Pulmonary artery aneurysm is a rare condition accounting for less than 1% of all intra thoracic aneurysms. This paper reports a case of giant aneurysm of the trunk and branches of the pulmonary artery, which was discover...Pulmonary artery aneurysm is a rare condition accounting for less than 1% of all intra thoracic aneurysms. This paper reports a case of giant aneurysm of the trunk and branches of the pulmonary artery, which was discovered incidentally on a computed tomography angiogram in a 48-year-old man with a past history of pulmonary tuberculosis. Besides the aneurysm there was dilation of the pulmonary annulus with massive pulmonary regurgitation, a tight mitral stenosis and sequelae of pleural and pulmonary tuberculosis. The patient is being followed-up with medical treatment and has been stable clinically for the last ten months.
Superior vena cava syndrome is a rare disease, most often found to result from a malignant process, which causes extrinsic compression of the superior vena cava. In recent years, there has been an increase of superior ve...Superior vena cava syndrome is a rare disease, most often found to result from a malignant process, which causes extrinsic compression of the superior vena cava. In recent years, there has been an increase of superior vena cava syndrome related to medical devices (implantable site, pacemaker [PM], central venous line for parenteral nutrition...). We report the case of a 37-year-old patient who developed a superior vena cava syndrome 12 years after implantation of a PM. The diagnosis was established on venography after two negative venous-CT focused on the superior vena cava. The superior vena cava syndrome improved immediately after angioplasty and stenting covering the PM probes at the superior vena cava/brachiocephalic venous trunk junction.
UNLABELLED: The study objective was to evaluate the potential increase in fatal bleeding risk related to curative anticoagulation of asymptomatic deep venous thromboses diagnosed by routine ultrasound screening after tot...UNLABELLED: The study objective was to evaluate the potential increase in fatal bleeding risk related to curative anticoagulation of asymptomatic deep venous thromboses diagnosed by routine ultrasound screening after total hip/knee replacement or hip fracture using data from a comprehensive literature review. MATERIALS AND METHODS: Rates of venous thromboembolic and bleeding events occurring with recommended prophylaxis, and rates of iatrogenic bleeding risk induced by curative anticoagulation were extracted from randomized clinical trials, diagnosis codes at discharge, electronic databases, and observational studies. The fatal events rate was calculated for pulmonary embolism, major bleeding with prophylaxis, and iatrogenic bleeding from curative anticoagulation by multiplying the mean rate by its case-fatality rate. Fatal event rates were evaluated for 10,000 total hip or knee replacements and for 10,000 hip fractures. RESULTS: For 10,000 patients undergoing total hip or knee replacement, five fatal pulmonary embolisms and two fatal bleedings are expected, despite recommended extension of thromboprophylaxis. Curative anticoagulation of asymptomatic venous thrombosis would add nine fatal bleedings, 8/9 related to distal thrombosis care. For 10,000 patients undergoing hip fracture surgery, six fatal pulmonary embolisms and 23 fatal bleedings are expected. Curative anticoagulation of asymptomatic venous thrombosis would add 16 fatal bleedings, 14/16 related to distal thrombosis care. CONCLUSION: Curative anticoagulation of asymptomatic distal deep vein thromboses, leads to more fatal bleeding compared to avoidable fatal pulmonary embolism. These findings strengthen recommendations against routine ultrasound screening for asymptomatic distal deep vein thrombosis.
Behçet's disease is a vasculitis affecting both arteries and veins. Cardiac involvement is less well known. The association of an aneurysm of the pulmonary artery and intracardiac thrombosis is rare, and a therapeutic ch...Behçet's disease is a vasculitis affecting both arteries and veins. Cardiac involvement is less well known. The association of an aneurysm of the pulmonary artery and intracardiac thrombosis is rare, and a therapeutic challenge. We report the case of a 26-year-old patient hospitalized for moderately abundant hemoptysis and New York Heart Association (NYHA) class III dyspnea, which illustrates the difficulty encountered when using anticoagulants in this complex situation.
