, p ¼ .05). A TI >1.68 was optimal for inaccurate deployment prediction. Conclusion: TI calculation can be useful to anticipate difficulties during stent graft deployment and to reduce mal-positioning.
European Journal of Vascular and Endovascular Surgery, 2015
WHAT THIS PAPER ADDS The present study is focused on the risk of stent graft malapposition after ... more WHAT THIS PAPER ADDS The present study is focused on the risk of stent graft malapposition after thoracic endovascular repair through an objective and accurate assessment of proximal landing zone anatomy with particular reference to aortic angulation. Objectives: The aim was to analyze the role played by anatomy and stent graft in the incidence of incomplete apposition to aortic arch. Methods: Between 2007 and 2014 data including available and suitable computed tomographic angiography (CTA) imaging of patients who had undergone thoracic endovascular aortic repair were reviewed. The study included 80 patients (65 men, 54 AE 21 years) treated for traumatic aortic rupture (n ¼ 27), thoracic aortic aneurysm (n ¼ 15), type B aortic dissection (n ¼ 24), penetrating aortic ulcer (n ¼ 5), intramural hematoma (n ¼ 2), aorto-oesophageal fistula (n ¼ 2), and aortic mural thrombus (n ¼ 5). Pre-and post-operative CTA images were analyzed to characterize bird beak in terms of length and angle, and to calculate aortic angulation within a 30 mm range at the proximal deployment zone. Results: Bird beak configuration was detected in 46 patients (57%): mean stent protrusion length was 16 mm (range: 8e29 mm) and mean bird beak angle was 20 (range: 7e40). The bird beak effect was significantly more frequent after traumatic aortic rupture treatment (p ¼ .05) and in landing zone 2 (p ¼ .01). No influence of either stent graft type or generation, or degree of oversizing was observed (p ¼ .29, p ¼ .28, p ¼ .81 respectively). However, the mean aortic angle of patients with bird beak was higher in the Pro-form group than that in the Zenith TX2 group (62 vs. 48 , p ¼ .13). Multivariate analysis identified the aortic angle of the deployment zone as the unique independent risk factor of malapposition (HR ¼ 1.05, 95% CI 1e1.10, p ¼ .005). The cutoff value of 51 was found to be predictive of bird beak occurrence with a sensitivity of 58% and a specificity of 85%. Conclusions: Assessment of proximal landing zone morphology to avoid deployment zones generating an aortic angle of over 50 can be recommended to improve aortic curvature apposition with the current available devices.
Journal des maladies vasculaires, 2008
To determine whether access to extra-corporal circulation (ECC) is necessary to treat acute desce... more To determine whether access to extra-corporal circulation (ECC) is necessary to treat acute descending thoracic aorta disease. From January 2004 to May 2006, 16 patients underwent endovascular stent-graft repair of the descending thoracic aorta, among them 13 (81%) were treated in an emergency setting (nine men, mean age: 75.4 years, range 30-94 years). The indication was traumatic aortic rupture (n=3, 23%), complicated acute type B dissection (n=4; 31%), symptomatic or ruptured thoracic aortic aneurysm (n=4; 31%), aorto-esophageal fistula (n=1; 7,5%) and aortic intramural haematoma (n=1; 7,5%). Computed tomography showed hemomediastin and/or hemothorax in five patients (38%). Transesophageal echocardiography and angiography were performed in two (15%) and one patients respectively. Cerebrospinal fluid drainage was performed for two patients (15%). Endovascular repair was successfully completed in 92.3% of cases. The 30-day mortality was 7.5% (n=1). There was one case (7.5%) of dela...
Annals of Vascular Surgery, 2010
We report a case of renal artery thrombosis resulting from a stent fracture in a patient with a s... more We report a case of renal artery thrombosis resulting from a stent fracture in a patient with a solitary functional kidney. It was successfully revascularized by surgical repair despite renal ischemia lasting more than 48 hours. This article illustrates the danger of generalizing endovascular stenting in renal artery disease regardless of the etiology. Renal artery entrapment must be kept in mind as a possible cause of renal artery stenosis. Treatment of compressive pathologies with stenting can lead to stent failure. Surgery remains the best approach for the treatment of this type of lesion.
