[Study of the impact of a post-acute coronary syndrome pharmaceutical interview in hospital]. / Étude de l'impact d'un entretien pharmaceutique post-syndrome coronarien aigu à l'hôpital.

OBJECTIVES: Post-acute coronary syndrome pharmaceutical interviews were set up in our establishment. The objective of this study was to assess their impact on patient knowledge and their benefit at one year on medication compliance, cardiovascular risk factors (smoking, overweight, dyslipidemia) and the recurrence rate. METHODS: Two groups were formed, an experimental group of patients who had benefited from pharmaceutical interviews and a control group of patients who had not benefited from them. The knowledge of the patients was measured using a quizz carried out before the interview and one month after for the experimental group, then one year after hospitalization for the two groups. A one-year follow-up of medication compliance assessed, control of cardiovascular risk factors and the rate of recurrence of acute coronary syndrome was carried out in both groups. RESULTS: A significant increase in knowledge (P<0.001) after the pharmaceutical interview and its maintenance over time were observed in the experimental group. One year after hospitalization, in the experimental group, the average score on the knowledge quizz (9.2/10) was significantly higher (P<0.005) than that of the control group (6.6/10); medication compliance was significantly better (P<0.05) and greater smoking cessation was observed. CONCLUSIONS: These encouraging results should be highlighted in order to perpetuate and develop such approaches around patient care.

Sexual dysfunction after elective laparoscopic or endovascular abdominal aortic aneurysm repair in men.

INTRODUCTION: Infrarenal abdominal aortic aneurysm (AAA) repair can lead to ejaculation and erection troubles in men. There are few studies on sexual dysfunction after endovascular repair (EVAR) but they suggest less retrograde ejaculation than after open repair. We assessed the sexual dysfunction and ejaculation troubles after elective laparoscopic repair or EVAR. METHODS: We conducted a monocentric prospective study on 124 patients undergoing AAA repair between 2013 and 2015. Sexual function was evaluated using the IIEF-15 questionnaire and questions on ejaculation. RESULTS: Only 45 patients (36.3%) accepted to complete the IIEF preoperatively with 20-37.8% having preoperative sexual dysfunction. Among them, 21 (46.7%) accepted to complete the questionnaire at 3, 6 and 12 months. Mean age at inclusion was 65±5.6 years in the laparoscopic group and 77±10.5 years in the EVAR group (P=0.003). Erectile and sexual function were slightly improved at 12 months in the laparoscopic group (+1.4 for erectile score and +4.6 for IIEF score) with no significant difference (P=0.83 and 0.74) whereas 8 patients (61.5%) had persistent ejaculation troubles at 3 months. In the EVAR group, patients had moderate sexual dysfunction at baseline without improvement at 12 months, but only one patient reported ejaculation troubles. CONCLUSIONS: Most patients eligible for AAA repair present with baseline erectile and sexual dysfunction. Laparoscopic AAA repair provides no onset of erectile or sexual dysfunction but a global improvement after surgery. Ejaculation troubles are frequent and persistent at 1 year. However, EVAR treatment, doesn't allow recovering of sexual function at 1 year. LEVEL OF EVIDENCE: 4.

[Is the ureteral length associated with the patient's size?] / La longueur de l'uretère est-elle liée à la taille du patient ?

OBJECTIVE: To assess the relation between the ureteral length and the patients' size. PATIENTS AND METHOD: Prospective study made between September 2012 and May 2014, on 87 patients with 42 men and 45 women, in whom the ureteral measure was performed during the various procedures that require the use of a pigtail stent. The average age of the population was 53 years old (±15.9) with an average height of 168.3cm (±8.4). This has been achieved through ureteral catheter combining fluoroscopy and endoscopy. RESULTS: The ureteral average length was 23.5cm (±2.33). The ureteral average length was 23.8cm (±2.18) for man and 23.2cm (±2.44) for women. In this population, there were a positive correlation between the size of the patients and the length of the ureters (r=0.75; P=0.01). However, this correlation was not found in all subgroups, particularly among women (r=0.16; P=0.30) and on the right side of men (r=0.34; P=0.12). This correlation was still true for the left side in the men's group (r=0.50; P=0.02). CONCLUSION: In this study, there is a positive correlation between the patients' size and the ureteral length. But this correlation is not found in some subgroups. It is better to perform in vivo the ureteral measurement to have the precise length in order to set up a pigtail stent adapted to the patient. LEVEL OF EVIDENCE: 3.