Techniques of insertion of implantable venous devices have been widely described. The use of ultrasound guidance is part of the good practice recommendations of the SOR 2008 but there are few data in the literature and r...Techniques of insertion of implantable venous devices have been widely described. The use of ultrasound guidance is part of the good practice recommendations of the SOR 2008 but there are few data in the literature and recommendations are based only on expert agreement. To this end we conducted a prospective, single-center study from January 2008 to August 2009 on percutaneous ultrasound-guided insertion of implantable devices. In addition to age, sex, the therapeutic indication and the site of implantation, we identified the operative time and number of venipunctures performed for each procedure. We then identified the infectious complications at three months and thromboembolic complications at 1 year and a half. Our study examined 102 consecutive patients. The mean age was 61.8 years (28-90); 71% of patients were men. For 101 patients, the internal jugular vein was punctured, the subclavian vein in one patient. In 86% of cases, the implantable venous device was inserted into the right vein. The average length of procedure was 30 minutes (18-60) for a single-vein puncture. Among the 102 patients, the overall morbidity was 7.8% with four infections (3.9%) and four thromboses (3.9%). There were no immediate perioperative complications (arterial puncture, hematoma, pneumothorax). In conclusion, percutaneous ultrasound-guided insertion of implantable venous devices in the internal jugular vein is a safe, minimally invasive technique which complies with the 2008 SOR recommendations by preventing the risk of venous thrombosis and avoiding repeated venous puncture. Less invasive than the open surgical approach, ultrasound-guided insertion is safer than puncture based solely on anatomical landmarks. In summary, this is a reliable, simple and easily reproducible technique which limits iatrogenic risks and improves patient comfort.
BACKGROUND: Peripheral arterial disease (PAD) is an important predictor of cardiovascular disease with major medico-economic consequences. However, systematic screening of asymptomatic patients free from history of cardi...BACKGROUND: Peripheral arterial disease (PAD) is an important predictor of cardiovascular disease with major medico-economic consequences. However, systematic screening of asymptomatic patients free from history of cardiovascular disease is debated. OBJECTIVE: Determining the prevalence, risk factors for PAD in a population of outpatients at intermediate or high-risk of cardiovascular disease, free from history of cardiovascular disease to assess the potential impact of PAD screening in such groups of patients. METHODS: Multicenter 1-day screening program of PAD conducted from 2008 to 2010 in a population defined by diabetes plus age greater than 50 years, positive active smoking status, or age greater than 70 years. PAD was defined as an ankle-brachial index (ABI) less than 0.9 measured as follows: lowest systolic ankle pressure divided by highest systolic arm pressure. RESULTS: Ten thousand six hundred and fourteen patients fulfilled study inclusion criteria: 16.7% (n = 1774) exhibited an ABI less than 0.9 and 3.8% (n = 407) an ABI less than 0.7. ABI greater than 1.3 was found in 7.7% of patients (n = 818). Age greater than 70 years, male gender, active smoking status, hypertension and diabetes (treated) were independent risk factors for PAD. CONCLUSION: Primary prevention outpatient screening of a population with intermediate or high cardiovascular risk can identify numerous patients with PAD. The medical impact in terms of cardiovascular mortality and morbidity of such a screening needs to be assessed.
