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Seventy five arteriographies were performed via the transradial route using 5F 130cm - long catheter. Prior to puncture the radial artery was evaluated with Allen test. Satisfying quality examinations were obtained for the thoracic aorta, selective carotid arteries examinations, infra renal aorta, pelvic and legs arteries. The major advantages obtained for the technique were the very low rate complication and technical failure. Transradial route for arteriography is a reasonable alternative approach to transfemoral or brachial arteriography for out patient management (peripheral angiography) in case in which transfemoral route is not feasible but also with patients with important haemorragic-risks.

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The authors report a case of persistent sciatic artery presenting with limb ischemia and pulsatile mass in the buttock treated only by femoro tibio peroneal by pass graft since follow up helical CTA at six months showed spontaneous aneurysmal exclusion by thrombosis of the persistent sciatic artery above the aneurysm. Review of the literature confirms the rarity of this anomaly, which is frequently associated with aneurysmal transformation and its specific inherent complications. It is treated by femoro popliteal shunt with endovascular embolization.

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Splenic artery aneurysms, once considered rare entities are now being reported with increasing frequency. Rupture may be the presenting and only symptom and can be fatal. The authors present two cases of splenic aneurysms treated by endovascular embolization. The initial imaging work-up included sonography, angiography and helical computed tomography with multiplanar and 3D reformations. This enabled comprehensive evaluation of the aneurysms, including their configuration, essential for coil selection. Embolization was uneventful. Post-embolization angiograms confirmed exclusion of the aneurysms. Follow-up CT at 9 months showed complete thrombosis of the aneurysms and no evidence of pancreatic or splenic complication. Endovascular management for definitive treatment of splenic aneurysms is technically possible and should be considered.

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A case of iliac aneurysm treated percutaneously by endovascular stent graft (Wallgraft - Boston) and transcatheter embolization of internal iliac artery in order to prevent retrograde filling of the aneurysm from the patent hypogastric artery is presented. The initial radiographic evaluation included arteriography, and 2D and 3D spiral CT angiograms. This enabled analysis of the extent of mural thrombus, flow direction, as well as selection of stent graft and coil size. The procedure of embolization and implantation was technically uneventful. Post procedure 3D CT and arteriography demonstrated exclusion of the aneurysm, and return to a normal flow pattern. Follow-up at 6 and 12 months confirmed the stability of the results. Percutaneous treatment of common iliac artery aneurysms involving the hypogastric artery can be performed easily, especially in elderly patients. 3D CT is essential in assessing the endo and extra luminal characteristics of the aneurysm to insure optimal results and to detect complications.

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The authors define the "throbbing buttocks syndrome" which can in fact correspond to different pathological entities: aneurysm of the persistent sciatic artery and/or congenital or traumatic arteriovenous fistula of the hypogastric and gluteal vessels. Seven cases are reported: 1 case of aneurysm of the persistent sciatic artery complicated by truncal embolism and fissuring which was treated successfully by occlusive endoaneurysmorrhaphy; and 6 cases of arteriovenous fistulas (1 traumatic and 5 congenital). In all cases of arteriovenous fistula the technique used involved initial embolization which was complicated by anterior ligature of the hypogastric artery and then by excision of the malformation which was extremely hemorrhagic in some cases. Out of these 6 cases, results have been satisfactory for 5 and incomplete for the remaining one.

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External compression of both arterial feeder and venous return of an MAV allows embolization material to be stabilized into the area of the shunts. 11 patients were treated according to this method, either by an external compression method (4 cases) or by tourniquets (4 cases) or by a balloon compressing the vena cava (3 cases). The material of embolization was in all cases Isobutyl-2-Cyano-Acrylate. 5 patients were successfully operated after the procedure and 7 patients had considerable improvement after embolization, 2 of them being considered as cured.

