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Freton L, Khene ZE, Richard C, Mathieu R, Alimi Q, Duval E, Vassal L, Bertheuil N, Aillet S, Bonnet F, Ravel C, Guenego A, Travers D, Morel-Journel N, Hascoet J, Peyronnet B. [Self-assessment of healthcare workers regarding the management of trans people in a university hospital]. Prog Urol 2021; 31:1108-1114. [PMID: 34147357 DOI: 10.1016/j.purol.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Trans people face more barriers when seeking healthcare than the cisgender population probably due to a lack of knowledge, education and comfort of healthcare workers. The purpose of this study was to assess the knowledge and comfort felt by healthcare professionals in managing trans people in a French university hospital. METHODS A self-questionnaire was emailed to healthcare professionals working in departments usually involved in the care of trans people in a French university hospital "not specialized" in medical and surgical gender transition. The questionnaire included demographic questions and Likert scales regarding their knowledge and comfort in taking care of trans people. Responses on the 7-point Likert scales were categorized into "low", "medium" and "high" groups, and responses on the 5-point Likert scales were categorized into "in favour", "neutral" and "against" groups. RESULTS One hundred and two (29%) healthcare professionals answered the questionnaire. Half worked in surgical departments (urology, plastic surgery, gynecology), 24% worked in medical departments (endocrinology, reproductive medicine, cytogenetics) and 26% worked in psychiatry. The majority (60.3%) rated their level of knowledge as "low" and 39.7% as "medium". Sixteen percent rated their level of comfort in managing trans people as "low", 72.5% as "medium" and 11.5% as "high". A majority (77.5%) were in favor of having the costs of gender transition care covered by the national health insurance system, 16.4% were neutral and 6% were against this idea. Feelings about surgical and hormonal gender transition were overwhelmingly (96.4%) in favour or neutral and 91% were willing to get more training and education to manage trans people. CONCLUSION The lack of comfort felt by healthcare professionals in university hospital in managing trans people seems to be related to a lack of knowledge and training in that field and not to a disagreement with the need of transgender healthcare. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- L Freton
- Université de Rennes, urologie, CHU Rennes, Rennes, France.
| | - Z-E Khene
- Université de Rennes, urologie, CHU Rennes, Rennes, France
| | - C Richard
- Université de Rennes, urologie, CHU Rennes, Rennes, France
| | - R Mathieu
- Université de Rennes, urologie, CHU Rennes, Rennes, France
| | - Q Alimi
- Université de Rennes, urologie, CHU Rennes, Rennes, France
| | - E Duval
- Réseau de Santé Trans, Rennes, France
| | - L Vassal
- Réseau de Santé Trans, Rennes, France
| | - N Bertheuil
- Université de Rennes, chirurgie plastique et reconstructrice, CHU Rennes, Rennes, France
| | - S Aillet
- Université de Rennes, chirurgie plastique et reconstructrice, CHU Rennes, Rennes, France
| | - F Bonnet
- Université de Rennes, endocrinologie, CHU Rennes, Rennes, France
| | - C Ravel
- Université de Rennes, laboratoire de biologie de la reproduction-CECOS, CHU Rennes, Rennes, France
| | - A Guenego
- Université de Rennes, endocrinologie, CHU Rennes, Rennes, France
| | - D Travers
- Université de Rennes, psychiatrie, CHU Rennes, Rennes, France
| | - N Morel-Journel
- Université de Lyon, urologie, Hospices Civils de Lyon, Lyon, France
| | - J Hascoet
- Université de Rennes, urologie, CHU Rennes, Rennes, France
| | - B Peyronnet
- Université de Rennes, urologie, CHU Rennes, Rennes, France
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Mocquard C, Aillet S, Riffaud L. Recent advances in trigonocephaly. Neurochirurgie 2019; 65:246-251. [DOI: 10.1016/j.neuchi.2019.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/08/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
