Long-term patency of bypass to the right atrium as a last resort in two hemodialysis patients: case report.

Introduction: Central venous occlusion (CVO), which is caused by central venous catheters in haemodialysis patients , remains a challenge in vascular surgery. Case presentation: The authors report data evaluating bypass graft patency and complications of two patients with CVO who have benefited from a subclavian artery to right atrium bypass using polytetrafuloroetylene. The first patient , underwent three times an angioplasty of the atrio prothetic anastomosis , finally the graft failed at 12 month. The second one, presented a steal syndrome with ischaemia of the right upper limb immediately postoperatively. Three months after the procedure , she underwent an angiographic control that showed a stenosis of the protheto atrial junction. Clinical discussion: Central venous occlusion in patients with end-stage kidney disease is most often due to central venous catheters. Although the endovascular therapy is the first-line approach to the treatment of CVO, the surgical bypass to the right atrium is often the last resort to preserve adequate vascular access in haemodialysis patients, with CVO. The autologous vein and bovine arterial bypass remains better than polytetrafuloroetylene grafts in terms of long-term patency. Only few cases have been reported un the literature , besides no long-term outcome data has been previously reported. Conclusion: Long-term secondary patency of bypass to the right atrium can be achieved, but requires strict follow-up, and multiple endovascular procedures to maintain the bypass access.

The SARS-CoV-2 responsible for phlegmasia cerulea dolens: a case report.

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic systemic infection that is responsible for serious coagulopathies similar to disseminated intravascular coagulation. Case Presentation: The authors report the case of a COVID-19 patient who presented with phlegmasia cerulea dolens (PCD) of the left lower limb, so he benefited from aponeurotomies of the internal and anterolateral muscular compartments. Clinical Discussion: The severe acute respiratory syndrome coronavirus 2 involves an inflammatory process in thrombotic events in COVID-19 patients, including a cytokine storm. PCD evolves in three semiological phases: venous stasis, weakening of the pulses, and the constitution of major ischemia. In the literature, the authors find many reports that have been published regarding increased thrombus formation in COVID-19 patients; these include DVT formation, pulmonary embolism, and stroke. Nevertheless, publications concerning PCD in COVID-19 patients remain rare. Conclusion: Although the severe acute respiratory syndrome coronavirus 2 remains a thrombogenic pathology, systematic anticoagulation is the subject of hypothesis. Hence the importance of regular monitoring of markers of vascular thrombosis.

Acute limb ischemia due to diclofenac sodium iatrogenic intra-arterial injection: a case report.

Diclofenac sodium is a nonsteroidal anti-inflammatory, the injection of which by the intra-arterial route can lead to serious vascular complications, including limb ischemia. Case presentation: We report the case of accidental intra-arterial injection of diclofenac sodium in the brachial artery leading to acute limb ischemia. Clinical discussion: Iatrogenic intra-arterial injection is rarely reported in the literature; however, it is toxic and can lead to limb amputation. Only two cases of intra-arterial injection of diclofenac have been reported in the literature. The proposed pathophysiological mechanism is vasospasm, intravascular thrombosis, and chemical endoarteritis. The most common anatomical location in accidental intra-arterial injection is the antecubital fossa, where branches of the ulnar and brachial arteries are more superficial. Conclusion: The injection of medication must be as careful as possible, since the intra-arterial injection can affect the functional prognosis of the organ.

Cannabis arteritis: A case report and brief review of the literature.

Introduction: Cannabis is commonly misused psychoactive drug which is known to be associated with a number of psychotic and somatic side-effects. Cannabis arteritis is a rare vascular disorder, since only about fifty cases have been reported in the literature. Case presentation: We report a case of a 40-year-old chronic cannabis user male, who was admitted for painful necrosis of the fifth toe of the right foot. The etiological investigation ruled out the main causes of juvenile arterial disease. Therefore cannabis was the only causative factor found in this patient. An amputation of the fifth toe was performed 20 days later of administrating Prostacyclin (Iloprost) , with a good postoperative improvement. Discussion: The main causes of juvenile arterial disease are: atheromatous arterial disease, thromboangiitis obliterans (Buerger's disease) , systemic or autoimmune diseases. The diagnosis of cannabis arteritis remains a diagnosis of exclusion. it remains a rare phenomenon which is responsible for various symptoms, which can go as far as the amputation of the limb. Several authors have classified cannabis arteritis as a clinical form of Buerger's disease, due to similar clinical semiology and similar appearance at arteriography. Nowadays, we don't know exactly the histopathologic patterns of this pathology. Conclusion: Although several therapeutic options exist, Cannabis weaning still the main part of cannabis arteritis treatment.

