[Celiac artery aneurysms: ultrasonographic appearances in two cases (author's transl)]

Two patients were treated surgically for an aneurysm of the celiac artery, one of atheromatous and the other of dysplasic origin. Diagnosis was established by mode B ultrasonography, and confirmed by arteriography and operative findings. Emphasis is placed on the possibility of detecting such lesions, when confronted with an atypical epigastric symptomatology, by means of ultrasonography, particularly by the use of an apparatus in real time. This should enable a more rapid and probably more precise approach to the aorta and large abdominal vessels.

[Subclavian steal syndrome from congenital atresia of the left subclavian artery (author's transl)]

Obstruction of the left subclavian artery is one of the rarest causes of the cogenital subclavian steal syndrome with a right-sided aorta. Radiological diagnosis can be made from a standard film which shows the aorta on the right, and a barium examination of the esophagus which demonstrates the absence of any compression posteriorly. Angiographic exploration (aortography, pulmonary angiography) is essential for positive confirmation of diagnosis and to exclude other types of congenital subclavian steal with a right-sided aorta. Certain cardiac malformations may be associated, but forms have been described without any other anomalies as in the case reported, which only became apparent when neurological symptoms developed in adult age.

[Leiomyosarcoma of the inferior vena cava (author's transl)]

A further case of leiomyosarcoma of the inferior vena cava is described, bringing the total number reported in the published literature to 63. The tumor was located in the inter-renal segment of the vena cava, and was effectively removed by excision combined with venous reconstruction, enabling conservation of the renal veins. These malignant tumors occur more frequently in women, and their symptomatology varies according to their location in either the upper, middle or lower area of the inferior vena cava. Upper segment tumors are revealed by a Budd-Chiari syndrome or obstruction of the right atrium and are usually rapidly fatal. Middle and lower segment tumors can be treated surgically, if diagnosis is made early enough and cavography is conducted.

[Pseudo-tumoral haematoma of the iliac fossa in haemophiliacs (author's transl)]

Pseudo-tumoral blood collections in haemophiliacs are uncommon but must be borne in mind because of their severity and of the need for timely and appropriate treatment. Surgical excision appears to be required as soon as the tendency towards enlargement is recognized and before the volume and complications of the tumour increase the difficulties, particularly in the iliac fossa. Other treatments, especially puncture-aspiration, seem to be ineffective and/or dangerous. A better knowledge of the pathogenic processes involved might lead to new therapeutic approaches.

[Aneurism in a persisting sciatic artery. One case (author's transl)]

The authors report on the first case of aneurism in a persisting sciatic artery observed in France. The condition was complicated by truncular embolism and fissuration and was successfully treated by endo-aneurismorrhaphy. Restoration of arterial continuity is nevertheless necessary in most cases of aneurysm affecting a complete persistant sciatic artery (providing the vascular supply for the whole lower limb) which represents the commonest anatomical type.

[Splenic trauma complicating translumbar aortography : a report on 2 cases (author's transl)]

Two very rare cases of splenic trauma following high translumbar aortography are described. Two types of clinical picture are observed : severe intraperitoneal hemorrhage, subcapsular and then intraperitoneal, from rupture of the spleen, and septic peritonitis following rupture of an intra- and perisplenic abscess. The authors review the frequency, mechanism, and prevention of complications following translumbar aortic puncture.

[Surgical treatment of chemodectomas of the neck (author's transl)]

About 16 cases of chemodectomas of the neck, with surgical management during the five past years, the authors present an actualisation about surgery of these tumors of the paraganglionnary system at the level of the neck. After recording the different means of the diagnosis, particulary carotid arteriography, they insist about the necessity of a complete excision of these tumors because of local risks due to the neurovascular compression and infiltration, and because of general risks due to malignant metastasis. Three major risks run with surgery in these cases: hemorrhagic, neurologic, and vascular risks (because of the possible extension to the carotidian axis). 14 total excisions and 1 incomplete excision were performed; 1 no-operated tumor was noted because of the death of the patient before surgery due to a metastatis paraplegia. 4 resections of the carotidian axis with 1 repair by end to end anastomosis and 3 by a vein graft were necessary. No mortality after surgery in these patients was encountered. No recurence, no metastatic phenomen in our patients after the total excision of the primary chemodectoma of the neck even for one histologically maligant tumor, three years ago.