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Isola N, Herlin C, Chaput B, Aillet S, Watier E, Bertheuil N. Upper body lift and breast reshaping with lateral chest wall perforator propeller flap following massive weight loss. ANN CHIR PLAST ESTH 2019; 65:44-53. [PMID: 31350099 DOI: 10.1016/j.anplas.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/04/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND After massive weight loss (MWL), female patients often develop upper trunk laxity and severe breast deformities. Usually several procedures are required to address upper body contouring issues. OBJECTIVES To achieve better breasts and improve upper body contour, the authors employed a combined approach, associating lateral chest wall perforator propeller flaps with an upper bodylift (UBL). METHODS Between September 2015 and March 2017, nine post-bariatric patients underwent simultaneously an UBL and autologous augmentation breast reshaping with lateral chest wall perforator propeller flaps. The authors analyzed the clinical indications, results and complications of this procedure. RESULTS Eighteen lateral perforator propeller flaps for autologous breast augmentation-mastopexy associated with an UBL were performed successfully. Mean pre-MWL body mass index (BMI) was 54.3±10.9kg/m2, with a mean preoperative pre-UBL BMI of 28.7±3.6kg/m2. The average weight loss before surgery was 67.7±22.4kg. The flaps were harvested on intercostal and/or lateral thoracic arteries. All donor sites had been closed primarily. Following the classification of Dindo and Clavien, four minor complications (I, II), and two major complications (IIIb), including two hematomas requiring reoperation, were reported. No flap necrosis occurred. Follow-up averaged 27.9±8.4months. The patients' satisfaction with their improved breast shapes and chest wall contours was "good", with an aesthetic outcome mean ranked 3.8±0.8 (out of 5). CONCLUSIONS After MWL, upper body deformities can be treated safely and reliably by a combined approach, associating an UBL and autologous lateral chest wall perforator flaps to provide more natural and durable breast shapes, as well as an upper circumferential reshaping.
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Affiliation(s)
- N Isola
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35200 Rennes, France
| | - C Herlin
- Department of Plastic Surgery and Burn Surgery, Hopital Lapeyronie, Montpellier University Hospital, 34090 Montpellier, France
| | - B Chaput
- STROMAlab, UMR5273 CNRS, UPS, EFS, INSERM U1031, Rangueil Hospital, 31100 Toulouse, France; Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - S Aillet
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35200 Rennes, France
| | - E Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35200 Rennes, France
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35200 Rennes, France; INSERM U1236, University of Rennes 1, 35000 Rennes, France; SITI Laboratory, Rennes University Hospital, 35000 Rennes, France.
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Beuzeboc Gérard M, Aillet S, Bertheuil N, Delliere V, Thienot S, Watier E. Surgical management of subcutaneous fat necrosis of the newborn required due to a lack of improvement: a very rare case. Br J Dermatol 2014; 171:183-5. [PMID: 24359190 DOI: 10.1111/bjd.12798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 12/01/2022]
Abstract
Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon and transient disease characterized by defined areas of fat necrosis and overlying cutaneous nodule lesions. It usually becomes apparent within the first 6 weeks of life in full-term or post-term infants. It is caused by generalized and/or local tissue hypoperfusion. The skin lesions of ScFN tend generally to improve spontaneously in a few weeks. We present a full-term newborn with birth distress. After therapeutic hypothermia, she presented voluminous and numerous subcutaneous fat necrosis with extensive calcifications. Surgical management was decided at her ninth month because of a total lack of regression. Hypercalcaemia, the most threatening complication, appeared only after this delayed surgery.