INTRODUCTION: Renal transplant patients are high cardiovascular risk patients. Regular ultrasound surveillance of the renal transplant artery and the iliac artery upstream from the anastomosis is required to detect poten...INTRODUCTION: Renal transplant patients are high cardiovascular risk patients. Regular ultrasound surveillance of the renal transplant artery and the iliac artery upstream from the anastomosis is required to detect potential arterial stenosis. The purpose of this article was to illustrate the hemodynamic impact of exercise in such patients and the screening efficiency of Doppler ultrasound stress testing. METHODS: Two renal transplant patients were hospitalized in our center for impaired renal function, worsening hypertension, and intermittent claudication. This association of peripheral vascular disease and renal dysfunction led us to perform a Doppler ultrasound stress test to search for vascular stenosis upstream from the graft. Hemodynamic fluctuations in the ipsilateral leg were recorded during flexion-extension exercises. RESULTS: Iliac artery lesions were found in both patients: the Doppler examination showed decreased systolic velocity in the graft artery during exercise, compatible with iliac steal syndrome. Surgical treatment was performed in both patients. After surgery, the control Doppler ultrasound stress test showed that systolic flow did not decline in the graft vessels during exercise. Renal function stabilized in one patient and improved in the other; claudication disappeared after surgery. CONCLUSION: Doppler ultrasound stress testing can be a valuable tool for detecting exercise-induced renal graft ischemia in transplant patients. Its screening performance should be determined in a larger population before routine use.
Denguir R, Frikha I, Kaouel K
… +15 more, Abdennadher M, Ziadi J, Jemel A, Ben Mrad M, Kallel S, Derbel B, Gueldiche M, Ghédira F, Mlaïhi S, Masmoudi S, Kalfat T, Menif J, Ben Omrane S, Karoui A, Khayati A
OBJECTIVES: The aim of this study was to review our experience in the management of traumatic rupture of the aortic isthmus, to evaluate the results of surgery and endovascular exclusion and to develop an adequate therap...OBJECTIVES: The aim of this study was to review our experience in the management of traumatic rupture of the aortic isthmus, to evaluate the results of surgery and endovascular exclusion and to develop an adequate therapeutic strategy based on the existence and severity of associated injuries. MATERIAL: A series of 37 patients presenting posttraumatic aortic rupture associated with other severe lesions was collected from 2000 to 2012. There were 33 males and four females, mean age 38 years. In this series, 25 patients underwent surgical treatment and 12 endovascular exclusion. RESULTS: Six patients died during or after surgery. Overall mortality was 16% (24% in the surgery group). The postoperative period was uneventful in all patients treated with the endovascular procedure. Postoperative computed tomography controls at one week, 1 month and 12 months showed good positioning of the stent without endoleakage. CONCLUSION: Traumatic aortic rupture is often the result of a severe high-energy chest trauma. Other serious injuries are often associated. Results of immediate surgical repair are associated with high morbidity and mortality. The advent of endovascular treatment has revolutionized the treatment of traumatic aortic rupture, especially in patients with a high surgical risk.
Laroche JP, Becker F, Khau-Van-Kien A
… +13 more, Baudoin P, Brisot D, Buffler A, Coupé M, Jurus C, Mestre S, Miserey G, Soulier-Sotto V, Tissot A, Viard A, Vignes S, Quéré I, Société française de médecine vasculaire
THE QUALITY STANDARDS OF THE FRENCH SOCIETY OF VASCULAR MEDICINE FOR THE ULTRASONOGRAPHIC ASSESSMENT OF VASCULAR MALFORMATIONS ARE BASED ON THE TWO FOLLOWING REQUIREMENTS: Technical know-how: mastering the use of ultraso...THE QUALITY STANDARDS OF THE FRENCH SOCIETY OF VASCULAR MEDICINE FOR THE ULTRASONOGRAPHIC ASSESSMENT OF VASCULAR MALFORMATIONS ARE BASED ON THE TWO FOLLOWING REQUIREMENTS: Technical know-how: mastering the use of ultrasound devices and the method of examination. Medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis. To achieve consistent practice, methods, glossary, and reporting. To provide good practice reference points, and promote a high-quality process. ITEMS OF THE QUALITY STANDARDS: The three levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Settings and use of ultrasound devices. Here, we discuss the methods of using ultrasonography for the assessment of peripheral vascular malformations and tumors.
