[Complications of infected aneurysm due to Salmonella enteritidis: a case report]. / Complications d'un anévrisme infecté à Salmonella enteritidis: à propos d'un cas.

Salmonelloses are becoming more frequented. To date, very few cases of aneurisms or vascular grafts infections have been described. We report the rare case of an extradigestive manifestation, due to Salmonella enteritidis affecting a patient with Behçet disease. The biological diagnosis is based on microorganism isolation from the site of infection but also from blood cultures. The initial treatment combined antibiotherapy and surgical procedure and replacement of the arteriovenous graft.

[Spontaneous aortic isthmus aneurysm: Exceptional revelation of Behçet's disease]. / Anévrisme spontané de l'isthme aortique révélant une maladie de Behçet.

Arterial involvement in Behçet's disease is rare. The exceptional aortic isthmus location is difficult to treat. We report the case of a young man in whom an aortic isthmus aneurysm revealed Behçet's disease. In this exceptional situation, we opted for classical open surgical repair despite current preference for endovascular treatment.

[False aneurysm of the abdominal aorta revealing Behçet's disease]. / Faux anévrisme de l'aorte abdominale sous-rénale révélant une maladie de Behçet.

Behçet's disease (BD) is a systemic vasculitis diagnosed on the basis of clinical criteria established by the International Study Group for Behçet's. Vascular involvement is common, affecting both arteries and veins. Aortic localizations are rare and severe and can be life-threatening in case of rupture. Thrombosis is observed but aneurysm or false aneurysm are more common. Computed tomographic angiography is essential for diagnosis and study of the characteristics of aneurysms and false aneurysms. Treatment relies on corticosteroids and immunosuppressive drugs in severe forms supplemented by open or endovascular repair. This latter approach represents a safe and efficient alternative to open surgery, it induces fewer pseudoaneurysms and increases the survival rate especially in association with immunosuppressors. We report a case of Behçet disease revealed by a false aneurysm of the abdominal aorta treated by deployment of a covered stent.

[Multiple tuberculous aortic aneurysms in a child. A case report]. / Multiples anévrismes aortiques d'origine tuberculeuse chez un enfant. A propos d'un cas.

INTRODUCTION: Tuberculous aortic aneurysms are rarely seen. Their major complication is unforeseeable and lethal aneurysmal rupture. We report an exceptional case of multiple tuberculous aortic aneurysms in a child. CASE REPORT: A 13-year-old girl was admitted to our hospital with abdominal pain. She reported a history of fever, night sweats and weight loss. Physical examination showed a pulsatile mass over the umbilicus. Thoracoabdominal angio-NMR revealed multiple pseudoaneurysms of the thoracic and abdominal aorta. The patient underwent elective laparotomy, resection of the abdominal aortic and in situ prosthetic repair with an aortic graft. The postoperative recovery was uneventful. The histopathologic examination of the aortic wall and para-aortic lymph nodes showed evident features of tuberculosis. Antituberculous chemotherapy was initiated. CONCLUSION: Tuberculous aortic aneurysms are rarely seen. Their major complication is rupture. Surgery must not be delayed just like antitubercular therapy.

[Giant aneurysm of the splenic artery. Case report and review of the literature]. / Anévrisme géant de l'artère splénique. A propos d'un cas et revue de la littérature.

INTRODUCTION: Giant splenic artery aneurysm is exceptional. We report a case and review the literature to ascertain the characteristic epidemiological, clinical and therapeutic features of this condition. CASE REPORT: A 62-year-old man was admitted for epigastric pain. Physical examination found an epigastric pulsatile mass. A contrast computed scan of the abdomen revealed a 10-cm thrombosed aneurysm of the splenic artery. An abdominal aortography, including selective celiac angiography, confirmed the presence of a 10-cm aneurysm originating from the medial third of the splenic artery. The patient underwent open surgical repair. The proximal and the distal splenic artery were ligated from within the aneurysm. The postoperative period was uneventful. CONCLUSION: Giant aneurysm of the splenic artery is a rare clinical entity. These aneurysms differ from usual splenic artery aneurysms in several ways involving the predominant gender, localization on the splenic artery, clinical presentation, and treatment.

