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[Peroperative angiography in reparative surgery of the lower limbs. Apropos of experience with 1099 cases]
G Courchia1, J M Serise, J L Moreau
1Service de Chirurgie Vasculaire, Hôpital Pellegrin, Bordeaux.
Insights
Per-operative angiography in 1,099 cases over 13 years improved early reintervention rates. This technique aids in surgical control, diagnosis, and blood flow assessment, reducing complications in vascular surgery.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Early reintervention after vascular surgery often leads to significant morbidity and mortality.
- Per-operative angiography offers a serial, detailed assessment comparable to pre-operative exploration.
Purpose of the Study:
- To evaluate the efficacy of per-operative angiography in vascular surgery.
- To assess its impact on early reintervention rates and surgical outcomes.
- To analyze technical details, indications, and discovered anomalies.
Main Methods:
- Retrospective analysis of 1,099 cases over 13 years.
- Utilized per-operative angiography including aortography and a six-successive X-ray film technique.
- Reviewed morphological and hemodynamic data in relation to surgical procedures like bypass, deblocking, and endarterectomies.
Main Results:
- The rate of early reintervention tripled from 6% to 19% between 1978-1986, likely due to expanded indications.
- Bypass surgeries showed fewer technical imperfections compared to deblocking (embolectomy) and endarterectomies.
- Dacron and in situ bypasses were more frequently implicated in immediate reinterventions than Dardik homografts or PTFE.
Conclusions:
- Per-operative angiography is a valuable tool for intraoperative assessment in vascular surgery.
- The technique aids in controlling restorative acts, diagnosing lesions, and evaluating blood flow.
- Careful consideration of hemodynamic issues during aortography is necessary for high-risk patients.
Abstract:
The authors report their experience of per-operatory angiography in a series of 1,099 cases over 13 consecutive years. The main interest is the limitation in the rate of early reintervention, which frequently causes morbidity and mortality in this type or surgery. The serial nature of the technique is emphasized, and is most comparable to pre-operatory exploration. The various technical details are specified. Some hemodynamic troubles noted during injection (aortography) contraindicate the method in high-risk subjects. The main indications are, above all, control of restorative acts, but also a per-operatory diagnosis of a lesion, and the assessment of blood stream at a lower level. The results are morphological and the various anomalies discovered are reviewed, with iconography, in relation to each type of surgical act (disobliteration, bypass). In situ bypasses are considered separately. The data are also hemodynamic, and justify the six successive X-ray film technique. Deblocking (embolectomy with a balloon catheter) and endarterectomies were found to give more technical imperfections than bypasses. The rate of extemporaneous corrections tripled during the second period (1978 to 1986), and this was no doubt due to an extension in operative indications (19% versus 6% at the beginning). Dacron bypasses (fibrinous debris) and in situ bypasses (detection of anatomical abnormalities, location of shunts) were more often incriminated in immediate reinterventions than Dardik homografts or PTFE.