Pierre Vandenbossche - Academia.edu (original) (raw)
Papers by Pierre Vandenbossche
Progres En Urologie, 2002
The authors report a case of ruptured aneurysm of the renal artery in a 70-year-old man urgently ... more The authors report a case of ruptured aneurysm of the renal artery in a 70-year-old man urgently admitted for massive haematuria and shock. As a result of a rapid diagnosis, ex situ resection of the aneurysm was performed with reconstruction of the renal artery pedicle using a vein graft and autologous renal transplantation in the iliac fossa. The patient had a favourable course at one year with normal renal function on laboratory tests and isotope scan. The authors review the literature concerning the epidemiology, classification, clinical features and management of aneurysms of the renal artery.
Acta Clinica Belgica, 1996
The authors report 3 cases of thromboembolic splenic infarction due to atherosclerosis of the tho... more The authors report 3 cases of thromboembolic splenic infarction due to atherosclerosis of the thoracic aorta and the splenic artery. On this occasion, a retrospective analysis of 64 splenic infarcts showed that, in contrast to the literature, the leading aetiology in our series consisted of haematologic disorders (50%), followed by cardiovascular diseases (29%) and by digestive disorders (20%). Mean age was 58 +/- 17 years and 50% of the patients were aged below 60 years. Hospital mortality rate was high (34%) but not directly related to splenic infarction, suggesting that splenic infarction often occurs in the setting of severe underlying diseases. Splenic infarct is part of the differential diagnosis of the left upper quadrant pain and can also mimic renal disorders. Laboratory values may show an inflammatory syndrome and an increase in serum lactate deshydrogenase. Diagnosis is often made by CT scan and can be confirmed by a selective spleen scintigraphy. Transoesophageal echocardiography is essential in the detection of cardiac and thoracic aorta embolic material.
Louvain Medical, 2006
Traumatic laceration is a very common problem. We describe a standardized management thanks to wh... more Traumatic laceration is a very common problem. We describe a standardized management thanks to which the best functional and cosmetical results should be obtained and infection avoided.
Acta Chirurgica Belgica, 2008
Aortic and iliac pseudo-aneurysms are infrequent but challenging complications after open surgica... more Aortic and iliac pseudo-aneurysms are infrequent but challenging complications after open surgical graft reconstructions, mostly having para-anastomotic localisations. The true corporeal peri-prosthetic false aneurysms are, up until now, very rarely documented presentations. We report the clinical case of an 8.8 cm diameter non-anastomotic and aseptic pseudo-aneurysm developed on aorto-bifemoral Dacron prosthesis in a symptomatic and high surgical risk patient. Considering the clinical presentation and the anatomical features, a chronic tear of the posterior prosthetic wall by prominent aortic remnant calcifications was evoked as the possible aetiology. An endovascular exclusion, using a tapered aorto-uni-iliac endograft coupled to a femoro-femoral bypass revascularisation, was technically successful. Despite scarce published clinical data focusing on the optimal treatment dedicated to this category of false aneurysm, this approach is thought to be beneficial in selected cases of high-risk surgical patients.
International surgery
Spiral CT has proved to be a valuable tool by providing various kinds of three-dimensional (3D) i... more Spiral CT has proved to be a valuable tool by providing various kinds of three-dimensional (3D) images of the studied structures. Such 3D images, which offer a more realistic depiction of the lesions, could be of interest for surgeons who are attempting to treat conservatively blunt abdominal traumas and lead to less inappropriate triage between conservative and operative management particularly for renal trauma. A good working relationship between surgeons and radiologists allowed us to perform an early follow-up 3D spiral CT on a commercially available spiral CT scanner. In the first adult patient, the 3D CT demonstrated minor spleen injury associated with severe lacerations of the left kidney with complete separation of the kidney lower pole. A delayed partial lower nephrectomy was performed. For the second 12-year-old patient presenting with severe spleen trauma and macroscopic hematuria, the 3D CT accurately documented the spleen and renal lesions that were safely amenable to n...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2002
The authors report a case of ruptured aneurysm of the renal artery in a 70-year-old man urgently ... more The authors report a case of ruptured aneurysm of the renal artery in a 70-year-old man urgently admitted for massive haematuria and shock. As a result of a rapid diagnosis, ex situ resection of the aneurysm was performed with reconstruction of the renal artery pedicle using a vein graft and autologous renal transplantation in the iliac fossa. The patient had a favourable course at one year with normal renal function on laboratory tests and isotope scan. The authors review the literature concerning the epidemiology, classification, clinical features and management of aneurysms of the renal artery.