Journal des Maladies Vasculaires, 2012
Annals of Vascular Surgery, 2011
In hemodynamically unstable patients, the management of retroperitoneal vascular trauma is both d... more In hemodynamically unstable patients, the management of retroperitoneal vascular trauma is both difficult and challenging. Endovascular techniques have become an alternative to surgery in several trauma centers. Between 2004 and 2006, 16 patients (nine men, mean age: 46 years, range: 19-79 years) with retroperitoneal vascular trauma and hemodynamic instability were treated using an endovascular approach. The mean injury severity score was 30.7 ± 13.1. Mean systolic blood pressure and the shock index were 74 mm Hg and 1.9, respectively. Vasopressor drugs were required in 68.7% of cases (n = 11). Injuries were attributable to road traffic accidents (n = 15) and falls (n = 1). The hemorrhage sites included the internal iliac artery or its branches (n = 12) with bilateral injury in one case, renal artery (n = 2), abdominal aorta (n = 1), and lumbar artery (n = 1). In all, 14 coil embolizations and three stent-grafts were implanted. The technical success rate was 75%, as early re-embolization was necessary in one case and three patients died during the perioperative period. Six patients died during the period of hospitalization (37.5%). No surgical conversion or major morbidity was reported. In comparison with particulates, coil ± stent-graft may provide similar efficacy with regard to survival, and thus may be a valuable solution when particulate embolization is not available or feasible.
Annales de Chirurgie Vasculaire, 2010
Nous rapportons un cas de thrombose de l'art ere r enale r esultant d'une rupture de stent chez u... more Nous rapportons un cas de thrombose de l'art ere r enale r esultant d'une rupture de stent chez un malade avec un rein fonctionnel unique. Il etait revascularis e avec succ es chirurgicalement en d epit d'une isch emie r enale de plus de 48 heures. Cet article illustre le danger de g en eraliser le stenting des l esions de l'art ere r enale ind ependamment de l' etiologie. Un pi ege de l'art ere r enale doitêtre gard e a l'esprit comme cause possible de st enose de l'art ere r enale. Le traitement des pathologies compressives par stenting peut mener a l' echec du stent. La chirurgie demeure la meilleure approche pour le traitement de ce type de l esion.
Journal of Vascular Surgery, 2010
To assess the potential benefit of the addition of a covered stent to a subintimal recanalized ar... more To assess the potential benefit of the addition of a covered stent to a subintimal recanalized artery in patients with femoro-popliteal occlusions. Methods: From September 2003 to October 2005, we retrospectively analyzed all patients admitted for severe claudication or critical limb ischemia related to long femoro-popliteal occlusions and treated with subintimal recanalization. Patients were divided into two groups depending on whether they received a stent or not. All patients in the group treated with stent received a stent graft, and the entire length of the recanalized artery was covered in each case. Demographic data, indications, procedure, and outcomes were examined using survival analysis statistical techniques. Results: Fifty-three patients (54 limbs) were treated consecutively for severe claudication (n ؍ 19) or critical limb ischemia (n ؍ 34). Thirty-four (64%) had a stent placed, while 19 (35.8%) did not. The mean length of the lesions treated was 20.11 cm (range, 5-35 cm). Statistically, there was no significant difference in lesion length, Rutherford stage of peripheral-artery disease, Transatlantic Inter-Society Consensus classification, and distal runoff between the two groups. The technical success rate was 94.5%, and two out of the three failures were treated with surgical bypass in one case and major amputation in the other. The third patient received only medical treatment. Combined procedures were required in the treatment of 68.2% of limbs in the no-stent group and 55.8% in the stent group. Mean follow up was 16.9 months (range, 1-35 months). At 1 year, primary, primary-assisted, and secondary patency for the stent vs no-stent groups was, respectively, 61.8% vs 78.9% (P ؍ .49), 70.6% vs 78.9% (P ؍ .78), and 88.2% vs 78.9% (P ؍ .22). The 1-year limb salvage rate for the stent vs no-stent group was 94.1% vs 100% (P ؍ .7). Conclusion: Combining subintimal angioplasty with a stent graft in femoro-popliteal lesions does not improve patency. The limb salvage rate remains high after addition of a stent graft. Rigorous monitoring is recommended to diagnose and treat restenosis early in order to improve patency.
