Radiologie et imagerie médicale

alternatives available. So far, future studies are needed to verify the long-term follow-up of biological inert tissues in patients with aortitis syndrome. References 1. Hotchi M. Pathological studies on Takayasu arteritis. Heart Vessels 1992;7:11-7. 2. Dion R, Verhelst R, Matta A, Rousseau M, Goenen M, Chalant C. Surgical angioplasty of the left main coronary artery. J Thorac Cardiovasc Surg 1990;99:241-50. 3. Ando M, Kosakai Y, Okita Y, Nakano K, Kitamura S. Surgical treatment for aortic regurgitation caused by Takayasu's arteritis. J Card Surg 1998;13:202-7. 4. Eishi K, Ishibashi-Ueba H, Nakano K, et al. Calcific degeneration of bioprosthetic aortic valves in patients receiving steroid therapy. J Heart Valve Dis 1996;5:668 -72. 5. Mishima Y. Leriche memorial lecture at the 24th World Congress: Takayasu's arteritis in Asia.

Purpose: To study the vasomotor responses of the renal microcirculation in patients with essential hypertension. Methods: We studied the reactivity of the renal microcirculation to papaverine, with intraarterial Doppler and quantitative arteriography, in 34 renal arteries of 19 hypertensive patients without significant renal artery stenosis. Isosorbide dinitrate was given to maximally dilate proximal renal arteries. APV (average peak blood flow velocity) was used as an index of renal blood flow. Results: Kidneys could be divided into two distinct subgroups based on their response to papaverine. An increase in APV of up to 55% occurred in 21 kidneys, an increase Ͼ 55% in 13 kidneys. Within each group the values were normally distributed. Both baseline APV and the effect of papaverine on mean velocity differed significantly between groups. Conclusion: There seems to be a subgroup of patients with essential hypertension that has an impaired reactivity to papaverine, consistent with a functional impairment of the renal microcirculation. Further studies are required to determine whether this abnormality contributes to or results from elevated blood pressure.

Purpose: To evaluate initial and midterm results of percutaneous treatment of peripheral aneurysms using covered stents. Methods: Between June 1994 and December 1997 we used covered stents (EndoPro System or Passager) on 19 patients with peripheral aneurysms (7 iliac, 5 subclavian, 3 femoral, 3 popliteal, 1 carotid). Results: Successful aneurysm exclusion was achieved in 18 of 19 patients (95%). In the short term (Ͻ30 days), one patient died of puncture site hemorrhage complicated by myocardial infarction; two femoral stents were surgically removed because of leakage. At subsequent follow-up (mean 20 months) two further unrelated deaths occurred. At 1 year (intention-to-treat) the stent was patent in 13 of 19 patients (68%) and the aneurysm was excluded in 17 of 19 (89%). Conclusion: Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural success. Continued exclusion of the aneurysms is achieved in a large proportion of patients but there is a relatively high rate of stent thrombosis.

Purpose: To report our experience with mechanical thrombectomy in proximal deep vein thrombosis (DVT). Methods: Eighteen patients with a mean (__+ SD) age of 37.6 __-16.1 years who presented with DVT in the iliac and femoral vein (n = 3), inferior vena cava (n = 5), or inferior vena cava and iliac vein (n = I0), were treated with the Amptatz Thrombectomy Device after insertion of a temporary caval filtel. Results: Successful recanalization was achieved in 15 of 18 patients (83%). Overall, the percentage of thrombus removed was 66 +-29%: 73 ---30% at caval level and 55 -36% at iliofemoral level. Complementary interventions (seven patients) were balloon angioplasty (n = 2), angioplasty and stenting (n = 2), thrombo-aspiration alone (n = I), thrombo-aspiration, balloon angioplasty, and permanent filter (n = 1)o and permanent filter alone (n = 1). There was one in-hospital death. Follow-up was obtained at a mean of 29.6 months; three patients had died (two cancers, one myocardial infarction); 10 had no or minimal sequelae; one had post-phlebitic limb. Conclusion: Mechanical thrombectomy is a potential therapeutic option in patients presenting with proximal DVT.

Objective > To evaluate mid-term primary patency of the femoral artery stenting in correlation with usCRP level and characteristics of the population, morphological aspect of the lesions and interventional techniques. Methods > Patients were prospectively included in a multicenter study (18 centers in France) after stenting (SMART, Cordis Johnson & Johnson, Issy-les-Moulineaux, France) of the superficial femoral

Purpose: We report the procedural details and immediate results of treatment of type II endoleaks after aortic stent-graft implantation. Methods: In a consecutive series of patients who had either Vangard (n = 53) or Talent (n = 7) aortic stent-grafts implanted, type II endoleaks were confirmed by means of angiography in 18 patients, with a mean (± SD) age of

Surgery for acute ischaemia complicating dissection of the descending aorta is associated with high mortality. We used an endovascular fenestration approach (scissor technique) to treat seven of 12 patients with ischaemic complications of descending aortic dissection; the remaining five patients were treated by stent implantation. Four of the 12 patients died (two in the fenestration group and two in the stenting group) in the days after the procedure. The remaining eight were symptom-free a mean of 9·4 (SD 8) months later. We suggest that the fenestration approach is a promising addition to endovascular treatment for patients with ischaemic complications of descending aortic dissection.

mThe development of a stenosis in a Brescia-Cimino fistula is a major clinical problem that threatens vascular access for dialysis. We reviewed the case notes of 46 children undergoing hemodialysis via Brescia-Cimino fistulae. Ten children (mean age 12.5 years) developed 14 stenoses located in the venous (10), anastomotic (3), or arterial (1) part of the fistula. Three (1 arterial and 2 anastomotic stenoses) of the 14 stenoses were treated surgically; the remaining 11 (10 venous and 1 anastomotic stenoses) were treated by angioplasty. Seventeen angioplasty procedures were performed by the percutaneous venous route under local anesthesia. Mean follow-up was 24 months. Restenosis within 6 months occurred in 5 patients, predominantly those who had angioplasty with low balloon inflation pressures; 1 was treated surgically; 4 underwent repeat angioplasty using higher balloon inflation pressures (3 patients) or a bigger balloon (1 patient). None subsequently developed restenosis. Angioplasty can be safely used to treat stenosis of arteriovenous fistulae, with a high initial (60% freedom from restenosis at 6 months) success rate. In summary, balloon angioplasty, repeated if necessary, is a safe and effective treatment for the majority of stenoses occurring in Brescia-Cimino fistulae. Restenosis can be safely treated by further angioplasty, which is associated with a high rate of ultimate clinical success.