The European journal of surgery = Acta chirurgica, 1997
Assessment of the videoscopic approach to the retroperitoneal space in the vicinity of the kidney... more Assessment of the videoscopic approach to the retroperitoneal space in the vicinity of the kidney and the adrenal gland. Open study. University hospital, Belgium. 10 patients who underwent 11 operations (adrenalectomy, n = 3, nephrectomy, n = 5, partial nephrectomy, n = 2, and renal cystectomy, n = 1). Direct CO2 insufflation of the retroperitoneal space in order to obtain a convenient retroperitoneal working space for renal and adrenal surgery. Feasibility, morbidity and mortality. 8 patients were operated on exclusively by the retroperitoneoscopic approach; 2 required the retroperitoneal and transperitoneal routes to be combined to complete an adrenalectomy. No patients required blood transfusion and no patient died. Median postoperative stay was 3 days. The CO2 insufflation technique of the retroperitoneum is safe and reproducible. Nevertheless, far from excluding each other, both approaches-laparoscopic and retroperitoneoscopic-are complementary in difficult cases, particularly ...
Pediatric Pulmonology, 1998
Journal of Endovascular Therapy, 2008
To evaluate the technical and clinical outcomes of primary subintimal (SA) and endoluminal angiop... more To evaluate the technical and clinical outcomes of primary subintimal (SA) and endoluminal angioplasty (EA) guided by an angiosome model of revascularization in diabetic patients with critical limb ischemia (CLI) and Wagner grade 1-4 foot ulcers. Methods: A retrospective review was undertaken of 98 diabetic CLI patients (68 men; mean age 72.8 years, range 46-94) who presented to our institution from January 2005 to January 2008 for treatment of Wagner grade 1-4 foot ulcers involving 124 limbs. Following the angiosome model of perfusion in the foot and ankle, the target arterial lesions in the 124 limbs were treated with 80 (64%) associated SA and EA procedures, 21 (17%) multilevel EAs, and 23 (18%) single SA techniques. Results: Initial technical success was achieved in 102 (82%) interventions: 82/103 SAs and 20/21 of the EAs. The 30-day survival rate was 98% (1 fatal myocardial infarction). The cumulative rates of primary and secondary patency, limb salvage, and clinical success were: 57%64%, 71%64%, 91%63%, and 85%63% at 12 months and 48%65%, 61%64%, 84%66%, and 73%66% at 32 months, respectively. Limb salvage appeared to be negatively affected at 3 years by the presence of Wagner grade 3-4 lesions (p,0.0002), the bedridden condition of patients (p,0.0001), end-stage renal disease (p,0.0001), left ventricular dysfunction (p,0.0001), and peripheral neuropathy (p50.023). Using the angiosome approach, complete healing of ulcers with or without minor amputation was seen in 79% (98/124 limbs), while 62 of 70 Wagner grade 1-2 and 36 of 54 Wagner 3-4 foot lesions healed in the first 1 to 3 months after revascularization. Conclusion: Targeted primary angioplasty following the angiosome model could be an effective therapeutic method in the ulcer healing process. However, beyond appropriate revascularization, aggressive control of concurrent risk factors in diabetic wound healing probably plays an equally relevant role.
