Céline Perot - Academia.edu (original) (raw)

Papers by Céline Perot

Journal des Maladies Vasculaires, 2014

ABSTRACT Objectifs Étudier la faisabilité d’un guidage échographique exclusif pour les gestes d’a... more ABSTRACT Objectifs Étudier la faisabilité d’un guidage échographique exclusif pour les gestes d’angioplastie de fistule artério-veineuse (FAV) et déterminer les avantages et inconvénients de cette technique. Méthodes Entre janvier 2013 et janvier 2014, 12 patients (13 sténoses) présentant une sténose significative de FAV ont bénéficié d’une angioplastie simple de la veine de drainage sous contrôle échographique exclusif. Les paramètres morphologiques (pourcentage et longueur de la sténose, diamètre minimal de la veine de drainage, distance entre la lésion et l’anastomose) et hémodynamiques (débit, vitesse systolique en sortie de sténose) ont été relevés avant, pendant et à un mois du geste. Résultats Sur les 13 lésions proposées à l’angioplastie sous échographie, 11 ont été traitées avec succès (85 %) ; les deux échecs correspondaient à un échec de cathétérisme. Le degré moyen de sténose était de 60,5 % (48–75) avec un diamètre minimal moyen de 2,13 mm (0,9–2,5). Les sténoses étaient situées à distance de l’anastomose pour 62 % des lésions et en juxta-anastomotiques pour 38 % des lésions. Les sténoses associées artérielles et/ou anastomotiques constituaient un critère d’exclusion pour la prise en charge échographique. Aucun stent n’a été posé en per-procédure. Les inflations étaient poursuivies jusqu’à la levée de la sténose contrôlée en écho-Doppler. Le nombre moyen d’inflations nécessaires pour lever la sténose était de 2 (1–3). Le succès technique était confirmé par la mesure de la vitesse systolique maximale en regard de la sténose inférieure ou égale à 3 m/s. Le temps moyen des procédures était de 49 minutes (30–90) incluant les mesures peropératoires. Le débit moyen postopératoire était supérieur à 600 mL/min. Il n’y a eu aucune complication en per- et postopératoire. Au contrôle écho-Doppler à un mois de l’intervention, aucune resténose ni chute de débit n’a été mise en évidence. Conclusion L’angioplastie de FAV sous guidage échographique exclusif est faisable, efficace et sûre. Les principaux avantages sont l’absence d’irradiation et d’utilisation de produit de contraste iodé ; cette technique permet également un contrôle immédiat du succès technique par les mesures hémodynamiques ; elle permet également de mieux cibler les lésions à traiter, de diminuer le risque de surdilatation et de diminuer les complications per- et postopératoires. Ces résultats viennent renforcer les données de la littérature pour un plus grand rôle de l’écho-Doppler dans le guidage et la thérapeutique vasculaire.

Minerva chirurgica, 2012

Ischemic gastritis is poorly known by physicians and is often fatal if not correctly diagnosed. H... more Ischemic gastritis is poorly known by physicians and is often fatal if not correctly diagnosed. Here, we report on the clinical, endoscopic and imaging features and treatment outcomes for five ischemic gastritis patients. This was a retrospective, single-centre study of patients treated for ischemic gastritis between January 2009 and April 2012. All patients underwent transluminal angioplasty or open revascularization surgery. Five patients (4 men, 1 female) were included in the present study. The condition was diagnosed in two cases of peritonitis with gastric or duodenal perforation, two cases of acute epigastric pain and one case of gastric bleeding, profuse vomiting and hypovolemic shock. Three of the five patients had endoscopically proven gastric ulcerations or necrosis. A computed tomography scan contributed to the diagnosis in all cases. The symptoms resolved in all cases after gastric revascularization via an aortohepatic bypass (N.=1), a renohepatic bypass (N.=1), a retrog...