[Double J stent removal's cost estimate using a re-sterilizable fibroscope in a French private structure]. / Évaluation du coût en structure privée d'une ablation de sonde double J en externe à l'aide d'un fibroscope re-stérilisable.

In front of the arrival of new devices intended to simplify the removal of double J stent, it poses the problem of the knowledge of the real cost of such an ablation under the current conditions of realization. MATERIAL AND METHOD: This is a monocentric economic evaluation of cost and remuneration needed data-gathering of quotation (CCAM, GHS/SE, …), estimate of the associated costs of wear and damping of the endoscopic equipments (endoscopes, cables, …), estimate of the cost of sterilization, estimate of the associated costs to the intervention of staff (Auxiliary nurse [AS] and Nurse [IDE]) with timing of the various tasks. RESULTS: Quotation CCAM JCGE004 (48€) gives access to fixed price SE1 (73.71€ for private clinic, and 75.89€ for public institution) without hospitalization nor anaesthesia. The costs were reported to an act of single double J removal. Concerning the equipments: 4.42€HT for the fibroscopes, graspers, cable and light. The costs of sterilization were: 17.95€HT. The timed workforce's costs were: 7.61-9.51€ for AS and 9.92-10.84€ for IDE. The cost of consumable was about 1.37 €HT, by excluding the common base from the extractions (1.876€HT). The total costs in France in 2016 were thus about 47.4 to 50.496€ including all taxes. CONCLUSIONS: This estimate will be used certainly for reflection on the investments and the future studies of the economic impact of the new devices of extraction, by correlating it of course with the various maintenance contracts from each institution. LEVEL OF PROOF: 4.

[Usefulness of urethral endoprosthesis in the management of urinary retention after brachytherapy for localized prostate cancer]. / Intérêt de l'endoprothèse urétrale dans la prise en charge d'une rétention aiguë d'urine après curiethérapie pour cancer localisé de la prostate.

Brachytherapy is a possible treatment for localized low risk prostate cancer. Although this option is minimally invasive, some side effects may occur. Acute retention of urine (ARU) has been observed in 5% to 22% of cases and can be prevented in most cases by alpha-blocker treatment. Several alternatives have been reported in the literature for the management of ARU following brachytherapy: prolonged suprapubic catheterization, transurethral resection of the prostate and also intermittent self-catheterization. The authors report an original endoscopic approach, using urethral endoprosthesis, with a satisfactory voiding status.

Right ventricular outflow tract prestenting with AndraStent XXL before percutaneous pulmonary valve implantation.

BACKGROUND: The indications for percutaneous pulmonary valve implantation (PPVI) have been extended to include large dysfunctional right ventricular outflow tracts (RVOTs). Prestenting of the RVOT is commonly performed before PPVI in order to ensure a stable landing zone. The AndraStent XXL (AndraMed GmbH, Reutlingen, Germany), a cobalt-chromium stent with semi-open cell design, has unique mechanical properties in this indication but is no longer available in France. AIMS: To assess the efficiency of AndraStent XXL before PPVI. METHODS: In this retrospective multicentre cohort study, 86 AndraStents XXL were implanted in 77 patients in 6 centres. RESULTS: PPVI was indicated mainly for pulmonary regurgitation (75.3%) in native or patched RVOT (88.3%). The stents were manually mounted on balloon catheters and delivered through sheaths using a conventional femoral approach. PPVI was performed successfully in 97.4% of patients after successful prestenting, generally during the same procedure (77.9%). There were no deaths associated with stent implantation, and four patients experienced five complications, mainly stent embolization, including one requiring surgery. Neither stent fracture nor dysfunction were observed in any patient during a mean follow-up of 19.2±8.7months. Stent analysis showed an excellent maximal stent expansion (97.1%) regardless of balloon size. A 22.3%±3.4 stent shortening with a 30mm balloon was observed. CONCLUSIONS: Implantation of large cobalt-chromium AndraStent XXL stents is efficient for prestenting before PPVI.

[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.

[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.

[Contrast-Enhanced Ultrasound (CEUS) for Surveillance after Endovascular Aortic Aneurysm Repair (EVAR)]. / Kontrastmittelverstärkter Ultraschall (CEUS) in der Verlaufskontrolle nach endovaskulärer Aneurysmaausschaltung (EVAR).