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Affiliation(s)
- M Beuzeboc Gérard
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud - University of Rennes 1, 16 Boulevard de Bulgarie, Rennes, 35200, France
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Cousin-Verhoest S, Heusse JL, Verhoest G, Aillet S, Watier E. Exérèse des nævus congénitaux géants : jusqu’où aller avec la chirurgie ? ANN CHIR PLAST ESTH 2012; 57:177-82. [DOI: 10.1016/j.anplas.2011.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 10/11/2011] [Indexed: 10/15/2022]
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Descheemaeker V, Aillet S, Morcel K, Gravier A, Meyer N, Levêque J. Pyoderma gangrenosum et cancer du sein : à propos d’un cas. ACTA ACUST UNITED AC 2008; 37:618-21. [DOI: 10.1016/j.jgyn.2008.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 01/24/2008] [Accepted: 06/11/2008] [Indexed: 11/26/2022]
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Abstract
UNLABELLED Reduction mammaplasty (RM) can be performed during adolescence if the functional capacity of the breast is preserved. Future breast feeding must be carefully considered in the therapeutic decision making process. PURPOSE OF THE STUDY Breast feeding after reduction mammaplasty performed during adolescence was assessed to determine surgical factors influencing outcome and patient reception of information concerning breast feeding. METHODS A questionnaire was sent to 109 women who had undergone reduction mammaplasty between 1981 and 1997 when they were 15-17 years old to ascertain their reasons for having surgery, their satisfaction, and their attitude towards breast feeding. RESULTS Sixty-five questionnaires (60%) could be analyzed. Mean delay since surgery was 8.1 years. Seventeen women (26%) had delivered 25 infants (mean 1.5). Mean delay after surgery to first delivery was 7.68 years. Five women (29%) nursed their first infant for a mean 11.3 days. None of the women interrupted breast feeding for a reason related to a nipple anomaly or difficult sucking. Twelve women (71%) did not nurse their first infant, because of the prior breast surgery for six of them. Among the 48 nulliparous women, 24 (50%) stated they would nurse their future infant. Although information on breast feeding was systematically delivered, 41 women (63%) stated they had not been informed. There was no statistical relationship between breast feeding and degree of satisfaction, patient-assessed scar quality, or nipple disorders. CONCLUSION Adolescents who undergo reduction mammaplasty can nurse their future infants with a complication rate similar to that in the general population. Special attention must be given to delivery of information on breast feeding.
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Affiliation(s)
- S Aillet
- Service de Chirurgie Plastique, Reconstructrice et Esthétique, Hôpital Sud, Université de Rennes, 35056 Rennes Cedex, France
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Abstract
UNLABELLED Reduction mammaplasty has now become routine surgery with good results in middle-aged women. However the scars it leaves, its psychological and functional (breastfeeding) impact could limited its indications in teenage girls. AIM The purpose of our study was to report the long-term results of reduction mammaplasty in teenage girls and to assess their consequences. MATERIAL AND METHODS We conducted a retrospective study of 65 reduction mammaplasty carried out between 1981 and 1997 in 15 to 17 years old girls. The study was based on data in their medical records and answers to a questionnaire which was sent to each patient. RESULTS Average followup was 8.1 years. The reduction technique with superior pedicle were mainly used. Average breast tissue excised was 1050 g. Minor complications occurred in three cases. Eleven revisions had to be carried out with 1.6 years on average after primary surgery. The psychological and functional complaints observed preoperatively disappeared in more than 90% of the cases. In over 80% of the cases the patients were pleased or very pleased with the shape, the volume kept and the symmetry. Scars were well accepted in 83% of the cases. Seventeen women were given birth to 25 children. Five of whom breast-fed their babies, while six refused because of their breast surgery history. Although information about breast-feeding after such surgery is systematically given, 41 women claimed they had not received it. CONCLUSION Reduction mammaplasty is reliable in teenage girls. Patients are generally satisfied and the remaining scar is well accepted. Breast-feeding is possible after this surgery and information on that point ought to be better developed.