[False aneurysm of the external iliac artery revealing Behçet's disease]. / Faux anévrysme de l'artère iliaque externe révélant une maladie de Behçet.

Behçet's disease is a vasculitis of unknown etiology. Vascular involvement is rare, but may be inaugural in many cases. We report a case of Behçet's disease revealed by a symptomatic pseudo-aneurysm of the external iliac artery. The symptomatology was non-specific. Ultrasound Doppler and computed tomographic angiography were essential for diagnosis. The pseudo-aneurysm was managed by endovascular treatment. Corticosteroid and immunosuppressant therapy were administrated after surgery.

[Multiple paragangliomas: about two cases]. / Paragangliomes multiples: à propos de deux cas.

The multiple paragangliomas are rare tumours, with slow evolution, posing diagnostic and therapeutic problems. The carotid and jugulo-tympanic localization are the most frequent, and the aortic localization is very infrequent. The association of two, three and four localization is possible in the multiple forms. These multiple localizations are more frequent in familial forms. Surgical removal is the first intention treatment of these tumours. In the multiple forms, the therapeutic strategy must be adapted to each case: usually, the intervention begins by the carotid localization. We report two cases of chemodectoma with multiple localizations. The first case is a 44 years-old woman, who presented a double localization: carotid (bilateral) and aortic (arch). The second case is a patient with a double aortic localization, carotid and aortic, associated to a tympano-jugular localization. Surgical treatment was performed for all these localization, except for the tympano-jugular localization, treated by embolization. The post-operative periods were uneventful. The first case had adjunctive radiotherapy.

[Cerebral revascularisation in Takayasu's arteritis]. / Revascularisation cérébrale dans la maladie de Takayasu.

SUBJECT: Supraaortic angioplasty is often not feasible in patients with Takayasu's arteritis because of involvement of long segment of arteries. Consequently, the role of surgical treatment in the management of cerebral ischemia is important in this disease. The objective of this work is to specify the indications and surgical techniques in lesions of arteries to the head in this disease and to report our experience. METHODS: Seven patients with cervical arterial lesions due to Takayasu's arteritis were treated by bypass surgery in the department of vascular surgery, Ibn-Sina hospital on one period of 11 years. RESULTS: It is about 6 women and one man of middle age at the time of the diagnosis of 33,8 years. The revealing signs were essentially of neurological and ocular order. Six of our patients were in inflammatory thrust at the time of the diagnosis, and required a medical treatment first to basis of corticosteroids. Bypasses from the ascending aorta to the carotid artery were performed in six cases. In one case, the bypass was performed between the brachiocephalic artery and common carotid artery. A death in relation with a cerebral hemorrhage occurred 2 days after the revascularisation. A clean improvement of the functional signs was noted among 3 patients, whereas the improvement was partial at two other. A secondary thrombosis of the bypass surgery occurred in 3 cases. CONCLUSION: The natural history of Takayasu's arteritis and its evolution is badly known. The operative indications must not rest solely on the only anatomical balance, but based on a bundle of arguments in which, the assessment of the cerebral blood flow would be useful. Cerebral hyperperfusion syndrom constitutes a major risk that can be reduced by staged revascularisations.

[False aneurysm of the carotid artery revealing Behçet disease]. / Faux anévrysme de l'artère carotide révélant une maladie de Behçet.

Vascular involvement in Behçet's disease often present as venous thrombosis. Arterial damage is rare. We report a case of Behçet's disease occurring in a 40-year-old woman revealed by a false aneurysm of the left common carotid artery. The intervention consisted in a prosthetic graft after endovascular control. After a 2-year follow-up period, the patient did not develop any postoperative complication.

[Peripheral arterial pseudo-aneurysm in Behçet's disease: Report of two cases]. / Pseudo-anévrisme artériel périphérique dans la maladie de Behçet : à propos de deux cas.

Behçet's disease is a systemic vasculitis of unknown etiopathogenesis. Arterial events such as pseudo-aneurysms are rare and may be the mode of occurrence of the disease. These pseudo-aneurysms tend, regardless of size, to progress rapidly to life-threatening rupture. We report two cases of arterial pseudo-aneurysms that ruptured. Treatment consisted of surgical repair in one case and arterial ligation in the other; the postoperative course was uneventful in both cases.

