Papers by Olivier Hartung
Methodist DeBakey Cardiovascular Journal, 2018
European Journal of Vascular and Endovascular Surgery, 2019
Conclusion-Despite both postoperative complications and the case of LRV thrombosis, these first p... more Conclusion-Despite both postoperative complications and the case of LRV thrombosis, these first procedures of NCS using the Da Vinci robot proves the technical feasibility and probably opens the way for new developments in the field of mini-invasive management of this pathology. References 1 Associated Da Vinci and magellan robotic system for successful treatment of nutcracker syndrome. Thaveau
The persistent sciatic artery: Report of ten cases
JMV-Journal de Médecine Vasculaire, 2020
OBJECTIVE The persistent sciatic artery (PSA) is a rare congenital anomaly with a high rate of an... more OBJECTIVE The persistent sciatic artery (PSA) is a rare congenital anomaly with a high rate of aneurysm formation, occlusion and stenosis. It may lead to severe complications including thrombosis, distal embolisation, or aneurysm rupture. We reported herein our experience in the management of PSA and its complications, and discuss the therapeutic options. METHODS Eight patients with 10 PSA were managed in our institutions between 1985 and 2017. An analysis was done for the clinical data, surgical technique, and results. RESULTS The series included six women and two men. The median age of the patients was 66,5 years (37-80 years). Physical examination found a pulsatile gluteal mass in five patients, sciatic neuropathy in two cases. Four patients had an acute ischemia of the lower limb. Cowie's sign was described in only two patients (diminished or absent femoral pulse but presence of popliteal pulse). Digital subtraction angiography was performed in all patients, and was completed with a computed tomography angiography (CTA) with a diagnosis of PSA, associated with a symptomatic aneurysmal lesion in seven cases and with an occlusion in one case. The treatment was surgical in all cases: bipolar exclusion of the aneurysm and bypass between the iliac artery and the PSA distal to the aneurysm was performed in four cases, only proximal and distal ligation was done in 2 other cases. A Chopart amputation was necessary in 2 cases. CONCLUSION We consider that the treatment of PSA is usually surgical in symptomatic cases. Surgical techniques depend on symptoms and classification describing anatomy of the PSA. However, future studies should compare the open versus the endovascular approach to optimize patient selection criteria and identify the most safe and effective strategy. In an asymptomatic patient, PSA does not require any intervention; continued follow-up is required because of the high incidence of aneurysmal formation and the risk of thromboembolic events.
Thrombectomie veineuse chirurgicale
Journal des Maladies Vasculaires, 2010
Annals of vascular surgery, 2018
Technical and clinical success of thoracic aortic endovascular procedures relies mainly on the ch... more Technical and clinical success of thoracic aortic endovascular procedures relies mainly on the choice of the proximal sealing zone (PSZ). The latter can be affected by multiple complications, all of them having a potential gravity and a direct link with the quality of the PSZ. The objective of this study was to analyze the risk factors of PSZ complications occurrence. Between 2007 and 2015, all the patients treated by a thoracic stent graft in zones 2, 3, or 4 were retrospectively reviewed, with analysis of the preoperative and postoperative angio-computed tomography. Proximal sealing zone complications are type Ia endoleaks, bird beak ≥20 mm, malposition ≥11 mm, migration ≥10 mm, and retrograde dissection. Three types of potential risk factors were analyzed: (1) related to the patients (age, gender, pathology, urgency, hybrid surgery); (2) related to the stent graft (bare or covered proximal stent, degree of oversizing, number of stents, generation); (3) related to the morphology (...
Journal des Maladies Vasculaires, 2013
Embolization is essential in the treatment of leg varicosities due to pelvic venous insufficiency
Phlebology: The Journal of Venous Disease, 2015
Purpose Pelvic venous insuffiency (PVI) can be responsible for pelvic congestion syndrome (PCS) a... more Purpose Pelvic venous insuffiency (PVI) can be responsible for pelvic congestion syndrome (PCS) and also lower limb varicose veins. Material and methods Charts of all women who had pelvic venography for PVI from September 2013 to August 2014 were reviewed. The procedure was performed under local anesthesia through left femoral approach. In case of reflux without associated obstructive lesions, embolization with coils and polidocanol foam was performed during the same procedure. Results 119 women, with median age 39 years were explored (86 with PCS and 102 with lower limb venous disease). Of these, 78 had an isolated reflux and were embolized and 41 had an obstructive disease (29 iliocaval obstructive lesions (ICOL), 4 nutcracker syndrome (NCS), and 8 with an association of both). Median follow-up was 4 months. Of the 12 NCS, 5 had surgical treatment and 7 had stenting of the left iliac vein without embolization. All patients with ICOL without NCS were treated by stenting in 28 and b...