Annals of Vascular Surgery, 2011

To compare the results of the endovascular aneurysm repair (EVAR) in patients considered as unfit... more To compare the results of the endovascular aneurysm repair (EVAR) in patients considered as unfit for surgery in a "high volume" center with the EVAR-2 trial results. In our center, between January 2006 and December 2008, 469 endovascular aorta treatments were performed in high-risk patients. All the data were prospectively collected in a database. Among 469 patients, we selected 191 patients considered as unfit for open surgery (group 1) corresponding to the EVAR trial criteria. Variables such as postoperative mortality at 30 days and 1 year, complications rates, as well as early and late redo surgery were evaluated. Long-term pharmacological treatment before surgery was listed. These results were compared with the EVAR trial (group 2). Survival during the follow-up was calculated according to the Kaplan-Meier method. Mortality at 30 days was 1.6% and 9% in groups 1 and 2, respectively (p = 0.002). Global complication rate was 44% and 43% in groups 1 and 2, respectively (p = 0.52). Over the follow-up period, the redo surgery rate was 13% and 26% in groups 1 and 2, respectively (p = 0.0102). In our cohort, the survival rate at 2 years was 84% with a residual number of 102 patients. Before surgery, a long-term antiplatelet treatment was prescribed in 89% and 58% of the patients and statins in 74% and 39% of the patients in groups 1 and 2, respectively (p < 0.0001). The EVAR-2 trial conclusions are in opposition to the practice of French vascular surgeons. Endovascular treatment of abdominal aortic aneurysms in high-risk patients is justified. This study confirms the importance of a multidisciplinary treatment for high-risk patients in high-volume centers.

Annals of Vascular Surgery, 2014

Annals of Vascular Surgery, 2013

This study compared early and mid-term results of endovascular treatment for abdominal aortic ane... more This study compared early and mid-term results of endovascular treatment for abdominal aortic aneurysms (AAAs) and pararenal aneurysms (PRAs). Using data from a prospective database, patients treated with endografts for AAA and PRA between January 2007 and December 2009 were analyzed. In both groups, mortality, endoleak rates, evolution of renal function, reintervention rate at 30 days and at mid-term follow-up, and aneurysmal sac evolution at 1 year were compared. In total, 379 patients were included: 264 treated for AAA and 115 for PRA. Median follow-up was 24 months (range 12-46 months) in both groups. Risk factors and medical history were comparable in both groups, except for chronic renal failure (higher in the PRA group; P = 0.003). The mortality rates at 30 days were 1% and 3% in the AAA and APR groups, respectively (P = 0.10). During follow-up, the mortality rates were 11.1% and 12.8% in the AAA and PRA groups, respectively (P = 0.72). The reoperation rates at 30 days were 8% and 10% in the AAA and PRA groups, respectively (P = 0.72). During follow-up, the reoperation rates were 9.2% and 9.9% in the AAA and PRA groups, respectively (P = 0.85). At 1 year, retraction of the aneurysmal sac was diagnosed in 48% of the patients in the AAA group and in 56% of the patients in the PRA group (P = 0.41). The incidence rates of new postoperative cases of renal insufficiency were 19.3% and 8.1% in the AAA and PRA groups, respectively (P = 0.008). At 30 days, the endoleak rates were 27.5% and 12.7% in the AAA and PRA groups, respectively (P = 0.001). At 1 year, the endoleak rates were 19.4% and 7.3% in the AAA and PRA groups, respectively (P = 0.007). When type II endoleaks were excluded, the endoleak rates were comparable in both groups (P = 0.5). At 1 year, in both groups, a retraction of the aneurysmal sac was significantly correlated to the absence of endoleak (P = 0.001). Early and mid-term results of AAA treatment with standard endografts and PRA treatment with fenestrated endografts are comparable.