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A case is reported of bilateral persisting sciatic arteries: complete on the right side but incomplete on the left, revealed by the onset of a distal embolism on the right side treated by exclusion and a right femoropopliteal shunt operation. The observation of this further case in France led to a review of the literature which demonstrated the rarity of this congenital anomaly, which usually however represents the only vascular axis to the lower limb, and the frequency of aneurysmal transformations with subsequent complications that are best treated by ligature combined with a femoropopliteal shunt.

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Seven patients with arteriovenous fistulae of the internal iliac artery are reported. Ages varied from 6 to 50 years (mean 32 years). Cutaneous angiomata , leg oedema and pain was present in 4 cases each, bleeding in 2 cases whilst only one was asymptomatic. Only 1 patient had cardiac insufficiency. In six patients the lesion was a congenital malformation but in one it was posttraumatic. Arteriography both global and selective, intravenous pyelography and cardiac output are routine. Recently, pelvic computerised tomography has been most helpful. Embolization is recommended in all cases with surgery within 24 hours unless the lesion is very extensive and considered to be inoperable. Repeat embolization is used for recurrence or very extensive lesions. Results were good in five patients; in two patients the results were clinically good but control angiograms showed a recurrence.

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Four cases of major vascular injury after disc surgery have been treated by the authors. In two instances the symptoms were those of an intra peritoneal haemorrhage after injury to the aorta or to the common iliac artery. These two cases were treated by resection-anastomosis of the vessel. In the two other cases, a fistula developed between the common iliac artery and the inferior vena cava or between the common iliac artery and the common iliac vein. Both lesions were also repaired two days and 10 days after disc surgery. A review of the literature has shown that these lesions are more frequent after surgery at L4-L5 level than at L5-S1 level. They are more frequent after repeated operation. They should be looked for when a fall in blood pressure is noted at the end of the surgical procedure. The published mortality is about 80 p. 100 in vessel division and 10 p. 100 after arterio venus fistula. The earlier the diagnosis is made, the higher is the proportion of healing.

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The functional or vital prognosis may be affected by the rare vascular accidents resulting from orthopedic operations. During a 10 year period (1970-1980), 55 vascular lesions were observed in 40 patients, and were either arterial (40 cases) or venous (15 cases) in type. Vascular injuries in 9 cases were due to spinal operations (cervical, lumbosacral or herniated disc arthrodesis), in 7 cases to shoulder operations (recurrent dislocation, excision of first rib), in 9 cases to hip surgery (prosthesis, plate and screws, fractured acetabulum), and in 15 cases to operations on the lower limbs (osteosynthesis of femur or tibia, meniscus operations, etc.). Emergency operation was necessary in 18 cases because of a hemorrhagic or ischemic syndrome, all other cases except three requiring secondary surgery for false aneurysms, arteriovenous fistulae, or residual ischemia. Four patients (10%) died, three following hip surgery, and 8 developed complications. The frequency, mechanism, diagnostic and therapy of these lesions are discussed.

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The authors report their experience of arterial trauma in civilian life in a series of 227 patients (average age 38.2 years) with 233 arterial lesions, treated between 1977 and 1981. Iatrogenic trauma is responsible for 45 p. 100 of cases, the remainder (55 p. 100) being due to road traffic and industrial accidents (29 p. 100), projectiles (16 p. 100) and knife wounds (10 p. 100). 40 p. 100 of patients were seen within 24 h, 30 p. 100 between 24 h and 8 days, and 30 p. 100 over 8 days after the initial trauma. Arteries of the limbs were involved in 61 p. 100 of cases, of the neck in 11 p. 100 of cases and of the trunk in 28 p. 100 of cases. All patients were operated upon, 18 died (7.7 p. 100) and 16 had to undergo amputation (6.8 p. 100). The authors emphasize firstly the serious nature of trauma to the great vessels which is life-threatening and to the popliteal arteries which threatens the functional prognosis, and secondly, the necessity of early diagnosis and treatment.

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