[The aneurysms of the aorta of tuberculous]. / Les anévrysmes de l'aorte d'origine tuberculeuse. À propos de trois cas.

Tuberculosis is a public health problem in Morocco, which is difficult to eradicate despite the recognized efficiency of health policies. Aortic aneurysm is rare and lethal complication of spontaneous evolution. Pathophysiological characteristics and the difficulty of early diagnosis worsen the prognosis.

[Bilateral carotid aneurysm revealing Takayasu disease]. / Anévrisme carotidien bilatéral révélant une maladie de Takayasu.

Extracranial carotid aneurysms caused by Takayasu's arteritis is extremely rare. Their evolutionary risk is dominated by rupture and cerebral ischemia. We report a case of a 23 years old woman presenting bilateral common carotid aneurysm secondary to Takayasu's arteritis. Surgical treatment with the patient under steroid coverage was performed to prevent the risque of rupture. The aneurysm was resected, reconstruction was performed with prothetic aortocarotid bypass. She was discharged without major complications. The graft have remanied patent during the four years follow-up periods. A biologic inflammatory syndrome and a parietal thickening of the aneurysm in a young woman must provoke diagnosis. The surgery must be appropriate every time that the diagnosis is carried considering the evolutionary risk of these aneurysms.

[Two cases of malignant tumors of the inferior vena cava]. / Deux cas de tumeurs malignes de la veine cave inférieure.

The malignant tumors of the inferior vena cava are rare. Their prognosis is bad. We report two cases of a 17-year-old and 46-year-old woman presenting the one an intimal sarcoma of the inferior vena cava and the other a metastatic of adenocarcinoma whose primary tumor was not identified. The aortic wall was invaded in both patients. The ureter repulsed in first case, was invaded in second case. The treatment consisted on resection of the tumor including the aortic wall with vein closure in both patients, with right nephrectomy in second patient. In the two cases, a prosthetic reconstruction of the arterial integrity was attempted with aortobiiliac bypass. The two patients died after relapse tumorous to the 6th month in first patient and by multisystem organ failure 5th day post-operative in second. Through these two personal cases, we try to point out the difficult problem of diagnosis that put these tumors and their bad prognosis despite an improvement of treatment.

[Arterial complications of hydatic disease]. / Les complications artérielles de la maladie hydatique.

We report two cases of hydatic cyst with rupture into the aorta in two young patients cared for at the Ibn Sina hospital in Rabat, Morocco. In the first patient, a false hydatic aneurysm of the descending thoracic aorta was discovered at surgery performed for suspected hydatic cyst of the lower lobe of the left lung. Despite reconstruction with a prosthetic graft, the patient died peroperatively due to exsanguination via uncontrollable bleeding through the aneurysmal sac. The second case was a 20-year-old woman whose false hydatic aneurysm of the thoracoabdominal aorta was disclosed by embolic ischemia of the lower limbs. Aorto-aortic reconstruction was followed by medical treatment with albendazol. During follow-up, the patient developed a hydatic cyst of the kidney and a parietal cyst. Both were treated surgically. An analysis of these two cases and 9 others reported in the literature concerning arterial involvement in hydatic disease revealed the characteristic clinical, radiological and therapeutic features of this rare but serious complication.

[Neurologic complications after surgery for subrenal abdominal aorta. Report of a case of Behcet's syndrome]. / Les complications neurologiques après chirurgie d'un anévrysme rompu de l'aorte abdominale sous-rénale. A propos d'un cas d'angio-Behçet.

Medullary ischemia is an uncommon and serious complication of subrenal aortic surgery. It generally occurs after surgery for ruptured aneurysms and second operations on the aorta. We report the case of a 29-year-old patient who had Behçet's disease with multiple arterial complications. The patient underwent emergency surgery for ruptured aneurysm of the abdominal aorta. An aorto-aortic prosthetic graft was implanted. The postoperative period was complicated by paraplegia and thrombosis of the prosthetic graft with dissection of the iliac arteries. The patient was reoperated and an aorto-bifemoral bypass was installed. After two years, the patient has recovered part of his neurological deficiency. The pathogenesis of this complication is well known, but prevention remains a challenge.