Langenbeck's Archives of Surgery, 2010

Journal of Endovascular Therapy, 2010

To describe a novel technique of cannulating a side branch during endovascular repair of a thorac... more To describe a novel technique of cannulating a side branch during endovascular repair of a thoracoabdominal aneurysm (TAAA). The approach evolved during endovascular repair of a type III TAAA in which a custom-designed graft with 3 caudally directed branches was being deployed in a patient who had a prior surgical repair for a type IV TAAA. Two of the branches were successfully cannulated and stented, but repeated efforts to cannulate the left renal branch and artery via the standard brachial approach were unsuccessful. A catheter positioned between the graft and the aneurysm sac was used to gain retrograde access to this branch. From a left brachial access this guidewire was snared and used to allow bridging stent deployment between the branch and the renal artery, thus completing the procedure. This report describes a novel technique to deal with challenging side branch cannulation that may be encountered during branched stent-graft deployment.

Journal of Endovascular Therapy, 2010

To describe our experience with the use of custom-designed branched or fenestrated endoprostheses... more To describe our experience with the use of custom-designed branched or fenestrated endoprostheses incorporating an inverted contralateral limb in the bifurcated component. Retrospective analysis was performed of a prospectively maintained database of all patients undergoing endovascular aneurysm repair using modular branched or fenestrated devices at a university teaching hospital between January 2004 and February 2010. Of 102 cases, 7 male patients (mean age 69 years) were treated with modular devices that incorporated an inverted contralateral limb in the bifurcated component. Five patients had thoracoabdominal aortic aneurysm (4 type IV and 1 type II), 1 patient had a pararenal abdominal aortic aneurysm, and another had type I endoleak from a migrated AneuRx stent-graft. The technique was used primarily because of an existing bifurcated prosthesis (n=5), but in 2 patients without prior open surgery, this technique was needed because of anatomical constraints. All devices were implanted as planned. There was no mortality. One patient required temporary hemodialysis prior to discharge; another patient developed permanent paraplegia, likely related to extensive aortic coverage. No device migration, component separation, or type I or III endoleaks were detected during a mean follow-up of 25 months, and no reinterventions have been necessary. The use of an inverted limb in the bifurcated component of modular endografts may allow endovascular treatment in scenarios where there is insufficient space to deploy a standard bifurcated component. This design modification allows an adequate sealing zone between the iliac extension limbs and the bifurcated component.

Journal of Endovascular Therapy, 2010

To describe the novel use of an Amplatzer occluder device to seal a secondary endoleak arising at... more To describe the novel use of an Amplatzer occluder device to seal a secondary endoleak arising at a scallop in a fenestrated stent-graft. A 67-year-old man with comorbidities precluding standard endovascular repair of a pararenal aortic aneurysm was treated with a fenestrated endoprosthesis containing one fenestration for the left renal artery and one scallop for the celiac trunk; the right renal and superior mesenteric arteries were occluded at presentation. Interval imaging at 2 years showed a proximal type I endoleak at the celiac trunk scallop associated with expansion of the aneurysm sac. Attempted repair with an aortic extension cuff and a "chimney" stent was unsuccessful. An Amplatzer Patent Foramen Ovale occluder device was deployed across the endoleak to provide aneurysm sac exclusion, which has been maintained at 6-month follow-up. Treatment of a secondary type I endoleak after implantation of a fenestrated endoprosthesis is challenging. The novel use of an Amplatzer occluder in this setting may be applicable to other situations in which an endovascular solution is desirable for complications of complex endovascular aneurysm repair.

Annals of Vascular Surgery, 2013

Peripancreatic artery aneurysms are a rare condition, representing &a... more Peripancreatic artery aneurysms are a rare condition, representing <2% of all splanchnic artery aneurysms, and have been significantly related to celiac axis stenosis. While they are most often asymptomatic, those aneurysms have a strong tendency to rupture (52% rupture rate at the initial presentation) and, in this case, the outcome is often dramatic. Given that reports of this disease are rare, appropriate guidelines are difficult to formulate and different treatment strategies have been proposed. Endovascular management seems to be efficient in the large majority of most recent reports, but open surgery still remains necessary for complex cases, especially when associated with celiac axis stenosis. We report a new occurrence of a symptomatic compressive aneurysm related to common bile duct compression that we treated using a hybrid procedure.

