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Master Thesis

État de l’art du service de chirurgie vasculaire du CHUGA dans les stratégies de revascularisation de l’artère fémorale des patients de plus de 75 ans dans l’ère endovasculaire

Abstract : Objectives. Peripheral arterial disease (PAD) particularly critical ischemia may impair ambulatory function and degrade quality of life. Recent advances in endovascular surgery make revascularisation possible in fragile patients and notably those over 75 years of age. This study provides an overview of revascularisation strategies concerning the femoral artery (FA) in patients over 75 operated in the Vascular Surgery Department of the University Hospital of Grenoble (CHUGA) in France. Methods. The study covers all patients 75 and over who benefitted from the inauguration in 2018 of a new interventional theatre for FA procedures in the Vascular Surgery Department of the University Hospital of Grenoble. The data collected included demographics, pre-operative clinical records, post-operative events including re-do surgery, amputation and mortality. Post-operative doppler data were included as well. All data were collected retrospectively. Events that took place within 30 post-operative days were considered early and those thereafter occurring within the first post-operative year were considered late. The major criterion analysed was clinical improvement of at least one level in the classification of Leriche and Fontaine. A comparative descriptive analysis was performed. A regression analysis was applied to factors affecting revascularisation. Results. This retrospective study includes 113 patients over a 2 year period and a total number of 123 revascularisations. One hundred and four patients underwent treatment by an exclusively endovascular approach. Nineteen underwent an open surgical procedure associated in some cases with a peri-operative endovascular approach. The average age of the population was 83.8; women represented 35.4% of the population. Medical history was similar to those of PAD in general. Early clinical success was achieved in 50% (52/104) of endovascular procedures versus 52% (10/19) of open procedures (p=0,83). At one year the late clinical success rates were 13.5% (14/104) and 5.3% (1/19) respectively (p=0,32). The primary post-operative patency rate were 81.7% (85/104) and 89.5% (17/19) respectively (p=0,41). Re-do procedures at one year were 8.9% (11/123) with no significant difference between the two groups (p=0.79). Early mortality after endovascular surgery (4,8%, 5/104) tended to be greater than that for open surgery; however, the tendency was the opposite at one year, 25.0% (26/104) versus 36.8% (7/19), (p=0.28). Discussion. This study describes the protocols of the Vascular Surgery Department of the University Hospital of Grenoble and shows the preference for the endovascular solution in patients over 75 and in need of revascularisation for PAD as well as results comparable to those of open surgery. The endovascular solution must be followed up closely over time including possible re-do surgery. This study reveals today’s reality in vascular surgery and the evolution of the populations treated and the problems posed. Difficulties in data collection reveal the importance of standardizing and conserving data concerning PAD patients in order to improve care and follow-up. The data of this study will help in the development of a tool to integrate data into the medical file; the tool is a work in progress of the Man Machine Interaction Institute of the University of Grenoble Alpes.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03285699
Contributor : Jean-Hugues Morneau <>
Submitted on : Tuesday, July 13, 2021 - 3:20:33 PM
Last modification on : Thursday, July 15, 2021 - 3:24:03 AM

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Grégoire Le. État de l’art du service de chirurgie vasculaire du CHUGA dans les stratégies de revascularisation de l’artère fémorale des patients de plus de 75 ans dans l’ère endovasculaire. Médecine humaine et pathologie. 2021. ⟨dumas-03285699⟩

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