[Arterial complications of Behcet's disease. Report of 13 cases]. / Les complications artérielles de la maladie de Behçet. A propos de 13 cas.

Vascular involvement, usually venous thrombosis, is common in Behçet's disease. Arterial manifestations, usually aneurysms or more rarely occlusion, are less common. We analyzed 13 cases of Behçet's disease with arterial complications. This fourth series in the literature was collected over 11 years. There were 12 men and 1 woman, mean age 41 +/- 7 years. Mean delay to arterial complications was 5.8 years (maximum 20 years) after the first sign of the disease. In the 13 patients in our series, there were a total of 18 arterial lesions, including one aneurysm and one stenosis of the internal carotid artery. There were 2 cases (10%) with lesions of the aorta (aneurysms). Approximately half of the arterial lesions (7/18) involved the femoral artery. There were 11 localizations on the femoropopliteal axis (11 aneurysms). One aneurysm of the humeral artery was the only localization in the upper limb. Vascular involvement was limited to arterial lesions in 9/13 patients with multiple lesions at different localizations in 2 patients. In two others, a second arterial localization occurred secondarily. All patients except one were operated. Mid-term complications are: 1 death and 4 thrombi including 3 with good results after reoperation. In these patients with Behçet's disease, risk of severe complications is important, requiring long-term surveillance.

[Abdominal aortic aneurysm and Behçet's disease: four cases]. / Anévrisme de l'aorte abdominale au cours de la maladie de Behçet. A propos de 4 cas.

Behçet's disease is an uncommon systemic process generally developing during the third or fourth decade of life. Recurrent inflammatory lesions are characteristic. Cardiovascular involvement, which may be arterial or venous, is rare but with particularly severe prognosis. Four cases of abdominal aortic aneurysm are reported. One patient underwent emergency surgery for acute rupture. All patients were male, age range 29-45 years, mean age 36.5 years. Three patients were followed for Behçet's disease. Surgical revascularization was performed in all four patients, mainly with prosthetic grafts, one with patch aortoplasty. The postoperative period was complicated by paraplegia and thrombosis of the prosthetic graft in the patient who underwent emergency surgery. On the basis of these cases and cases reported in the literature, it can be concluded that morbidity and mortality are high because of the etiology underlying vascular involvement in Behçet's disease.

[Aneurysm of a persistent sciatic artery: five case reports]. / Anévrisme sur artère sciatique persistante.

We report five cases of a persistent sciatic artery. The lesion was unilateral in all cases. Four patients were treated by exclusion of the aneurysm with ligature of the internal iliac artery with an associated femoropopliteal bypass in two. Surgical treatment was declined by one patient. We discuss the embryology, pathology, clinical aspects and surgical procedures involved.

[Takayasu's disease in Morocco. Report of 47 cases]. / La maladie de Takayasu au Maroc. A propos de 47 observations.

PURPOSE: Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. We studied Moroccan patients to evaluate clinical, biological, radiological and evolution features of this disease in our country. METHODS: Forty-seven patients with Takayasu's arteritis were studied retrospectively between 1988 et 1999. RESULTS: In our series involvement of the aortic arch and its branches was more frequent than the abdominal aorta and its branches. Stenotic lesions of renal arteries were rare. Ultrasound was useful in the diagnosis and the monitoring of the disease. Treatment with glucocorticoids gave good results, with improvement in half of the patients and remission with stabilisation in 40% of cases. Tuberculosis occurred in 8.5% of patients. CONCLUSION: The use of ultrasound and computed tomography angiography is helpful for the diagnosis and monitoring of the disease progression. Glucocorticoids help to induce long remission in about 80% of treated patients. We don't find any relationship between Takayasu's arteritis and tuberculosis.

[False hydatic aneurysm of the thoraco-abdominal aorta]. / Faux anévrysme hydatique de l'aorte thoraco-abdominale.

Arterial complications of hydatic disease are rarely encountered. We report a false hydatic aneurysm of the thoracoabdominal aorta revealed by ischemic embolism of the lower limbs. Surgical treatment included aorto-aortic prosthesis and albendazol for 6 months. Results at 18 months are excellent with negative hydatic serology. In endemic areas, hydatic disease is a possible cause of false aneurysms. Long-term surveillance is required after curative surgery and medical treatment.