Journal des Maladies Vasculaires, 2014

ABSTRACT Objectifs Étudier la faisabilité d’un guidage échographique exclusif pour les gestes d’a... more ABSTRACT Objectifs Étudier la faisabilité d’un guidage échographique exclusif pour les gestes d’angioplastie de fistule artério-veineuse (FAV) et déterminer les avantages et inconvénients de cette technique. Méthodes Entre janvier 2013 et janvier 2014, 12 patients (13 sténoses) présentant une sténose significative de FAV ont bénéficié d’une angioplastie simple de la veine de drainage sous contrôle échographique exclusif. Les paramètres morphologiques (pourcentage et longueur de la sténose, diamètre minimal de la veine de drainage, distance entre la lésion et l’anastomose) et hémodynamiques (débit, vitesse systolique en sortie de sténose) ont été relevés avant, pendant et à un mois du geste. Résultats Sur les 13 lésions proposées à l’angioplastie sous échographie, 11 ont été traitées avec succès (85 %) ; les deux échecs correspondaient à un échec de cathétérisme. Le degré moyen de sténose était de 60,5 % (48–75) avec un diamètre minimal moyen de 2,13 mm (0,9–2,5). Les sténoses étaient situées à distance de l’anastomose pour 62 % des lésions et en juxta-anastomotiques pour 38 % des lésions. Les sténoses associées artérielles et/ou anastomotiques constituaient un critère d’exclusion pour la prise en charge échographique. Aucun stent n’a été posé en per-procédure. Les inflations étaient poursuivies jusqu’à la levée de la sténose contrôlée en écho-Doppler. Le nombre moyen d’inflations nécessaires pour lever la sténose était de 2 (1–3). Le succès technique était confirmé par la mesure de la vitesse systolique maximale en regard de la sténose inférieure ou égale à 3 m/s. Le temps moyen des procédures était de 49 minutes (30–90) incluant les mesures peropératoires. Le débit moyen postopératoire était supérieur à 600 mL/min. Il n’y a eu aucune complication en per- et postopératoire. Au contrôle écho-Doppler à un mois de l’intervention, aucune resténose ni chute de débit n’a été mise en évidence. Conclusion L’angioplastie de FAV sous guidage échographique exclusif est faisable, efficace et sûre. Les principaux avantages sont l’absence d’irradiation et d’utilisation de produit de contraste iodé ; cette technique permet également un contrôle immédiat du succès technique par les mesures hémodynamiques ; elle permet également de mieux cibler les lésions à traiter, de diminuer le risque de surdilatation et de diminuer les complications per- et postopératoires. Ces résultats viennent renforcer les données de la littérature pour un plus grand rôle de l’écho-Doppler dans le guidage et la thérapeutique vasculaire.

Minerva chirurgica, 2012

Ischemic gastritis is poorly known by physicians and is often fatal if not correctly diagnosed. H... more Ischemic gastritis is poorly known by physicians and is often fatal if not correctly diagnosed. Here, we report on the clinical, endoscopic and imaging features and treatment outcomes for five ischemic gastritis patients. This was a retrospective, single-centre study of patients treated for ischemic gastritis between January 2009 and April 2012. All patients underwent transluminal angioplasty or open revascularization surgery. Five patients (4 men, 1 female) were included in the present study. The condition was diagnosed in two cases of peritonitis with gastric or duodenal perforation, two cases of acute epigastric pain and one case of gastric bleeding, profuse vomiting and hypovolemic shock. Three of the five patients had endoscopically proven gastric ulcerations or necrosis. A computed tomography scan contributed to the diagnosis in all cases. The symptoms resolved in all cases after gastric revascularization via an aortohepatic bypass (N.=1), a renohepatic bypass (N.=1), a retrog...

