Presse Med
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A revolutionary technology has totally renovated the treatment of aneurysms of the abdominal aorta. Classical "dissection-graft" procedures require a wide abdominal incision with clamping and declamping times, and often major blood loss. Perioperative mortality varies from 3% to 7% depending on the team's experience and the presence of comorbidities. Complications occur in 30% of the patients; often benign they can be quite serious. As direct consequence of the development of peripheral stents, endoprostheses can now be introduced via the femoral route through a short inguinal incision. Operative trauma is considerably reduced, greatly shortening the recovery time. Mortality is low, of around 1%, and postoperative complications are much less frequent and much less severe. There is also a 3-fold reduction in the duration of the hospital stay. ⋯ Improved prosthetic design and durability is an important point. Randomized studies organized in France, as well as in England and Holland and the United States, are currently assessing the contribution of this new technique and its relative role compared with conventional surgery.
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ACUTE REJECTION: Endomyocardial biopsy is the most reliable method to detect acute rejection but is an invasive procedure. Other non-invasive methods have been proposed including tissular Doppler ultrasonography with analysis of the posterior wall velocity and teletransmitted study of the intramyocardial amplitude of the QRS complex. Adding plasmapheresis to the conventional treatment is helpful in improving survival and reducing the incidence of late coronary disease after severe acute reflection. Plasmapheresis also has a preventive effect as do certain inductors such as anti-thrombocyte globulin (ATG).