The Journal of Emergency Medicine, 2002
European Journal of Vascular and Endovascular Surgery, 2009
Introduction: This study aims to assess the patency, the clinical success and the limb-salvage ra... more Introduction: This study aims to assess the patency, the clinical success and the limb-salvage rates of combined subintimal (SA) coupled to endoluminal angioplasty (EA) as the initial treatment of ischaemic inferior-limb ulcers in diabetic patients and to study the influence of other concurrent factors in the tissue-healing process. Materials and method: Since September 2002 until December 2007, a consecutive series of 176 limbs with manifold ischaemic wounds in 161 diabetic patients were treated by associated multilevel angioplasties in a multidisciplinary 'diabetic-foot team' (a third-line diabetic-care institution integrating two departmental hospitals). There were 98 associated SA with EA procedures, 26 re-vascularisations by single SA technique and 52 others including selective multilevel EAs that were retrospectively reviewed. The mean follow-up period was 22.1 months (in the range of 1e50 months) by clinical and duplex evaluation (every 6 months).
European Journal of Emergency Medicine, 1997
European Journal of Emergency Medicine, 2001
The number of geriatric patients admitted to the accident and emergency department is growing. Th... more The number of geriatric patients admitted to the accident and emergency department is growing. These patients also present increasing functional dependence and a large panel of associated diseases and associated problems. For the purpose of describing this phenomenon, we prospectively studied the epidemiology of patients 75 years and older entering the emergency department of a university hospital localized in a rural area. From January 1996 up to January 1997, 1298 patients aged 75 years or older were admitted to the emergency department. This age group represented 12.3% of all the patients admitted during the period. Ž. The gender distribution was almost equal: 56% were female and 44% male. Most of them 75% were referred by their general practitioner although 15% came spontaneously. The most Ž. common complaints were, in decreasing order: general condition impairment 21.5% , dys-Ž. Ž. Ž. Ž. pnoea 15% , falls and traumas 15% , abdominal problems 13% , thoracic pain 9% , syncope, Ž. Ž. dizziness 7% and stroke 5.5%. Hospitalization was necessary in 69% of cases. Among the Ž. patients coming spontaneously a larger proportion 55% were sent back home compared with only 25% of those referred by their general practitioner.
Archives de Pédiatrie, 1998
British Journal of Surgery, 1997
Progres En Urologie, 2002
The authors report a case of ruptured aneurysm of the renal artery in a 70-year-old man urgently ... more The authors report a case of ruptured aneurysm of the renal artery in a 70-year-old man urgently admitted for massive haematuria and shock. As a result of a rapid diagnosis, ex situ resection of the aneurysm was performed with reconstruction of the renal artery pedicle using a vein graft and autologous renal transplantation in the iliac fossa. The patient had a favourable course at one year with normal renal function on laboratory tests and isotope scan. The authors review the literature concerning the epidemiology, classification, clinical features and management of aneurysms of the renal artery.
Acta Clinica Belgica, 1996
The authors report 3 cases of thromboembolic splenic infarction due to atherosclerosis of the tho... more The authors report 3 cases of thromboembolic splenic infarction due to atherosclerosis of the thoracic aorta and the splenic artery. On this occasion, a retrospective analysis of 64 splenic infarcts showed that, in contrast to the literature, the leading aetiology in our series consisted of haematologic disorders (50%), followed by cardiovascular diseases (29%) and by digestive disorders (20%). Mean age was 58 +/- 17 years and 50% of the patients were aged below 60 years. Hospital mortality rate was high (34%) but not directly related to splenic infarction, suggesting that splenic infarction often occurs in the setting of severe underlying diseases. Splenic infarct is part of the differential diagnosis of the left upper quadrant pain and can also mimic renal disorders. Laboratory values may show an inflammatory syndrome and an increase in serum lactate deshydrogenase. Diagnosis is often made by CT scan and can be confirmed by a selective spleen scintigraphy. Transoesophageal echocardiography is essential in the detection of cardiac and thoracic aorta embolic material.
Louvain Medical, 2006
Traumatic laceration is a very common problem. We describe a standardized management thanks to wh... more Traumatic laceration is a very common problem. We describe a standardized management thanks to which the best functional and cosmetical results should be obtained and infection avoided.