Annals of Vascular Surgery, 2017
supra-aortic trunks (SAT). The rare symptomatic forms are caused by the compression of the esopha... more supra-aortic trunks (SAT). The rare symptomatic forms are caused by the compression of the esophagus, the aneurysmal transformation of AL, embolism causing ischemia of the upper limb or posterior CVA. The aim of this work was to establish the theoretical feasibility of a hybrid treatment and its limits with a radio-anatomical study. The secondary objective was to evaluate clinical feasibility. Materials and Methods: 180 angio-CTs of patients presenting AL were studied. The diameters, the distances and the morphology of SAT were analyzed with the t test using the SPSS22 software. Between 2010 and 2015 all the patients with a symptomatic AL were analyzed. The clinical and anatomical data and the morbi-mortality at D30 and the mid-term results were studied. Results: A diverticulum of Kommerell was present in 112 cases (62%), and a bicarotid trunk in 81 cases (45%). In three cases there was a right sided arch. The latter were analyzed separately. The distance between the right subclavian artery (SCA) and AL was 3.2±6 mm. The distance between the two SCAs was small. To obtain a neck for stentgraft implantation a double transposition (or bypass) was necessary (left common SCA-carotid, right common SCA-carotid) in case of a diverticulum not accessible to embolization. The neck was longer in the presence of a bicarotid trunk. Seven patients (four women; mean age 63 years) were treated for symptomatic AL: dysphagia (1), cerebellar CVA (2), acute upper limb ischemia (1), thoracic pain (1) and rupture (1). Three presented a diverticulum of Kommerell. The treatment consisted in a transposition of AL in the right common carotid (5) with plug embolization (4); debranching of both thoracic SCAs with stentgraft (1); carotido-right SCA bypass with embolization of the AL aneurysm with plug and a thoracic stentgraft (1). The mean duration of follow-up was 28 months (4-66). The primary patency rate and the absence of endoleak reached 100%. One patient underwent an amputation of the forearm for post-ischemic septic complications. Conclusion: The morphometric radio-anatomical study proved the theoretical feasibility of a hybrid treatment and its limits. The hybrid treatment in our clinical experience confirms the radio-anatomical data with good mid-term performances.
Chirurgie des veines perforantes dans le traitement des ulcères d'origine veineuse
Phlebologie, 1999
Depuis dix ans, le traitement chirurgical des ulceres d'origine veineuse a beneficie de l'... more Depuis dix ans, le traitement chirurgical des ulceres d'origine veineuse a beneficie de l'apport de l'echographie-Doppler pour le depistage et la localisation des perforantes incontinentes et de la chirurgie endoscopique pour leur traitement. Cependant, I'attitude a adopter vis-a-vis des perforantes en presence d'un ulcere n'est pas clairement definie faute d'etudes rigoureuses sur des series ayant un suivi suffisamment long. Les publications sur les techniques d'interruption des perforantes par voie endoscopique sous-fasciale ne font que souligner leur faisabilite et leurs avantages a court terme sur la chirurgie a ciel ouvert. En effet, la morbidite en est moindre et la duree d'hospitalisation plus courte, Pour ces raisons, ces techniques mini-invasives ont remplace les interventions de type Linton. Mais faut-il toujours interrompre les perforantes signalees incontinentes par echographie-Doppler ? Lorsque le reseau profond est continent, I'incontinence isolee des perforantes est rare et le plus souvent il existe une incontinence saphenienne qu'il suffit de traiter meme s'il s'agit d'une recidive. Lorsque le reseau profond est incontinent ou est le siege de lesions obstructives, les resultats de l'interruption des veines perforantes sont mediocres a moins qu'un geste correcteur puisse etre effectue sur la voie profonde. En pratique cependant, en presence d'ulcere recalcitrant malgre un traitement medical bien conduit et apres traitement des incontinences sapheniennes et gemellaires, il parait logique d'interrompre les perforantes incontinentes meme si le resultat est aleatoire a long terme. En faveur de cette attitude, des auteurs ont cite la relation etroite qu'ils ont observee entre oubli de perforantes lors de la chirurgie et recidive de l'ulcere.
La phlegmasia caerulea dolens : aspects diagnostiques et thérapeutiques
Stv Sang Thrombose Vaisseaux, Jun 10, 2002
La phlegmasia caerulea dolens est une forme rare mais grave de thrombose veineuse profonde etendu... more La phlegmasia caerulea dolens est une forme rare mais grave de thrombose veineuse profonde etendue source d'ischemie tissulaire. Son diagnostic est essentiellement clinique devant la classique triade associant douleur, œdeme et cyanose du membre atteint. L'echo-doppler et le phleboscanner confirment le diagnostic et permettent d'orienter le traitement. Ses complications principales sont la gangrene veineuse et l'embolie pulmonaire. Un traitement medical associant anticoagulation par voie intraveineuse, surelevation du membre et repos au lit strict doit etre institue. L'instauration d'un traitement interventionnel par thrombolyse ou thrombectomie chirurgical est discute en fonction de l'etat du patient et de l'etiologie.
