[Unusual complication of Behcet's disease]. / Complication exceptionnelle de la maladie de Behçet.

Arterial involvement in Behcet's disease is rare and the tibioperoneal trunk localisation is exceptional. We report the case of a young men with Behcet's disease and in whom the evolution to angiobehcet was unusual. The medical treatment and the therapeutic abstention were decided according to a bundle of argument.

[Multiple aortic and femoral aneurysms: Unusual revelation of Behçet's disease]. / Multiples anévrismes aortiques et fémoral : mode de révélation inhabituel de la maladie de Behçet.

Arterial involvement in Behçet's disease is rare, the aortic localization is one of the most severe manifestations of the disease. We present an exceptional case of Behçet's disease revealed by two infrarenal abdominal aorta aneurysms, associated to a femoral artery pseudoaneurysm. The management of aneurysms in Behçet's disease is delicate, and requires the combination of surgical treatment with adjuvant medical drug therapy in order to reduce complications risk.

[Giant ruptured common femoral artery aneurysm revealing Behçet's disease]. / Rupture d'anévrisme géant de l'artère fémorale commune révélant une maladie de Behçet.

Vascular involvement in Behçet's disease is rare. Aneurysmal arterial involvement is the severe form of the disease, it constitutes a therapeutic challenge given its severity, and frequent secondary complications, especially at anastomosis. The systematic immunosuppressive drug treatment and surgical technique thoroughness can reduce relapse rate. We report the case of a young man in whom a ruptured false aneurysm of the common femoral artery revealed Behçet's disease. He underwent an open repair, with prosthetic arterial reconstruction, and anastomosis reinforcement with teflon.

[Isolated atrial septal aneurysm: Exceptional cause of digital ischemia - a case report]. / Anévrysme isolé du septum interauriculaire : cause exceptionnelle d'ischémie digitale.

An atrial septal aneurysm (ASA) is a rare but well recognized entity characterized by saccular deformity of the atrial septum that bulges into the right or left atrium. Diagnosis can be established using transthoracic and transesophageal echocardiography. Although this abnormality is considered clinically benign, it has been independently associated with systemic or cerebral embolism. We present a unique case of isolated atrial septal aneurysm complicated by digital ischemia in a 51 years old woman.

[Acute lower limb ischemia revealing a paraneoplastic floating aortic thrombus]. / Ischémie aiguë de membre inférieur, révélant un thrombus aortique flottant paranéoplasique.

The floating mural thrombus of abdominal aorta is a rare and serious pathology detected as cause of peripheral and visceral embolism. Isolated aortic mural thrombosis is an unusual pathology occurring in an apparently normal aorta. A thorough search of embolic source must be initiated. Therapeutic management is based on systemic anticoagulation with the use of surgical approach in some cases.

[Painful cervical mass revealing an aneurysm of the internal jugular vein]. / Masse cervicale douloureuse révélant un anévrysme de la veine jugulaire interne.

Internal jugular vein aneurysms or phlebectasia of the internal jugular vein are considered a benign pathology. They are more and more diagnosed with the evolution of imaging techniques : ultrasonography, angioscanner and MRI. Clinically they are often by chance, however accompanying clinical signs can be seen such as pain, hoarseness or vocal cord paralysis. Several differential diagnoses can be mentioned such as laryngocoele, gill cyst, paraganglioma and hemangioma. They are of unknown etiology with several hypotheses on the etiopathogenesis and on the frequent localization on the right. Conservative treatment can be chosen for small aneurysms and in children. Surgical treatment finds its indication especially in the event of a complication such as thrombosis or for an aesthetic interest; other treatments such as endovascular treatment are being evaluated. We report the case of a 67-year-old woman admitted for a painful latero-cervical mass, and in whom the diagnosis of an aneurysm of the internal jugular vein was suspected and confirmed by ultrasound and CTscan. The patient received successful surgical treatment.

[Occlusion of the abdominal aorta in patients infected with the human immunodeficiency virus: Clinical case and review of the literature]. / Occlusion de l'aorte abdominale chez les patients infectés par le virus de l'immunodéficience humaine : cas clinique et revue de littérature.

HIV infection has now become a chronic disease with a good life expectancy thanks to antiretrovirals. The mortality currently is attributed to other pathologies in particular cardiovascular because of the inflammation and the side effects of the drugs. All arteries can be damaged in HIV, especially the aorta, with several types of lesions which can be occlusive, aneurysmal, dissecting, even with the cases of arteriovenous fistula which have been described. HIV occlusive arterial disease is different from atheromatous disease in HIV-free patients and this is confirmed by pathology and ultrasound studies, which makes it more difficult to manage HIV-related occlusions. The open surgical treatment especially in the acute forms is disappointing with complications of rethrombosis and infectious and of sepsis of prosthesis considering the immunosuppression, the endovascular treatment begins to become the treatment of choice in the aneurysmal pathology and probably it would be in the future for occlusive disease.

[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.

[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.

[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.