Contrast-Enhanced Ultrasound (CEUS) for Surveillance after Endovascular Aortic Aneurysm Repair (EVAR) Abstract. Minimally invasive endovascular aneurysm repair is the most common technique for symptomatic and larger aortic aneurysms. Possible complications, e.g. endoleaks, may occur any time, therefore the patients need a life-long surveillance program after aneurysm repair. This article gives an overview of the surveillance of endografts with a special focus on contrast-enhanced ultrasound.

[Quality standards for duplex ultrasonographic assessment (duplex us) of abdominal aortic stent grafts]. / Standards de qualité pour la pratique de l'écho-Doppler dans la surveillance des endoprothèses aortiques abdominales.

The quality standards of the French Society of Vascular Medicine for the ultrasound assessment of lower limb arteries in vascular medicine practice are based on the principle that these examinations have to meet two requirements: technical know-how (knowledge of devices and methodologies); medical know-how (level of examination matching the indication and purpose of the examination, interpretation and critical analysis of results). OBJECTIVES OF THE QUALITY STANDARDS: To describe an optimal level of examination adjusted to the indication or clinical hypothesis; to establish harmonious practices, methodologies, terminologies, results description and report; to provide good practice reference points and to promote a high quality process. THEMES OF THE QUALITY STANDARDS: The three levels of examination, indications and objectives for each level; the reference standard examination (level 2) and its variants according to indications; the minimal content of the exam report, the medical conclusion letter to the corresponding physician (synthesis, conclusion and management suggestions); commented glossary (anatomy, hemodynamics, signs and symptoms); technical basis; device settings. Here, we discuss duplex ultrasound for the supervision of the aortic stent grafts.

[Endovascular treatment of acute limb ischemia occurred after popliteal stent fracture]. / Traitement endovasculaire d'une ischémie aiguë survenue après fracture d'un stent poplité.

Angioplasty stenting of popliteal artery lesions is a common procedure in endovascular surgery. Stent fractures in popliteal artery maybe asymptomatic or cause restenosis, false-aneurysm or acute thrombosis. We report one case of acute limb ischemia occurred after a popliteal stent fracture placed four months earlier. The patient underwent an angioplasty stenting, completed with thrombolysis and thrombectomy. This case-report aims to illustrate complications of stent fracture in popliteal artery and possibility's to manage it by endovascular approach.

[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.

[Endovascular repair of iliocaval arteriovenous fistula complicating lumbar disc surgery]. / Traitement endovasculaire d'une fistule artério-veineuse ilio-cave compliquant une chirurgie discale lombaire.

Vascular complications of lumbar disc surgery are rare. Few cases have been reported. Arteriovenous fistulas are the most common. They are due to anatomical relationships between the last lumbar vertebrae, the corresponding discs, and the iliac vessels; degenerative lesions of the intervertebral discs facilitate instrumental vessel perforation, and operative difficulty. Computed tomography is particularly accurate for making the diagnosis. Treatment strategies consist in surgery or endovascular management. Percutaneous endovascular treatment using a stent-graft is a reasonable option for treating arteriovenous fistula. We describe the case of a 50-year-old patient who developed an iliocaval arteriovenous fistula following lumbar disc hernia surgery. The lesion was excluded by a stent-graft. The postoperative period was uneventful.

[Indication for total knee arthroplasty: evidence mapping]. / Indikation zur endoprothetischen Versorgung des Kniegelenks - ein Evidence Mapping.

BACKGROUND: Joint replacement surgery is one of the most often performed routine procedures for the treatment of knee osteoarthritis in Germany. Currently, there is no consensus on indication criteria for total knee arthroplasty (TKA). OBJECTIVES: The topic indication for TKA was processed using six guiding questions concerning: 1) Common practice in determining the indication for TKA; 2) Inclusion criteria in clinical trials; 3) Treatment goals/goal criteria; 4) Predictors for goal attainment; 5) Economic aspects of determining a TKA indication; 6) Guidelines of the "Working Group of Scientific Medical Societies" (AWMF) in other areas. METHODS: The evidence mapping was conducted by systematically searching Medline via Ovid, the Cochrane Library, through hand searching national guidelines and selected journals as well as the AWMF guideline portal. RESULTS OF THE GUIDING QUESTIONS: 1) In Germany there is currently no consented guideline regarding indications for TKA surgery. 2) Indication criteria for clinical trials are: diagnosed osteoarthritis of the knee, limitations of age and BMI. The most common criteria for exclusion include rheumatoid/inflammatory arthritis, secondary diagnoses and allergies. 3) As yet, no international initiatives have been identified which, by involving all relevant stakeholders, have reached consensus regarding the indication criteria for TKA. 4) A variety of predictors were identified with effects on individual treatment goals acting in different directions. 5) Very few studies were identified concerning economic aspects of determining TKA indication. 6) Comparable AWMF guidelines are currently not available. CONCLUSION: The findings of this study suggest that specific systematic reviews are needed to explore the following questions: What are the treatment goals of a TKA intervention? For whom are these relevant? And how are they measured? Continuous analyses are recommended in the field of predictors for a positive TKA outcome.