Annals of Vascular Surgery, 2011

To compare the results of the endovascular aneurysm repair (EVAR) in patients considered as unfit... more To compare the results of the endovascular aneurysm repair (EVAR) in patients considered as unfit for surgery in a "high volume" center with the EVAR-2 trial results. In our center, between January 2006 and December 2008, 469 endovascular aorta treatments were performed in high-risk patients. All the data were prospectively collected in a database. Among 469 patients, we selected 191 patients considered as unfit for open surgery (group 1) corresponding to the EVAR trial criteria. Variables such as postoperative mortality at 30 days and 1 year, complications rates, as well as early and late redo surgery were evaluated. Long-term pharmacological treatment before surgery was listed. These results were compared with the EVAR trial (group 2). Survival during the follow-up was calculated according to the Kaplan-Meier method. Mortality at 30 days was 1.6% and 9% in groups 1 and 2, respectively (p = 0.002). Global complication rate was 44% and 43% in groups 1 and 2, respectively (p = 0.52). Over the follow-up period, the redo surgery rate was 13% and 26% in groups 1 and 2, respectively (p = 0.0102). In our cohort, the survival rate at 2 years was 84% with a residual number of 102 patients. Before surgery, a long-term antiplatelet treatment was prescribed in 89% and 58% of the patients and statins in 74% and 39% of the patients in groups 1 and 2, respectively (p < 0.0001). The EVAR-2 trial conclusions are in opposition to the practice of French vascular surgeons. Endovascular treatment of abdominal aortic aneurysms in high-risk patients is justified. This study confirms the importance of a multidisciplinary treatment for high-risk patients in high-volume centers.

Annals of Vascular Surgery, 2014

Annals of Vascular Surgery, 2013

This study compared early and mid-term results of endovascular treatment for abdominal aortic ane... more This study compared early and mid-term results of endovascular treatment for abdominal aortic aneurysms (AAAs) and pararenal aneurysms (PRAs). Using data from a prospective database, patients treated with endografts for AAA and PRA between January 2007 and December 2009 were analyzed. In both groups, mortality, endoleak rates, evolution of renal function, reintervention rate at 30 days and at mid-term follow-up, and aneurysmal sac evolution at 1 year were compared. In total, 379 patients were included: 264 treated for AAA and 115 for PRA. Median follow-up was 24 months (range 12-46 months) in both groups. Risk factors and medical history were comparable in both groups, except for chronic renal failure (higher in the PRA group; P = 0.003). The mortality rates at 30 days were 1% and 3% in the AAA and APR groups, respectively (P = 0.10). During follow-up, the mortality rates were 11.1% and 12.8% in the AAA and PRA groups, respectively (P = 0.72). The reoperation rates at 30 days were 8% and 10% in the AAA and PRA groups, respectively (P = 0.72). During follow-up, the reoperation rates were 9.2% and 9.9% in the AAA and PRA groups, respectively (P = 0.85). At 1 year, retraction of the aneurysmal sac was diagnosed in 48% of the patients in the AAA group and in 56% of the patients in the PRA group (P = 0.41). The incidence rates of new postoperative cases of renal insufficiency were 19.3% and 8.1% in the AAA and PRA groups, respectively (P = 0.008). At 30 days, the endoleak rates were 27.5% and 12.7% in the AAA and PRA groups, respectively (P = 0.001). At 1 year, the endoleak rates were 19.4% and 7.3% in the AAA and PRA groups, respectively (P = 0.007). When type II endoleaks were excluded, the endoleak rates were comparable in both groups (P = 0.5). At 1 year, in both groups, a retraction of the aneurysmal sac was significantly correlated to the absence of endoleak (P = 0.001). Early and mid-term results of AAA treatment with standard endografts and PRA treatment with fenestrated endografts are comparable.