Right subclavian artery to right atrium bypass using Polytetrafluoroethylene (PTFE) graft in hemodialysis patient with central venous occlusion: Case report.

Introduction: Central venous Occlusion (CVO) is a serious complication that occurs mainly in patients with long term central venous catheters for dialysis. It remains a challenge in vascular surgery. Case presentation: We report a case of a patient with end-stage kidney disease (ESKD), who was admitted for chronic occlusion of the superior and inferior vena cava and underwent a right subclavian artery to right atrium (RA) bypass using polytetrafuloroetylene (PTFE) graft. Clinical discussion: Central venous catheters remains the main cause of CVO in ESKD. Although the endovascular therapy is the main approach in the treatment of CVO, the surgical bypass to the RA is often the last resort to preserve vascular access in hemodialysis patients. The autologous vein and bovine arterial bypass remains better than PTFE grafts in terms of long term patency. Conclusion: fistulas as a first approach for dialysis access must be privileged at the expense of central catheters. However bypass to RA by mini thoracotomy incision remains as an excellent option for dialysis access in ESKD with CVO.

Covid-19 responsible for acute limb ischemia twice at 2 different stages in a patient on anticoagulation: A case report.

INTRODUCTION: Coronavirus disease-2019 is a worldwilde pandemic not limited to pulmonary dysfunction. it is a systemic infection responsible for serious coagulopathies. CASE PRESENTATION: We report the case of a patient who presented an acute ischemia of the left lower limb, after day 5 of (Covid-19) infection, with a second thrombotic localization in the left upper limb at the twentieth day of post covid while he was on anticoagulation. CLINICAL DISCUSSION: Several studies have shown the involvement of the inflammatory process in the thrombotic state in patients with (Covid-19) infection. The inflammatory process leads to the activation of the thrombotic cascade. Various elevated markers have been identified frequently and described to determine the progression of sepsis-induced prothrombotic disease secondary to Covid-19. Our case remains unique in its kind, since the patient presented twice the acute ischemia of the limbs, the first at the left lower limb, while he was on preventive low molecular weight heparin (LMWH), the second time at the left upper limb, while he was on anticoagulation (RIVAROXABAN 20 mg/jr). Although the efficiency of preventive anticoagulation in Covid-19 patients has not been established, it remains systematic as a prescription in the hospital environment. CONCLUSION: All in all, The regular monitoring of vascular markers thrombosis, and preventive anticoagulation remains the only weapon available to any clinician to fight against vascular thrombotic complications in Covid-19 patients, though its realiability has not been proven.

Late-onset mycotic aneurysm of brachial artery secondary to infective endocarditis: case report.

Infective endocarditis remains a dreaded and severe disease because of its course, its complications, its need for good antibiotic management, as well as its morbidity. Peripheral mycotic aneurysm is a rare complication of infective endocarditis. We report the case of a 62-year-old female patient who presented with Streptococcus SPP infective endocarditis treated by antibiotics. Two months later, she presented with a mycotic aneurysm of the right brachial artery with the same germ, we have performed a brachial artery ligation, then a complete revascularization by graft of the saphenous vein. Through this case, we should not forget that the lesional assessment is always necessary to avoid missing serious complications that could threaten the functional prognosis, even vital.

Popliteal artery entrapment syndrome: a case report with literature review.

Popliteal artery entrapment syndrome generally causes calf claudication in young active adult. It is resulting of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. We present the case of a 36-year-old male with left calf claudication limb in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically.

Endovascular treatment of a ruptured post-traumatic false aneurysm of the aortic isthmus: A case report.

INTRODUCTION: The false aneurysm of the aortic isthmus is, given its severity and case fatality rate, a subject of interest in vascular surgery. The interest of this article is the analysis of the different characteristics of this pathology based on the study of a case report and on a review of the literature. CASE REPORT: This is a 21-year-old patient admitted for the management of a severe polytrauma following a fall from a cliff, causing him paraplegia following a fracture of the dorsal spine which is objectified on the CT bodyscan, which also shows the presence of a localized dissection with ruptured false aneurysm of the isthmus. After emergency conditioning and initial neurosurgical management by vertebral osteosynthesis, the postoperative effects are aggravated by the occurrence of a bilateral massive pulmonary embolism. Thus, given the high risk of complications or death following classic thoracotomy surgery, we decided to carry out endovascular treatment by placing a covered endoprosthesis. DISCUSSION: The aortic isthmus false aneurysm is a relatively rare condition that mainly interests the young subject in an often-post-traumatic context. The surgical treatment represented by thoracotomy, which, in addition to being invasive, exposes the patient to multiple complications as disabling as each other. All of these elements explain the advantage of endovascular treatment, which is much less invasive with a better prognosis. CONCLUSION: The therapeutic management of a pseudoaneurysm of the isthmus is undergoing constant development; endoprostheses currently occupy the place of choice in the treatment of these lesions.