Experimental laparoscopic aortobifemoral bypass with end-to-side aortic anastomosis
Surgical Laparoscopy Endoscopy & Percutaneous Techniques
The goal of this animal experiment was to demonstrate the feasibility of laparoscopic end-to-side... more The goal of this animal experiment was to demonstrate the feasibility of laparoscopic end-to-side aortic anastomosis, which is mandatory in certain cases presenting with aortoiliac occlusive disease. Six piglets were submitted to laparoscopic approach of the aortoiliac vessels using the "apron" technique. After clamping the infrarenal aorta with a laparoscopic Satinsky clamp, a 3-cm end-to-side laparoscopic aortic anastomosis was constructed. Mean operative and dissection times were 198 (170-240) and 92 (75-105) min, respectively, with a mean blood loss of 86 (50-120) mL. Mean preoperative and postoperative hematocrits were 38 (3448) and 38 (34-46). Aortic cross-clamp and anastomotic times were 51 (40-65) and 44 (35-60) min, respectively. No extra sutures were needed to secure the anastomoses. At autopsy, all the anastomoses were patent without stenoses. Results indicate the feasibility of laparoscopic aortobifemoral bypass with an end-to-side aortic anastomosis.
Laparoscopic aorto-iliac surgery: present status and future perspectives
Surgical technology international, 1999
Over the past few years, the concept of "minimally invasive surgery" has generated a si... more Over the past few years, the concept of "minimally invasive surgery" has generated a significant interest in the field of cardiovascular surgery. Congenital heart diseases such as patent ductus arteriosus, vascular ring or atrial septal defect have been treated using video-assisted technology. Although patients have undergone mitral valve replacement and repair, the focus of interest in the development of video-assisted cardiac surgery is in the treatment of coronary artery disease.
Journal des Maladies Vasculaires, 2013
Les occlusions veineuses ilio-caves sont principalement de cause post-thrombotique. Leur traiteme... more Les occlusions veineuses ilio-caves sont principalement de cause post-thrombotique. Leur traitement repose sur la compression et la prévention des récidives, mais un traitement interventionnel peut s'avérer nécessaire pour les patients fortement invalidés. S'il a longtemps reposé sur des techniques chirurgicales, les progrès des techniques endovasculaires ont changé la donne. Patients et méthodes.-De janvier 1996 à juin 2012, 202 patients ont été admis dans notre service pour traitement de lésions obstructives chroniques invalidantes des veines iliaques avec ou sans atteinte de la veine cave inférieure (VCI) et des veines fémorales communes (VFC). Parmi eux, 93 (117 membres, 55 femmes, âge médian 45 ans, 16-86) présentaient une occlusion d'au moins un segment veineux. La répartition en classe clinique CEAP était : 2 C2, 68 C3, 7 C4, 1 C5 et 16 C6. Une claudication veineuse était présente chez 80 patients et le score veineux d'invalidité médian était de 3. L'étiologie était post-thrombotique dans 82 cas et due à une fibrose rétropéritonéale dans huit cas, à un cancer dans un cas, à une agénésie cave sus-rénale dans un cas et à un syndrome de Cockett dans un cas. Le nombre médian de segments veineux atteints et occlus était de trois (1-7) et deux (1-7). Les lésions étaient bilatérales avec atteinte de la VCI chez 23 patients. La VFC était lésée chez 63 patients dont 27 occlusions. Un clip ou un filtre cave était présent dans six cas. Le délai médian TVP-intervention était de 92 mois (2-573). Résultats.-Aucun décès n'est survenu en périopératoire. Le taux de succès technique est de 85 %. Trois échecs ont été traités par stenting de la veine lombaire ascendante et un par stenting cavo-azygos. Les procédures associées comportent sept endophlébectomies de la VFC, un retrait et trois stenting de filtre VCI et un stent-couvert de l'AFS. La durée médiane de séjour était de deux jours. Des complications postopératoires sont survenues dans neuf cas : six thromboses (quatre traitées avec succès par thrombectomie chirurgicale), un hématome rétropéritonéal (embolisation), une FAV cutanée et un hémothorax. Le suivi médian est de 35 mois (6-184). Les complications tardives comprennent : six thromboses (une traitée par thrombectomie) et quatre resténoses. Dans deux cas, des lésions de la VFC non traitées initialement ont été stentées secondairement. Les taux de perméabilités primaire, primaire assistée et secondaires sont respectivement de 85 %, 88 % et 94 % à 1 an et 82 %, 86 % et 92 % à cinq et dix ans. Conclusion.-Le traitement des occlusions ilio-caves invalidantes a grandement bénéficié de l'apport du stenting qui est devenu la technique de référence.