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Affiliation(s)
- S Aillet
- Service de chirurgie plastique, reconstructrice et esthétique, CHU Rennes, hôpital sud, boulevard de Bulgarie, BP 90347, 35203 Rennes, France
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Cardon A, Aillet S, Jarno P, Bensalah K, Le Du J, Idrissi A, Kerdiles Y. [Endarteriectomy of the femoral tripod: long-term results and analysis of failure factors]. Annales de Chirurgie 2001; 126:777-82. [PMID: 11692764 DOI: 10.1016/s0003-3944(01)00593-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
STUDY AIM The aim of this retrospective study was to report immediate and long term results of endarteriectomies of the common femoral artery (CFA) and/or femoral tripod and to analyse predictive factors of failure. PATIENTS AND METHODS Between 1982 and 1995, 110 endarteriectomies were performed in 101 patients, 52% of them in limb salvage situation. The arteriogram showed a thrombosis or stenosis of the common femoral artery in 100% of cases. There was a stenosis of the deep femoral artery (DFA) in 79% of cases. The superficial femoral artery (SFA) was thrombosed in 40% of cases. One artery only of the lower leg was permeable in 43.3% of cases. Run off was judged bad in 38% of patients. RESULTS The endarteriectomy could be realised in 93 patients (84.5%). It concerned the only common femoral artery in 20% of cases (patch angioplasty in 55% of cases), common and deep femoral arteries in 50.5% of cases (82% of patch), CFA, DFA and SFA at its origin in 29.1% of cases (93% of patch). Perioperative mortality rate was 1%. Local morbidity rate was 21.6% with 18% of minor complications and 3.6% of complications requiring a second operation. There were 2% of vascular complications (1 thrombosis and 1 false-aneurysm). Mean follow-up was 43 months in 90 patients. There were restenosis or thrombosis (5.5%), false-aneurysms (2.2%) and amputations (6.6%). Femoro-popliteal (10%) and iliac complementary bypasses (6.6%) were necessary. Permeability was 94.9% at 3 years and 88.8% at 5 years. Clinical results were considered good in 80.7% of the cases at 3 years and in 71.7% at 5 years. With univariate analysis, the predictive factors for failure were: limb salvage (P < 0.01), altered popliteal run off (P < 0.03) and extended distortion of the deep femoral artery (P < 0.05). CONCLUSION Isolated endarteriectomy of the femoral tripod is a low risk and effective technique. A femoropopliteal revascularisation should be associated in case of a major alteration of the deep femoral artery.
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Affiliation(s)
- A Cardon
- Service de chirurgie vasculaire, hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203 Rennes, France.
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Cardon A, Aillet S, Ledu J, Kerdiles Y. Pseudo-aneurysm of the popliteal artery by femoral exostosis in a young child. J Cardiovasc Surg (Torino) 2001; 42:241-4. [PMID: 11292943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Exostosis is a solitary benign bone tumor frequently observed in children. It may be totally quiescent or provoke complications. We report a case of pseudo-aneurysm of the popliteal artery caused by an exostosis on the lower metaphysis of the femur in a 12-year-old boy. This unusual complication mostly reported in young males (mean age 19 years) occurs in the context of an initial trauma in half the cases. Surgical treatment is a semi-emergency requiring both bone and arterial repair. Preventive surgery should be discussed for all cases of exostosis with a risk of arterial damage due to the gravity of the potential vascular complications.
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Affiliation(s)
- A Cardon
- Vascular Unit, Hopital Sud, Rennes, France.
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Cardon A, Chakfé N, Thaveau F, Gagnon E, Hartung O, Aillet S, Kerdiles Y, Dion YM, Kretz JG, Doillon CJ. Sealing of polyester prostheses with autologous fibrin glue and bone marrow. Ann Vasc Surg 2000; 14:543-52. [PMID: 11128447 DOI: 10.1007/s100169910102] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to develop a sealing technique for polyester prosthetic grafts able to promote healing and reduce intimal hyperplasia. The porcine experimental model was aortoiliac bypass with a 6-mm diameter knitted polyester prosthetic graft implanted for 14 and 90 days. Animals were divided into three groups according to sealing technique as follows: pre-clotting with blood (group I, n = 12), sealing with autologous fibrin glue (group II, n = 14), and sealing with autologous fibrin glue and bone marrow cells (group III, n = 16). Feasibility and quality of sealing were evaluated by scanning electron microscopy prior to implantation and by assessment of blood loss. After removal, prostheses were cut into three segments comprising the proximal anastomosis, midsection, and distal anastomosis. Pieces were fixed, embedded in paraffin, and serially sectioned for histologic study. Histological study focused on the degree of stenosis and hyperplasia of the neointima of each prosthesis. The results of this short-term study indicate that sealing of polyester vascular prosthetic grafts with autologous fibrin glue and bone marrow cells is effective in reducing intimal hyperplasia. However further study will be needed to assess long-term healing.