Sacciform aneurysm of the right common iliac artery in Behcet's disease treated with EVAR: Case report.

INTRODUCTION: Behcet's disease is a systemic vasculitis with vascular tropism usually manifested by phlebitis. Arterial manifestations are rare, most often result in aneurysms than occlusions. The objective of this article, is to relate our experience and pretherapeutic reasoning for the indication of an endovascular treatment of an atypical sacciform iliac aneurysm, in an elderly patient followed for Behcet's disease. CASE REPORT: This is a 73-year-old patient, followed for Behcet's disease under immunosuppressive treatment and corticosteroids treatment, admitted to our structure, for the surgical management of an aneurysm of the right common iliac artery diagnosed by computed tomographic angiography performed for chronic paroxysmal abdominal pain, treated by EVAR after a multidisciplinary discussion, complicated by a thrombosis of the left leg of the bifurcated aortic stent graft the, managed by performing an extra anatomical bypass, complicated late by the appearance of a Scarpa hematoma, who was evacuated. DISCUSSION: Behcet's disease is a systemic vasculitis with vascular tropism, usually affecting young. Our case is an elderly subject, whose diagnosis and follow-up of Behcet's disease is recent and whose discovery of this aneurysm was fortuitous, after performing a CT angiogram required for another reason. The objective of this article, is to relate our experience and pre-therapeutic reasoning for theindication of an endovascular treatment, and our management of the complications. CONCLUSION: Endovascular treatment of iliac sacciform aneurysm by placing a covered stent is a good alternative to conventional surgery with fewer complications; especially in front of a field of Behcet's disease.

Multiple paradoxical embolisms revealing a patent foramen ovale in a patient with deep venous thrombosis: A case report.

INTRODUCTION: Paradoxical embolism is a rare medical phenomenon. Depending on the site of embolisation, it can cause different symptoms. Although rare, mesenteric ischemia can reveal paradoxical embolism, and the embolisation of two different sites is rarely described in the literature. CASE PRESENTATION: We report the observation of a patient with a table associating an acute mesenteric ischemia and an acute ischemia of the upper limb; whose the etiological assessment revealed a deep venous thrombosis of the lower limbs complicated by pulmonary embolism. CLINICAL DISCUSSION: These paradoxical embolisms occurred through a patent foramen ovale. The diagnosis of the patent foramen ovale in this patient was revealed by transthoracic echocardiography, with bubble test. The patient benefited from an embolectomy of the superior mesenteric artery and an embolectomy using fogarty catheter by approching humeral artery at the elbow crease with good postoperative evolution. The patient was put on long-term anticoagulation with Acenocoumarol (because of low socio-economic level of our patient). We didn't recommended the closure of the PFO because of the small size of the shunt and especially because the patient refuses that procedure. CONCLUSION: Paradoxical embolism remains a pathology rarely mentioned by clinicians, although it can engage the functional and vital prognosis of the patient, hence the interest of a good cardiac evaluation in any patient with embolic ischemia.

Acute Abdominal Compartment Syndrome complicating a chronic mesenteric ischemia revascularization.

BACKGROUND: Abdominal Compartment Syndrome (ACS) is a pathological condition that results from an increase in pressure within the abdomen associated with organ failure. It can be acute or chronic, primary or secondary. ACS poses a serious diagnostic challenge for physicians as the clinical presentation is varied and can mimic other medical pathologies. To prevent a multi-organ failure and ultimately death due to this disease, the World Society of Abdominal Compartment Syndrome (WSACS) suggested clinical criteria and biology tests to facilitate an early diagnosis of acute ACS. CASE PRESENTATION: We report a case of 61 year-old man diagnosed with chronic mesenteric ischemia that has been successfully treated by prosthetic bypass. The postoperative period was eventual, the patient presented complications corresponding essentially to a manifest acute ACS. The treatment consisted on abdominal decompression and resuscitation measures. CONCLUSIONS: An early diagnosis of ACS disease for an appropriate therapeutic initiation is mandatory to prevent its complications and save the patient's life prognosis.