Sealing of Polyester Prostheses with Autologous Fibrin Glue and Bone Marrow
Annals of Vascular Surgery, 2000
The purpose of this study was to develop a sealing technique for polyester prosthetic grafts able... more 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.
Iliocaval Venous Obstruction
Rutherford's Vascular Surgery, 2010
Surgical Endoscopy, 1999
Background: Colic ischemia is a serious complication that can occur after abdominal aortic surger... more Background: Colic ischemia is a serious complication that can occur after abdominal aortic surgery. It has been described in two patients after laparoscopic aortic surgery. The goal of the current experiment was to determine the feasibility of inferior mesenteric artery (IMA) reimplantation during laparoscopic aortobifemoral bypass (LAFB). Methods: Six piglets were submitted to the laparoscopic approach according to the "apron" technique previously described. The infrarenal aorta was clamped and an LAFB was performed using a dacron graft. The IMA was reimplanted in the body of the graft with a running 5-0 polypropylene suture. Results: Mean operation and dissection times were 282.5 min (range, 270-310 min) and 123 min (range, 110-140 min), respectively, with a mean blood loss of 108 ml (range, 80-150 ml). Aortic clamping and anastomotic times were 123 min (range, 110-135 min) and 33 min (range, 24-45 min), respectively. The IMA reimplantation took 55 min (range, 45-70 min). At autopsy, all anastomoses were patent with no stenosis nor leak. Conclusion: Laparoscopic IMA reimplantation during laparoscopic aortobifemoral bypass is feasible.
Results of Stenting for Postthrombotic Venous Obstructive Lesions
Perspectives in vascular surgery and endovascular therapy, 2012
Venous obstructive lesions represent a therapeutic challenge. Postthrombotic lesions are the most... more Venous obstructive lesions represent a therapeutic challenge. Postthrombotic lesions are the most complex and very prone to rethrombosis. Technical success can be achieved in more than 85% of the cases (100% when recanalization with thrombolysis is not needed) with a low rate of periprocedural complications and no mortality. The overall rate of thrombotic events after stenting is around 5%. Patency rates depend on multiple criteria, including the need for thrombolysis and the involvement of the common femoral vein and of the inferior vena cava. Primary, assisted-primary, and secondary patency rates were 67%, 89%, and 93%, respectively, at 6 years in the study by Neglén and 66%, 70%, and 77%, respectively, in the intention-to-treat European multicentric study, at 5 and 10 years. Stenting is a minimally invasive and safe technique with good long-term clinical results and patency rates. It represents the method of choice for the treatment of postthrombotic iliofemoral venous obstructions.
A comparaison of the standard bolia technique versus subintimal recanalization plus Viabahn stent graft in the management of femoro-popliteal occlusions
Journal of Vascular …, 2010
Fifty-three patients (54 limbs) were treated consecutively for severe claudication (n = 19) or cr... more Fifty-three patients (54 limbs) were treated consecutively for severe claudication (n = 19) or critical limb ischemia (n = 34). Thirty-four (64%) had a stent placed, while 19 (35.8%) did not. The mean length of the lesions treated was 20.11 cm (range, 5-35 cm). Statistically, there was no ...
Annals of vascular surgery, Jan 8, 2017
Most of the experience on fenestrated endovascular aneurysm repair (F-EVAR) involves the custom-m... more Most of the experience on fenestrated endovascular aneurysm repair (F-EVAR) involves the custom-made Zenith® endograft (Cook). The fenestrated Anaconda® endograft (Vascutek) was introduced with the potential advantages of complete repositioning and lack of stent material on the main aortic body for more versatility. However, few data are available. Our objective was to assess its mid-term results in the treatment of complex aortic aneurysms. Consecutive patients treated with the custom-made Fenestrated Anaconda® Endograft in France and the Principality of Monaco, from December 2010 to October 2015, were included. Eighty-six patients were included over 16 centers (82 men, mean age 73.4 ± 8.1 years, 16 (18.6%) symptomatic aneurysms). The repositioning system was used in 68 cases (79.1%). Two hundred and ninety-two visceral/renal vessels were targeted, with a mean number of 3.4 ± 0.6 target vessels/patient and a successful reconstruction in 99.3% of the cases (290/292 vessels). Periope...
Thoracoscopic descending thoracic aorta to femoral artery bypass. Experimental study and clinical application
Journal des Maladies Vasculaires
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Papers by Olivier Hartung