Acta Chirurgica Belgica, 2008
Aortic and iliac pseudo-aneurysms are infrequent but challenging complications after open surgica... more Aortic and iliac pseudo-aneurysms are infrequent but challenging complications after open surgical graft reconstructions, mostly having para-anastomotic localisations. The true corporeal peri-prosthetic false aneurysms are, up until now, very rarely documented presentations. We report the clinical case of an 8.8 cm diameter non-anastomotic and aseptic pseudo-aneurysm developed on aorto-bifemoral Dacron prosthesis in a symptomatic and high surgical risk patient. Considering the clinical presentation and the anatomical features, a chronic tear of the posterior prosthetic wall by prominent aortic remnant calcifications was evoked as the possible aetiology. An endovascular exclusion, using a tapered aorto-uni-iliac endograft coupled to a femoro-femoral bypass revascularisation, was technically successful. Despite scarce published clinical data focusing on the optimal treatment dedicated to this category of false aneurysm, this approach is thought to be beneficial in selected cases of high-risk surgical patients.
International surgery
Spiral CT has proved to be a valuable tool by providing various kinds of three-dimensional (3D) i... more Spiral CT has proved to be a valuable tool by providing various kinds of three-dimensional (3D) images of the studied structures. Such 3D images, which offer a more realistic depiction of the lesions, could be of interest for surgeons who are attempting to treat conservatively blunt abdominal traumas and lead to less inappropriate triage between conservative and operative management particularly for renal trauma. A good working relationship between surgeons and radiologists allowed us to perform an early follow-up 3D spiral CT on a commercially available spiral CT scanner. In the first adult patient, the 3D CT demonstrated minor spleen injury associated with severe lacerations of the left kidney with complete separation of the kidney lower pole. A delayed partial lower nephrectomy was performed. For the second 12-year-old patient presenting with severe spleen trauma and macroscopic hematuria, the 3D CT accurately documented the spleen and renal lesions that were safely amenable to n...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2002
The authors report a case of ruptured aneurysm of the renal artery in a 70-year-old man urgently ... more The authors report a case of ruptured aneurysm of the renal artery in a 70-year-old man urgently admitted for massive haematuria and shock. As a result of a rapid diagnosis, ex situ resection of the aneurysm was performed with reconstruction of the renal artery pedicle using a vein graft and autologous renal transplantation in the iliac fossa. The patient had a favourable course at one year with normal renal function on laboratory tests and isotope scan. The authors review the literature concerning the epidemiology, classification, clinical features and management of aneurysms of the renal artery.
The European journal of surgery = Acta chirurgica, 1997
Assessment of the videoscopic approach to the retroperitoneal space in the vicinity of the kidney... more Assessment of the videoscopic approach to the retroperitoneal space in the vicinity of the kidney and the adrenal gland. Open study. University hospital, Belgium. 10 patients who underwent 11 operations (adrenalectomy, n = 3, nephrectomy, n = 5, partial nephrectomy, n = 2, and renal cystectomy, n = 1). Direct CO2 insufflation of the retroperitoneal space in order to obtain a convenient retroperitoneal working space for renal and adrenal surgery. Feasibility, morbidity and mortality. 8 patients were operated on exclusively by the retroperitoneoscopic approach; 2 required the retroperitoneal and transperitoneal routes to be combined to complete an adrenalectomy. No patients required blood transfusion and no patient died. Median postoperative stay was 3 days. The CO2 insufflation technique of the retroperitoneum is safe and reproducible. Nevertheless, far from excluding each other, both approaches-laparoscopic and retroperitoneoscopic-are complementary in difficult cases, particularly ...