Cutaneous necrosis of the arteriovenous fistula puncture site in chronic hemodialysis: A historical complication or an ever-present threat? A series of 26 cases.

INTRODUCTION: Cutaneous necrosis (CN) at the puncture site of the arteriovenous fistula (AVF) in chronic hemodialysis (CHD) is a rare but potentially fatal complication. The objective of our work was to establish the associated complications, vascular prognosis, and patient survival of CHD patients presenting cutaneous necrosis. METHODS: This retrospective study (January 2016 to March 2020) was conducted in the Department of Vascular Surgery and the Department of Nephrology at the University Hospital Center Mohammed VI of Oujda, Morocco. Included were all CHD patients admitted for treatment of cutaneous necrosis at the puncture site of a native AVF. RESULTS: Data from 26 cases were collected. The mean age was 58.7 ± 16 years, 70.8% were female, and 25% had diabetic nephropathy; 42.3% of the AVFs were radiocephalic and 46.1% were brachiocephalic; 42.2% of patients presented active bleeding, of whom 91% required a blood transfusion; 80.8% of the AVFs were complicated by aneurysms. Fistulography showed stenosis in 42.3% of cases. Urgent surgical intervention was performed on all the patients. Fifty percent of patients required placement of a short-term hemodialysis catheter. Two patients had presented a recurrence. Death occurred in one case following a massive hemorrhagic shock. CONCLUSION: Cutaneous necrosis is a relatively common complication and requires early screening and immediate surgical intervention.

Morocco's First Biobank: Establishment, Ethical Issues, Biomedical Research Opportunities, and Challenges.

BACKGROUND: Biobanks are highly organized infrastructures that allow the storage of human biological specimens associated with donors' personal and clinical data. These infrastructures play a key role in the development of translational medical research. In this context, we launched, in November 2015, the first biobank in Morocco (BRO Biobank) in order to promote biomedical research and provide opportunities to include Moroccan and North African ethnic groups in international biomedical studies. Here, we present the setup and the sample characteristics of BRO Biobank. METHODS: Patients were recruited at several departments of two major health-care centers in the city of Oujda. Healthy donors were enrolled during blood donation campaigns all over Eastern Morocco. From each participant, personal, clinical, and biomedical data were collected, and several biospecimens were stored. Standard operating procedures have been established in accordance with international guidelines on human biobanks. RESULTS: Between November 2015 and July 2020, 2446 participants were recruited into the BRO Biobank, of whom 2013 were healthy donors, and 433 were patients. For healthy donors, the median age was 35 years with a range between 18 and 65 years and the consanguinity rate was 28.96%. For patients, the median age was 11 years with a range between 1 day and 83 years. Among these patients, 55% had rare diseases (hemoglobinopathies, intellectual disabilities, disorders of sex differentiation, myopathies, etc.), 13% had lung cancer, 4% suffered from hematological neoplasms, 3% were from the kidney transplantation project, and 25% had unknown diagnoses. The BRO Biobank has collected 5092 biospecimens, including blood, white blood cells, plasma, serum, urine, frozen tissue, FFPE tissue, and nucleic acids. A sample quality control has been implemented and suggested that samples of the BRO Biobank are of high quality and therefore suitable for high-throughput nucleic acid analysis. CONCLUSIONS: The BRO Biobank is the largest sample collection in Morocco, and it is ready to provide samples to national and international research projects. Therefore, the BRO Biobank is a valuable resource for advancing translational medical research.

Tuberculosis of the renal artery: a rare cause of renovascular arterial hypertension.

Tuberculosis is an endemic disease in Morocco. Main blood vessels are rarely affected; the few mentioned cases are aneurysmal. We report a 17-year-old patient presenting with renovascular arterial hypertension, revealed thanks to the discovery of an occlusion of the right renal artery in Duplex scan. During the intervention, the observation of pararenal and mesenteric tuberculous polyadenopathy let us suggest the same kind of lesion at the level of the occluded renal artery. Once antituberculosis treatment had been carried out, the right renal artery was revascularized with a right iliorenal bypass using reversed internal saphenous vein. The postoperative course was uneventful, with an 18-month follow-up. Arterial pressure was normal without antihypertensive treatment, and the bypass was patent. As far as we know, this is the first case of renovascular arterial hypertension resulting from tuberculosis treated with an iliorenal bypass.