European Journal of Vascular and Endovascular Surgery, 2015
ABSTRACT The aim was to analyze the role played by anatomy and stent graft in the incidence of in... more ABSTRACT The aim was to analyze the role played by anatomy and stent graft in the incidence of incomplete apposition to aortic arch. Between 2007 and 2014 data including available and suitable computed tomographic angiography (CTA) imaging of patients who had undergone thoracic endovascular aortic repair were reviewed. The study included 80 patients (65 men, 54 ± 21 years) treated for traumatic aortic rupture (n = 27), thoracic aortic aneurysm (n = 15), type B aortic dissection (n = 24), penetrating aortic ulcer (n = 5), intramural hematoma (n = 2), aorto-oesophageal fistula (n = 2), and aortic mural thrombus (n = 5). Pre- and post-operative CTA images were analyzed to characterize bird beak in terms of length and angle, and to calculate aortic angulation within a 30 mm range at the proximal deployment zone. Bird beak configuration was detected in 46 patients (57%): mean stent protrusion length was 16 mm (range: 8-29 mm) and mean bird beak angle was 20° (range: 7-40°). The bird beak effect was significantly more frequent after traumatic aortic rupture treatment (p = .05) and in landing zone 2 (p = .01). No influence of either stent graft type or generation, or degree of oversizing was observed (p = .29, p = .28, p = .81 respectively). However, the mean aortic angle of patients with bird beak was higher in the Pro-form group than that in the Zenith TX2 group (62° vs. 48°, p = .13). Multivariate analysis identified the aortic angle of the deployment zone as the unique independent risk factor of malapposition (HR = 1.05, 95% CI 1-1.10, p = .005). The cutoff value of 51° was found to be predictive of bird beak occurrence with a sensitivity of 58% and a specificity of 85%. Assessment of proximal landing zone morphology to avoid deployment zones generating an aortic angle of over 50° can be recommended to improve aortic curvature apposition with the current available devices. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Journal des maladies vasculaires, 2008
To determine whether access to extra-corporal circulation (ECC) is necessary to treat acute desce... more To determine whether access to extra-corporal circulation (ECC) is necessary to treat acute descending thoracic aorta disease. From January 2004 to May 2006, 16 patients underwent endovascular stent-graft repair of the descending thoracic aorta, among them 13 (81%) were treated in an emergency setting (nine men, mean age: 75.4 years, range 30-94 years). The indication was traumatic aortic rupture (n=3, 23%), complicated acute type B dissection (n=4; 31%), symptomatic or ruptured thoracic aortic aneurysm (n=4; 31%), aorto-esophageal fistula (n=1; 7,5%) and aortic intramural haematoma (n=1; 7,5%). Computed tomography showed hemomediastin and/or hemothorax in five patients (38%). Transesophageal echocardiography and angiography were performed in two (15%) and one patients respectively. Cerebrospinal fluid drainage was performed for two patients (15%). Endovascular repair was successfully completed in 92.3% of cases. The 30-day mortality was 7.5% (n=1). There was one case (7.5%) of dela...
Electroencephalography and clinical neurophysiology
Motor evoked potentials (MEPs) following magnetic stimulation were recorded in 22 patients comato... more Motor evoked potentials (MEPs) following magnetic stimulation were recorded in 22 patients comatose as a result of head injury (13 cases), stroke (7 cases) or anoxia (2 cases). Somatosensory evoked potentials (SEPs) from median nerve were recorded as well in 19 cases in the same session. Thirteen patients died or remained vegetative (59.1%), 3 were severely disabled (13.6%) and 6 showed a good recovery (27.3%). MEPs were significantly related to the outcome; they appeared to be a more accurate prognostic indicator than the Glasgow Coma Scale (GCS). However, 1 out of 6 patients with bilaterally absent MEPs (16.7%) showed a good recovery. SEPs were significantly related to the outcome as well, but the combined use of SEP and MEP improved the outcome prediction, decreasing the rate of false negatives. Two patients had normal sensorimotor function, 13 a combined sensorimotor dysfunction, while 4 had a pure motor dysfunction. Our results suggest that SEPs and MEPs may improve the assessm...
Journal des Maladies Vasculaires, 2012
Annals of Vascular Surgery, 2011
In hemodynamically unstable patients, the management of retroperitoneal vascular trauma is both d... more In hemodynamically unstable patients, the management of retroperitoneal vascular trauma is both difficult and challenging. Endovascular techniques have become an alternative to surgery in several trauma centers. Between 2004 and 2006, 16 patients (nine men, mean age: 46 years, range: 19-79 years) with retroperitoneal vascular trauma and hemodynamic instability were treated using an endovascular approach. The mean injury severity score was 30.7 ± 13.1. Mean systolic blood pressure and the shock index were 74 mm Hg and 1.9, respectively. Vasopressor drugs were required in 68.7% of cases (n = 11). Injuries were attributable to road traffic accidents (n = 15) and falls (n = 1). The hemorrhage sites included the internal iliac artery or its branches (n = 12) with bilateral injury in one case, renal artery (n = 2), abdominal aorta (n = 1), and lumbar artery (n = 1). In all, 14 coil embolizations and three stent-grafts were implanted. The technical success rate was 75%, as early re-embolization was necessary in one case and three patients died during the perioperative period. Six patients died during the period of hospitalization (37.5%). No surgical conversion or major morbidity was reported. In comparison with particulates, coil ± stent-graft may provide similar efficacy with regard to survival, and thus may be a valuable solution when particulate embolization is not available or feasible.