[Endovascular treatment of intra-thoracic left subclavian artery aneurysm]. / Traitement endovasculaire d'un anévrisme de l'artère sous-clavière gauche intrathoracique.

Aneurysms of the subclavian artery are rare, and remain asymptomatic until complications. We report one case of atherosclerotic aneurysm of the proximal portion of the left subclavian artery fortuitously discovered and successfully treated by endovascular stent graft. This case report aims to illustrate endovascular procedures in the management of difficult access lesions or in high-risk surgical patients.

[Aortic stent migration: a rare complication after endovascular repair]. / Migration d'endoprothèse aortique : une complication rare après traitement endovasculaire.

Migration of an aortic stent is one of the most serious complications that can occur during follow-up after endovascular repair of an abdominal aortic aneurysm. We report the case of a 75-year-old man who underwent endovascular treatment for an infra-renal aortic aneurysm using an aorto-mono-iliac stent associated to a femoro-femoral bypass. The angiography performed at the end of procedure showed complete exclusion of the aneurysm. The postoperative course was uneventful. CT scans at 1, 6 and 12 months were normal. The CT scan at the 18th month showed a proximal migration of the stent, which was complicated by a type 1 endoleak and a stent disjunction with a type 3 endoleak. Revision surgery was indicated but the patient died from aneurismal rupture pending treatment. The migration of an aortic stent is a rare but serious complication of endovascular aneurysmal repair. Prevention requires a precise anatomical selection and adequate deployment of the stent graft.

[Massive hemoptysis following thoracic aortic rupture: an advancing field]. / Hémoptysie massive survenue après traitement endovasculaire d'un anévrisme aortique. Une prise en charge en pleine évolution.

We report the case of a 57-year-old woman who presented with massive hemoptysis and thoracic pain 3 years after the endovascular treatment of a thoracic aortic aneurysm. Emergency work up revealed the presence of an endoleak, leading to the pressurization of the aneurysm sac and its subsequent rupture into the lung parenchyma. The discussion includes presentation, clinical course, diagnosis, complications and new therapeutic options in the management of a massive hemoptysis secondary to aortic rupture. All together, the case and discussion highlight the classical rules of critical care and the recent advances in endovascular treatment of thoracic aortic rupture.

[Risk of recurrence and postoperative intervertebral disc degeneration after lumbar intervertebral disc operation - is an anulus closure prosthesis the solution?]. / Rezidivrisiko und postoperative Bandscheibendegeneration nach lumbaler Bandscheibenoperation - ist eine Anulus-Verschluss-Prothese die Lösung?

A lumbar disc herniation is a frequent pathology. The incidence of a postoperative recurrence is between 1-18%. According to the current literature, a large anular defect and a limited perioperative microdiscectomy leads to an increased risk of recurrence. In contrast, a generous perioperative microdiscectomy comes along with an accelerated postoperative disc height loss and a progressive degenerative disc disease. The present work discusses the position of an anular-closure-device in respect of the problem risk of recurrence versus postoperative degenerative disc disease.

La hernie discale lombaire (HDL) est une pathologie à haute prévalence. Le risque le plus important après une chirurgie dédiée à cette pathologie est celui d'une récidive herniaire, dont l'incidence est estimée, selon divers auteurs, entre 1 et 18%. La littérature actuelle suggère qu'une interruption de continuité de l'anneau fibreux associée à une microdiscectomie chirurgicale incomplète expose le patient à un risque de récidive herniaire. Cependant, une discectomie étendue est associée à une perte de hauteur discale et par conséquent à une dégénérescence discale post-opératoire accélérée. Le chirurgien du rachis est donc confronté à un dilemme lors de chaque opération pour une HDL. Depuis quelques temps, des systèmes nommés «dispositifs de fermeture de l'anneau fibreux¼ sont apparus dans le but de réduire le risque de récidive herniaire post-opératoire. Ce document, en exposant la situation réelle d'un patient, discute la possibilité de recours à un dispositif de fermeture de l'anneau fibreux en tenant compte de la problématique du risque de récidive ainsi que de celui de dégénérescence discale.