Place of endovascular repair in the treatment of abdominal aortic aneurysm.

AIM: Open repair for abdominal aortic aneurysm (AAA) has a significant morbidity and mortality. Since the introduction of endovascular techniques, much progress has been made. The aim of this study is to clarify the feasibility and the results of endovascular aneurysm repair (EVAR) in short and middle terms. METHODS: Between 2008 and 2015, 14 patients underwent EVAR. The average age was 65 years. Comorbidities were found in 7 patients. It was coronary artery disease in 3 cases and severe respiratory failure in 4 cases. The aneurysm was atherosclerotic in 12 cases and inflammatory in 2 cases. The average length of the proximal neck was 29 mm. The mean aneurysm diameter was 65mm. A bifurcated stent graft has been deployed in 12 cases and an aorto-mono-iliac stent graft was deployed in 2 cases. RESULTS: Immediate technical success was achieved in 13 patients. Immediate surgical conversion was performed in 1 case. The average hospital stay was 5 days. We haven't deployed any early death. After a mean follow-up of 3 years, we deployed 3 late deaths; two deaths were not related to the aneurysm and one death was secondary to rupture of the aneurysm caused by a proximal stent graft migration. CONCLUSION: EVAR is actually a therapeutic increasingly used. Its results, especially late, are still being evaluated. Meanwhile, its indications must be selective.

[Results of surgical treatment of intracardiac total anomalous pulmonary venous return]. / Résultats du traitement chirurgical du retour veineux pulmonaire anormal total intracardiaque :à propos de 7 cas.

BACKGROUND: Total anomalous pulmonary venous return (TAPVR) has a rather low incidence (1-3%) of all congenital heart disease. Intracardiac TAPVR represent 25-30% of all TAPVR. AIM: To report our results and long-term follow-up of surgical management of intracardiac TAPVR. METHODS: Retrospective study of 7 patients with intra cardiac TAPVR treated surgically between Mai 1992 and July 2007. RESULTS: The surgical technique has been an intra atrial procedure in all cases. We didn't report any early post-operative death. Early postoperative complications were principally pulmonary infections. We report one death at three months of follow-up caused by laryngeal stenosis. Late follow-up was good for all patients. CONCLUSION: Good result of surgical treatment of intracardiac TAPVR depends on early diagnosis and adequate surgical technique.

[Prosthetic valve endocarditis: about 14 cases]. / La prise en charge chirurgicale des endocardites infectieuses sur prothese valvulaire: a propos de 14 cas.

BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious complication of valve surgery. AIM: The aim of this study is to determine the diagnostic and therapeutic management for PVE. METHODS: It's a retrospective study about 14 cases of PVE operated in the department of cardiovascular surgery of la Rabta hospital between January 1996 and December 2006. RESULTS: In two cases, surgery was performed emergent, in the remnant cases surgery was elective. The coagulase-negative staphylococcus (CNS) is the predominant cause of these PVE.Surgery consisted on seven mitral prosthesis replacements and seven aortic prosthesis replacements.Hospital mortality was 50%. CONCLUSION: In conclusion attention should be made to prevent endocarditis when possible. In case of PVE, an early diagnosis a leads to earlier application of appropriate therapies and improved outcome.

[Veinous thrombectomy. Six case reports]. / La thrombectomie veineuse. A propos de 6 cas.

The aim of this study is to raise up the effect of surgical thrombectomy among other alternative therapies. This retrospective study reports 6 patients (mean age 63 years) admitted with phlegmasia cerulea dolens. All patients underwent surgical venous thrombectomy associated with infracava filter insertion in 2 cases. One patient died in the early postoperative course. In all other cases we noticed good early and late outcome both on clinical examination and duplex scanning assessment. In conclusion, surgical venous thrombectomy can be considered as a good and efficient procedure in the presence of phlegmasia cerulea dolens in order to relieve ischemia and to prevent whenever possible severe chronic venous disorders. However, fibrinolytic therapy might achieve as good results as surgery. Thus, the latter is to be reserved to very severe veinous ischemia with limb loss threatening where fibrinolytic therapy fails or is contre-indicated.