Electroencephalography and Clinical Neurophysiology, 1990
Neurophysiologie Clinique/Clinical Neurophysiology, 1992
Sununary -Four hundred and tlfirty-nine carotid endarterectomies (CEAs) with routine use of patch... more Sununary -Four hundred and tlfirty-nine carotid endarterectomies (CEAs) with routine use of patchgraft angioplasty were performed in 375 patients; the indwelling shunt was used only in patients showing clamp-related EEG abnormalities. Five patients showed EEG abnormalities just after head positioning, which reversed after removal of head hyperextension; three cases suffered EEG flattening due to severe bradycardia or cardiac arrest before carotid clamping, which promptly reversed after treatment. Clamprelated EEG abnormalities appeared in 106 operations (24.2%) and all reversed after the insertion of the indwelling shunt; patients with occlusion of the contralateral intemal carotid artery showed a 68.8% rate of EEG clamp-related changes. The short term follow-up (one month after the operation) showed six minor strokes with complete recovery (1.37%), one intmoperative stroke (0.23%), three delayed major strokes (0.69%) and three neurological deaths (0.69%). The long-term follow-up over an average of 42 months showed a 3.7% rate of relevant neurological complications (ie permanent deficits + death) and a 3.16% rate significant restenosis or occlusion of the operated carotid artery. Our results show that the routine use of EEG monitoring and patch-graft angioplasty allow to perform CEAs with a very high degree of safety, improving the clinical course of the disease.
Journal of Vascular Surgery, 2010
To assess the potential benefit of the addition of a covered stent to a subintimal recanalized ar... more To assess the potential benefit of the addition of a covered stent to a subintimal recanalized artery in patients with femoro-popliteal occlusions. From September 2003 to October 2005, we retrospectively analyzed all patients admitted for severe claudication or critical limb ischemia related to long femoro-popliteal occlusions and treated with subintimal recanalization. Patients were divided into two groups depending on whether they received a stent or not. All patients in the group treated with stent received a stent graft, and the entire length of the recanalized artery was covered in each case. Demographic data, indications, procedure, and outcomes were examined using survival analysis statistical techniques. Fifty-three patients (54 limbs) were treated consecutively for severe claudication (n=19) or critical limb ischemia (n=34). Thirty-four (64%) had a stent placed, while 19 (35.8%) did not. The mean length of the lesions treated was 20.11 cm (range, 5-35 cm). Statistically, there was no significant difference in lesion length, Rutherford stage of peripheral-artery disease, Transatlantic Inter-Society Consensus classification, and distal run-off between the two groups. The technical success rate was 94.5%, and two out of the three failures were treated with surgical bypass in one case and major amputation in the other. The third patient received only medical treatment. Combined procedures were required in the treatment of 68.2% of limbs in the no-stent group and 55.8% in the stent group. Mean follow up was 16.9 months (range, 1-35 months). At 1 year, primary, primary-assisted, and secondary patency for the stent vs no-stent groups was, respectively, 61.8% vs 78.9% (P=.49), 70.6% vs 78.9% (P=.78), and 88.2% vs 78.9% (P=.22). The 1-year limb salvage rate for the stent vs no-stent group was 94.1% vs 100% (P=.7). Combining subintimal angioplasty with a stent graft in femoro-popliteal lesions does not improve patency. The limb salvage rate remains high after addition of a stent graft. Rigorous monitoring is recommended to diagnose and treat restenosis early in order to improve patency.
Annals of Vascular Surgery, 2010
We report a case of renal artery thrombosis resulting from a stent fracture in a patient with a s... more We report a case of renal artery thrombosis resulting from a stent fracture in a patient with a solitary functional kidney. It was successfully revascularized by surgical repair despite renal ischemia lasting more than 48 hours. This article illustrates the danger of generalizing endovascular stenting in renal artery disease regardless of the etiology. Renal artery entrapment must be kept in mind as a possible cause of renal artery stenosis. Treatment of compressive pathologies with stenting can lead to stent failure. Surgery remains the best approach for the treatment of this type of lesion.