Langenbeck's Archives of Surgery, 2010

Journal of Endovascular Therapy, 2010

To describe a novel technique of cannulating a side branch during endovascular repair of a thorac... more To describe a novel technique of cannulating a side branch during endovascular repair of a thoracoabdominal aneurysm (TAAA). The approach evolved during endovascular repair of a type III TAAA in which a custom-designed graft with 3 caudally directed branches was being deployed in a patient who had a prior surgical repair for a type IV TAAA. Two of the branches were successfully cannulated and stented, but repeated efforts to cannulate the left renal branch and artery via the standard brachial approach were unsuccessful. A catheter positioned between the graft and the aneurysm sac was used to gain retrograde access to this branch. From a left brachial access this guidewire was snared and used to allow bridging stent deployment between the branch and the renal artery, thus completing the procedure. This report describes a novel technique to deal with challenging side branch cannulation that may be encountered during branched stent-graft deployment.

Journal of Endovascular Therapy, 2010

To describe our experience with the use of custom-designed branched or fenestrated endoprostheses... more To describe our experience with the use of custom-designed branched or fenestrated endoprostheses incorporating an inverted contralateral limb in the bifurcated component. Retrospective analysis was performed of a prospectively maintained database of all patients undergoing endovascular aneurysm repair using modular branched or fenestrated devices at a university teaching hospital between January 2004 and February 2010. Of 102 cases, 7 male patients (mean age 69 years) were treated with modular devices that incorporated an inverted contralateral limb in the bifurcated component. Five patients had thoracoabdominal aortic aneurysm (4 type IV and 1 type II), 1 patient had a pararenal abdominal aortic aneurysm, and another had type I endoleak from a migrated AneuRx stent-graft. The technique was used primarily because of an existing bifurcated prosthesis (n=5), but in 2 patients without prior open surgery, this technique was needed because of anatomical constraints. All devices were implanted as planned. There was no mortality. One patient required temporary hemodialysis prior to discharge; another patient developed permanent paraplegia, likely related to extensive aortic coverage. No device migration, component separation, or type I or III endoleaks were detected during a mean follow-up of 25 months, and no reinterventions have been necessary. The use of an inverted limb in the bifurcated component of modular endografts may allow endovascular treatment in scenarios where there is insufficient space to deploy a standard bifurcated component. This design modification allows an adequate sealing zone between the iliac extension limbs and the bifurcated component.

Journal of Endovascular Therapy, 2010

To describe the novel use of an Amplatzer occluder device to seal a secondary endoleak arising at... more To describe the novel use of an Amplatzer occluder device to seal a secondary endoleak arising at a scallop in a fenestrated stent-graft. A 67-year-old man with comorbidities precluding standard endovascular repair of a pararenal aortic aneurysm was treated with a fenestrated endoprosthesis containing one fenestration for the left renal artery and one scallop for the celiac trunk; the right renal and superior mesenteric arteries were occluded at presentation. Interval imaging at 2 years showed a proximal type I endoleak at the celiac trunk scallop associated with expansion of the aneurysm sac. Attempted repair with an aortic extension cuff and a "chimney" stent was unsuccessful. An Amplatzer Patent Foramen Ovale occluder device was deployed across the endoleak to provide aneurysm sac exclusion, which has been maintained at 6-month follow-up. Treatment of a secondary type I endoleak after implantation of a fenestrated endoprosthesis is challenging. The novel use of an Amplatzer occluder in this setting may be applicable to other situations in which an endovascular solution is desirable for complications of complex endovascular aneurysm repair.

Annals of Vascular Surgery, 2013

Peripancreatic artery aneurysms are a rare condition, representing &a... more Peripancreatic artery aneurysms are a rare condition, representing <2% of all splanchnic artery aneurysms, and have been significantly related to celiac axis stenosis. While they are most often asymptomatic, those aneurysms have a strong tendency to rupture (52% rupture rate at the initial presentation) and, in this case, the outcome is often dramatic. Given that reports of this disease are rare, appropriate guidelines are difficult to formulate and different treatment strategies have been proposed. Endovascular management seems to be efficient in the large majority of most recent reports, but open surgery still remains necessary for complex cases, especially when associated with celiac axis stenosis. We report a new occurrence of a symptomatic compressive aneurysm related to common bile duct compression that we treated using a hybrid procedure.