UNLABELLED: Thrombosis events may occur in celiac disease. Thrombophilic risk factors have been reported. INTRODUCTION: To report two cases of cerebral venous thrombosis in celiac disease patients and to determine associ...UNLABELLED: Thrombosis events may occur in celiac disease. Thrombophilic risk factors have been reported. INTRODUCTION: To report two cases of cerebral venous thrombosis in celiac disease patients and to determine associated thrombophilic factors. Case 1: a 63-year-old woman was admitted for cerebral venous thrombosis. Her past history included celiac disease which was untreated for the last 10 years. Biological data showed moderate hyperhomocysteinemia and positive reaction for antiphospholipid antibodies. Case 2: a 19-year-old girl was hospitalized for seizures and impaired consciousness. MRA demonstrated longitudinal sinus thrombosis with parietal infarction. Biological findings showed: protein S deficiency and positive reaction for antiendomysium and antigliadin antibodies. Gastroesophageal endoscopy with biopsy showed villous atrophy. Both patients improved under anticoagulant treatment. CONCLUSION: The sites of associated venous thrombosis are generally unusual in celiac disease, yet the cerebral localization is only exceptionally reported. It is essential to search for risk factors. Gluten-free diet remains the mainstay treatment for patients with celiac disease.
Desmopressin is a synthetic vasopressin analog that increases the plasma levels of coagulation factor VIII, von Willebrand factor, and tissue plasminogen activator. This hemostatic agent, which can be administered either...Desmopressin is a synthetic vasopressin analog that increases the plasma levels of coagulation factor VIII, von Willebrand factor, and tissue plasminogen activator. This hemostatic agent, which can be administered either parenterally or intranasally, has been approved for use in the prevention and treatment of hemorrhagic events during surgery in patients with hemophilia A, in cases of prolonged idiopathic bleeding, and for complications associated with platelet antiaggregant therapy. This case report describes cardiac toxicity associated with desmopressin administered according to the recommended indications: a 55-year-old woman diagnosed with Wegener's granulomatosis (WG) was treated with desmopressin to improve hemostasis and shorten bleeding time before a planned renal biopsy. She developed cardiac arrest within 60 minutes of the desmopressin injection. Cardiopulmonary resuscitation began immediately and was successful, although the patient subsequently died of WG-associated complications. Desmopressin administration thus appears, in some cases, to be associated with a high risk of thrombotic events, possibly by stimulating the rapid release of endothelial factors such as an abnormal multimeric form of von Willebrand factor, which might cause platelet aggregation. Clinicians should be aware of the possible occurrence of this little-known but potentially serious cardiac event associated with desmopressin administration and be prepared to initiate cardiopulmonary resuscitation immediately if needed.
OBJECTIVES: To describe and compare the evolution of digital pressure on both hands during a dialysis session in patients without digital ischemia, and to identify the parameters influencing the digital pressure. MATERIA...OBJECTIVES: To describe and compare the evolution of digital pressure on both hands during a dialysis session in patients without digital ischemia, and to identify the parameters influencing the digital pressure. MATERIALS: Patients with an upper limb vascular access were prospectively included. Digital systolic pressure on the third finger of both hands measured by photoplethysmography and brachial systolic pressure were recorded before dialysis (H0) and every hour (from H1 to H4). RESULTS: Among 53 patients, 49 were included (exclusions: one surgery for ischemia, one hand tremor, two no consent). None of them had digital ischemia. Digital pressure homolateral to the vascular access was significantly lower compared with controlateral side before and during dialysis. Digital pressure significantly decreased on both sides during dialysis. Brachial pressure decreased significantly compared to H0. Only the brachial pressure decrease was correlated with the decrease of digital pressure. The digital pressure was less than 30 mmHg in six patients. No evidence of digital ischemia was reported after a 6-month follow-up. CONCLUSION: To our knowledge, this is the first study showing a significant decrease of digital pressure in both hands during hemodialysis in patients without digital ischemia. Further studies are necessary to investigate which parameters can affect digital pressure and to look for clinical consequence of this measurement.