Pediatric Pulmonology, 1998
Journal of Endovascular Therapy, 2008
To evaluate the technical and clinical outcomes of primary subintimal (SA) and endoluminal angiop... more To evaluate the technical and clinical outcomes of primary subintimal (SA) and endoluminal angioplasty (EA) guided by an angiosome model of revascularization in diabetic patients with critical limb ischemia (CLI) and Wagner grade 1-4 foot ulcers. Methods: A retrospective review was undertaken of 98 diabetic CLI patients (68 men; mean age 72.8 years, range 46-94) who presented to our institution from January 2005 to January 2008 for treatment of Wagner grade 1-4 foot ulcers involving 124 limbs. Following the angiosome model of perfusion in the foot and ankle, the target arterial lesions in the 124 limbs were treated with 80 (64%) associated SA and EA procedures, 21 (17%) multilevel EAs, and 23 (18%) single SA techniques. Results: Initial technical success was achieved in 102 (82%) interventions: 82/103 SAs and 20/21 of the EAs. The 30-day survival rate was 98% (1 fatal myocardial infarction). The cumulative rates of primary and secondary patency, limb salvage, and clinical success were: 57%64%, 71%64%, 91%63%, and 85%63% at 12 months and 48%65%, 61%64%, 84%66%, and 73%66% at 32 months, respectively. Limb salvage appeared to be negatively affected at 3 years by the presence of Wagner grade 3-4 lesions (p,0.0002), the bedridden condition of patients (p,0.0001), end-stage renal disease (p,0.0001), left ventricular dysfunction (p,0.0001), and peripheral neuropathy (p50.023). Using the angiosome approach, complete healing of ulcers with or without minor amputation was seen in 79% (98/124 limbs), while 62 of 70 Wagner grade 1-2 and 36 of 54 Wagner 3-4 foot lesions healed in the first 1 to 3 months after revascularization. Conclusion: Targeted primary angioplasty following the angiosome model could be an effective therapeutic method in the ulcer healing process. However, beyond appropriate revascularization, aggressive control of concurrent risk factors in diabetic wound healing probably plays an equally relevant role.
The Journal of Emergency Medicine, 2002
European Journal of Vascular and Endovascular Surgery, 2009
Introduction: This study aims to assess the patency, the clinical success and the limb-salvage ra... more Introduction: This study aims to assess the patency, the clinical success and the limb-salvage rates of combined subintimal (SA) coupled to endoluminal angioplasty (EA) as the initial treatment of ischaemic inferior-limb ulcers in diabetic patients and to study the influence of other concurrent factors in the tissue-healing process. Materials and method: Since September 2002 until December 2007, a consecutive series of 176 limbs with manifold ischaemic wounds in 161 diabetic patients were treated by associated multilevel angioplasties in a multidisciplinary 'diabetic-foot team' (a third-line diabetic-care institution integrating two departmental hospitals). There were 98 associated SA with EA procedures, 26 re-vascularisations by single SA technique and 52 others including selective multilevel EAs that were retrospectively reviewed. The mean follow-up period was 22.1 months (in the range of 1e50 months) by clinical and duplex evaluation (every 6 months).
European Journal of Emergency Medicine, 1997
European Journal of Emergency Medicine, 2001
The number of geriatric patients admitted to the accident and emergency department is growing. Th... more The number of geriatric patients admitted to the accident and emergency department is growing. These patients also present increasing functional dependence and a large panel of associated diseases and associated problems. For the purpose of describing this phenomenon, we prospectively studied the epidemiology of patients 75 years and older entering the emergency department of a university hospital localized in a rural area. From January 1996 up to January 1997, 1298 patients aged 75 years or older were admitted to the emergency department. This age group represented 12.3% of all the patients admitted during the period. Ž. The gender distribution was almost equal: 56% were female and 44% male. Most of them 75% were referred by their general practitioner although 15% came spontaneously. The most Ž. common complaints were, in decreasing order: general condition impairment 21.5% , dys-Ž. Ž. Ž. Ž. pnoea 15% , falls and traumas 15% , abdominal problems 13% , thoracic pain 9% , syncope, Ž. Ž. dizziness 7% and stroke 5.5%. Hospitalization was necessary in 69% of cases. Among the Ž. patients coming spontaneously a larger proportion 55% were sent back home compared with only 25% of those referred by their general practitioner.
Archives de Pédiatrie, 1998
British Journal of Surgery, 1997