[Axillary-femoral by passes. Technic. Complications. Results (92 patients) (author's transl)]

Between January 1970 and October 1977, 95 operations of revascularisation of 124 lower limbs were carried out using the axillary artery in 92 patients. 84 patients had very severe ischemia, acute or chronic, which threatened the survival of the limb. In all, direct surgery was too dangerous (77 cases) or impossible owing to local or regional problems (7 cases). The results gave a mortality during the first two months of 13% in which infective complications of the technic accounted for 3.5%. The latter were frequent (12%) but a certain number of them could have been prevented (6%). 55 patients (65%) had a good result at two months (weight-bearing conserved) whilst 20%, i.e. 18 patients were amputated, of which five had a permeable by pass which permitted conservation of the knee. We observed the highest percentage of deaths (3/8 i.e. 37%) in bilateral emergency revascularisations for acute ischemia. We observed a very low percentage of early thrombosis (4%) in axillary bifemoral by pass performed for chronic ischemia. The operation is of great value when no other direct surgical technic is possible and only in these cases. 8 patients underwent an axillary by pass to treat infective complications of aorto-iliac surgery. 4 early deaths showed the severity of this complication (50%). Tactical aspects are discussed briefly.

[Aneurysm due to an exostosis of the upper end of the tibia (author's transl)]

The authors describe a case of aneurysm of the popliteal artery which developed in the vicinity of a solitary bony exostosis. In a review of the literature they found 33 other cases, in the majority of which the aneurysm was a false aneurysm. Diagnosis was made by arteriography. The results of treatment were good unless complications such as thrombosis or emboli were already present. In the authors' case, resection of the exostosis and arterial grafts were performed with a good end result.

[Arterial lesions caused by the Fogarty catheter (author's transl)]

The authors report 7 cases of arterial wound consecutive to the use of the Fogarty catheter: 1 rupture, 1 perforation, 2 arteriovenous fistulae. They investigate the mechanism and stress the importance of preoperative angiography to minimize the risk of unknwon anomalies. Also they indicate the ease and efficiency of the surgical correction when needed.

[Atypical angiographic appearances of aneurisms of the abdominal aorta (author's transl)]

On the basis of 72 radio-surgical cases of abdominal aortic aneurism, the authors stress the value of atypical angiographic findings, which are ten in number. The presence of clot within the aneurism itself may explain a disparity between radiological and surgical findings. Failure to recognize these atypical signs is very serious, when the diagnosis of aneurism is not suspected clinically. Antero-posterior and, above all, lateral abdominal aortography is essential in the angiographic study of aneurisms of the abdominal aorta. Careful search for these 10 atypical signs should make it possible to avoid missing latent aneurisms. Lateral abdominal aortography is essential in order to determine the state of the abdominal collaterals of the aorta and, in particular, the superior mesenteric artery.

[Atheromatous stenosis and occlusion of the brachiocephalic arterial trunk. Apropos of 24 operated cases]

The author reports an unpublished series of 24 operated cases and considers the surgical problems raised by atheromatous stenosis and obstruction of the innominate artery. At present, excellent results may be obtained thanks to: 1) better precision of the indications, excluding patients with neurological complications undergoing aggravation or permanent neurological signs; 2) at present, operations by the cervical route should be performed when the state of the heart and lungs prevents direct surgery by sternotomy, which remains, however, the method of choice.

Fractures of the clavicle and injuries of the sub-clavian artery. Report of 10 cases

During four years, the authors have observed ten lesions of the sub-clavian artery associated with a fracture of the clavicle. The clinical picture in one case out of two was that of an acute ischemia of the upper limb. The surgical repair has been performed in 8 cases. The thoracic approach was necessary three times. The clavicle was resected in most cases. The prognosis of these lesions depends on the rapidity of their recognition, and of their treatment, and on the fact whether the brachial plexus is involved or not

[Chances of avoiding amputation in an arteritis patient with gangrene]

During the period 1970-1974, restorative surgery was carried out 324 times in patients with gangrene or severe ischaemia caused by arteritis of the lower limbs. In 67 percent of the cases major excision surgery, such as amputation at the thigh or of the whole leg, was avoided and the support was retained. In 61 cases (19 percent) amputation was necessary either immediately or within a few weeks or months. Death occurred in 47 patients (14 percent) either in the operative period or in the 3 following years.