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Affiliation(s)
- A Cardon
- Vascular Surgery Department, Rennes University Hospital Center, France
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Cardon A, Aillet S, Podeur L, Durrieux T, Dupont Bierre E, Ledu J, Kerdiles Y. [Isolated popliteal arteries: results of surgical treatment and causes of failure]. Ann Chir 2000; 125:752-6. [PMID: 11105347 DOI: 10.1016/s0003-3944(00)00269-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED Isolated popliteal artery is defined as an obstruction of a superficial femoral artery with a patent popliteal segment followed by an obstructed distal popliteal artery or a patent leg artery less than 5 cm long. PURPOSE The aim of this retrospective study was to report the results of surgical treatment and the causes of failures. PATIENTS AND METHODS From 1988 to 1996, 31 patients with isolated popliteal artery were operated on with femoropopliteal bypass. The age of the patients ranged from 45 to 92 years, (mean: 79 years); all had critical ischemia that threatened limb viability. All underwent preoperative arteriography and diagnosis was confirmed by intraoperative arteriography. RESULTS In the postoperative course, there were 22 patent bypasses (68%) with minor amputation in five patients, and nine thromboses that required a major amputation in seven patients, a trans-metatarsal amputation in one, and a medical treatment in one. With a mean 37-month follow-up, seven thromboses required a major amputation in five patients, a new bypass in one and a medical treatment in one. The death rate was 34% at two years. The actuarial patency rates of the bypasses were 51% at one year, 38% at two years and 25% at five years. The limb salvage rate was identical. The patency rates were 65% at one, two and five years for venous bypasses and 38%, 13% and 0% respectively for PTFE bypasses. Statistical analysis showed two causes of failure: the absence of a run-off branch and the use of PTFE prostheses. No other statistically significant cause of failure was demonstrated among those analysed. Favourable anatomic conditions for a bypass to a leg artery were not predictive of failure of a femoro-popliteal bypass on the isolated arterial segment. CONCLUSION Bypass to isolated popliteal artery is indicated in patients whose limb viability is jeopardized. Results may be considered as satisfactory especially if there is a run-off branch and if a venous graft is available for the bypass.
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Affiliation(s)
- A Cardon
- Service de chirurgie vasculaire, hôpital Sud, Rennes, France
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Cardon A, Aillet S, Desjardins JF, Hocdet V, Tardivel R, Le Du J, Langlais F, Kerdiles Y, Saiag B. [Biomechanical study of the vasomotor system of the arterial smooth muscle after long-term cryopreservation of a human arterial graft at two different temperatures -80 and -150C]. J Mal Vasc 1999; 24:118-25. [PMID: 10399644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
We conducted two parallel studies on cryopreserved arterial homografts: a biomechanical study based on traction tests and a functional study coupled with a histology examination. Twenty-four arterial segments from 6 donors (2 iliac and 2 superficial femoral segments per donor) were cryopreserved at -150 degrees C and -80 degrees C. Cryopreservation lasted at least 6 months. Lengthening at rupture, the Young elasticity module, and rupture stress were calculated from the traction test. Results were significantly different depending on the preservation temperature. The functional properties of the cryopreserved arterial grafts were evaluated by studying the vasomotricity capacity of the vascular smooth muscle (VSM) and the endothelium. The expected results (direct contracture of VSM induced by PHE and endothelial dependent relaxation of VSM induced by ACH) were measured on fresh arteries. Cryopreserved arteries showed no response to physiological doses of PHE and ACH, whatever the preservation temperature. In one-third of the cases, a lower amplitude vasoconstriction was obtained using nonphysiological doses of PHE; there was no relaxation with ACH.
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Affiliation(s)
- A Cardon
- Service de Chirurgie Vasculaire, CHU Hôpital Sud, Rennes
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