Endovascular therapy for steno-occlusive subclavian artery disease early and long-term outcomes in a multicentric Tunisian study.

AIM: To evaluate the outcomes of endovascular therapy in patients with subclavian steno-occlusive disease over the short and long term in a Tunisian population. MATERIALS AND METHODS: Patients who underwent endovascular treatment of subclavian artery (SCA) steno-occlusive disease between 2013 and 2019 in three Tunisian centers were evaluated retrospectively. After treatment, patients were follow-up was scheduled at 1, 3, 6, 12 months postoperatively and annually afterwards by Doppler ultrasound and clinical findings. Primary outcomes included technical, clinical procedural success rates and limb salvage rate. Secondary outcomes included the occurrence of periprocedural complications and primary patency rates. RESULTS: 56 patients (33 males, 58.9%) were evaluated. Patients' mean age was 61.5 + years. Technical success rate was 94.6 %, being 100% in case of stenosis and 78.5% in case of occlusion. The technical success rate was 94.6%. The clinical success rate was 100% and the upper limb salvage rate was 100%. Minor amputations were performed on 5 patients. Perioperative mortality and morbidity rates were 0% and 8.9% respectively. Mean follow-up was 26.7±16.4 months (range 12-86 months). Two in-stent restenosis occurred (at 12 and 15 months) and one case of thrombosis at the 16th month. The primary patency rates were 88.7%+4.3% at the end of the first year and 78.7%+6.1% at 3 years. CONCLUSION: Endovascular treatment can be considered as a safe and effective treatment of SCA steno-occlusive disease, with low perioperative complication rates and a good patency rates over long term. KEY WORDS: Subclavian artery stenosis, Subclavian artery occlusion, endovascular, subclavian revascularization.

Endovascular management of an isolated common iliac artery aneurysm: a case report.

Isolated iliac artery aneurysms are rare, and treatment by conventional surgery gives good results. Endovascular repair of such aneurysms has recently become the preferred form of treatment, provided the appropriate anatomy for endovascular repair exists. We report the case of a 60-year-old man admitted in our department for an aneurysm of the left primitive iliac artery revealed by intermittent claudication and treated by a covered stent after embolization of the hypogastric artery by an Amplatzer Vascular Plug with a good result. This case highlights the importance of preservation of the collaterals of the hypogastric artery when you treat such entity; in order to avoid transient gluteal claudication and sexual dysfunction.

Case Report: Mycotic common carotid artery pseudoaneurysm in a child. A case report.

Extracranial carotid artery aneurysms in children are extremely rare, nevertheless associated with a great potential of thromboembolic episodes and rupture especially those with mycotic origin. The surgical treatment is very challenging, and there is still a controversy concerning revascularisation after the resection of the aneurysm. In this manuscript, we report the observation of an 8-year-old boy with the medical history of Leukemia who is admitted urgently for a mycotic right common carotid artery aneurysm, occurring after a chemoport infection who was operated on in our cardiovascular surgery department with surgical resection and ligation. It is the second report in the pediatric literature of a mycotic pseudoaneurysm situated in the common carotid artery, but the first documented by medical imagery. Through this case, we highlight that ligation of the infected carotid artery can be a safe and efficient alternative especially in Children.

Alveolar Hemorrhage Following Thrombolytic Therapy for Acute Myocardial Infarction: Two Case Reports and Literature Review.

Alveolar hemorrhage (AH) is a heterogeneous clinical syndrome with a high mortality rate, characterized by extensive bleeding into the alveolar spaces. AH secondary to systemic thrombolysis treatment in the setting of acute myocardial infarction is an uncommon complication, but potentially fatal and can lead to acute respiratory failure. This entity is rarely reported in the literature. We report two cases of acute AH after intravenous thrombolysis for acute myocardial infarction, which could contribute to the literature on the subject, and discuss the risk factors as well as the clinical and radiological findings supporting the diagnosis. We overview also the rare previous published case reports in this context, and we contrast our findings with those reported in the literature.

Hybrid Management of a Pseudoaneurysm of the Inferior Gluteal Artery Following a Stab Wound.

Aneurysms and pseudoaneurysms of the gluteal artery are rare. They represent less than 1% of the described arterial aneurysms. Those that touch the inferior gluteal artery are even rarer. Only a few cases have been described worldwide. Such cases often present with a variable time course, mode of injury, and associated symptoms, leading to their misdiagnosis and improper treatment. We present the case of a 30-year-old male, who presented to our emergency room one week after a stab wound in the left gluteal region causing a pseudoaneurysm of the left inferior gluteal artery with a sciatic compartment syndrome treated by a hybrid approach.

Acute ischemia of the lower limb on ECMO: risk factors and preventive modalities.

The acute ischemia of the lower limb on the veno-arterial Extracorporeal Membrane Oxygenation (ECMO) is a frequent and dangerous complication that can put the vital and functional prognosis at risk. Several risk factors have been incriminated and the lack of a sufficient distal perfusion is the most common. We report the case of an 11-year-old girl with veno-arterial ECMO for acute myocarditis complicated by severe acute lower limb ischemia.

Spontaneous Aortocaval Fistula with Abdominal Aortic Aneurysm 5 Years after Aortic Valve Replacement Complicated by Aortic Dissection.

Iatrogenic aortic dissection after cardiac surgery is a rare and serious complication, the management of which involves many therapeutic modalities and whose prognosis is associated with high rate of morbidity and mortality. The authors report the case of a 61-year-old man presented with aortocaval fistula and aortic dissection 5 years after aortic valve replacement.

Iatrogenic occlusion of the circumflex artery and left ventricle pseudoaneurysm after mitral annuloplasty.

Ischemic iatrogenic lesions can complicate surgical procedures on the mitral valve. One of the causative mechanisms is direct injury to or distortion of the circumflex coronary artery. The risk of damaging the circumflex coronary artery depends mainly upon the proximity of that vessel to the posterior segment of the mitral annulus, and this varies from patient to patient. Herein, we report a case of iatrogenic circumflex coronary artery lesion with left ventricular aneurysm after mitral annuloplasty, in order to highlight a possible relationship between iatrogenic circumflex lesions and coronary dominance in a 70-year-old man who had severe mitral regurgitation. .