Identification of potential proteases for abdominal aortic aneurysm by weighted gene coexpression network analysis.

Proteases are involved in the degradation of the extracellular matrix (ECM), which contributes to the formation of abdominal aortic aneurysm (AAA). To identify new disease targets in addition to the results of previous microarray studies, we performed next-generation sequencing (NGS) of the whole transcriptome of Angiotensin II-treated ApoE-/- male mice (n = 4) and control mice (n = 4) to obtain differentially expressed genes (DEGs). Identified DEGs of proteases were analyzed using weighted gene coexpression network analysis (WGCNA). RT-qPCR was conducted to validate the differential expression of selected hub genes. We found that 43 DEGs were correlated with the expression of the protease profile, and most were clustered in immune response module. Among 26 hub genes, we found that Mmp16 and Mmp17 were significantly downregulated in AAA mice, while Ctsa, Ctsc, and Ctsw were upregulated. Our functional annotation analysis of genes coexpressed with the five hub genes indicated that Ctsw and Mmp17 were involved in T cell regulation and Cell adhesion molecule pathway, respectively, and that both were involved in general regulation of the cell cycle and gene expression. Overall, our data suggest that these ectopic genes are potentially crucial to AAA formation and may act as biomarkers for the diagnosis of AAA.

Management of accessory renal arteries during aneurysm repair in a patient with end-stage renal failure.

The presence of accessory renal artery is a frequent anatomic variation that can challenge abdominal aortic aneurysm (AAA) repair. Here, we show an image of an abdominal aortic aneurysm extended to multiple accessory renal arteries in a patient known for an end-stage renal failure. This case raises the questions of the criteria that should be taken in consideration for an optimal management of accessory renal artery during AAA repair.

[Superficial temporal artery pseudoaneurysm: 2 cases]. / Pseudo-anévrisme de l'artère temporale superficielle : deux cas.

BACKGROUND: Pseudoaneurysm of the superficial temporal artery causes tumefaction in the temporal region. Herein, we report two cases. PATIENTS AND METHODS: Case 1 : a 32-year-old man presented with a slightly pulsatile nodular formation measuring 2 cm in the right temporal region that had appeared nine months after traumatic injury. A diagnosis of superficial temporal artery pseudoaneurysm was considered. Excision was performed with ligation of the afferent and efferent artery. The clinical diagnosis was confirmed by histopathology. Case 2 : a 24-year-old man presented with a nonpulsatile subcutaneous tumefaction on his left temple. Surgery was proposed based on a supposed epidermal cyst. However, the perioperative aspect suggested a lesion of arterial origin and excision was performed following ligation of the afferent and efferent artery. CONCLUSION: Pseudoaneurysm of the superficial temporal artery must be considered for all temporal cutaneous formations, particularly when there is a history of trauma. The clinical diagnosis may be confirmed by Doppler ultrasound. Surgery is the treatment of reference.

Effects of long-term chloroquine administration on the natural history of aortic aneurysms in mice.

Autophagy regulates cellular homeostasis and integrates the cellular pro-survival machinery. We investigated the role of autophagy in the natural history of murine abdominal aortic aneurysms (AAA). ApoE(-/-) mice were implanted with saline- or angiotensin II (Ang-II)-filled miniosmotic pumps then treated with either the autophagy inhibitor chloroquine (CQ; 50 mg·(kg body mass)(-1)·day(-1), by intraperitoneal injection) or saline. Ang-II-elicited aneurysmal expansion of the suprarenal aorta coupled with thrombus formation were apparent 8 weeks later. CQ had no impact on the incidence (50% for Ang-II compared with 46.2% for Ang-II + CQ; P = NS) and categorical distribution of aneurysms. The markedly reduced survival rate observed with Ang-II (57.1% for Ang-II compared with 100% for saline; P < 0.05) was unaffected by CQ (61.5% for Ang-II + CQ; P = NS compared with Ang-II). CQ did not affect the mean maximum suprarenal aortic diameter (1.91 ± 0.19 mm for Ang-II compared with 1.97 ± 0.21 mm for Ang-II + CQ; P = NS). Elastin fragmentation, collagen accumulation, and smooth muscle attrition, which were higher in Ang-II-treated mice, were unaffected by CQ treatment. Long-term CQ administration does not affect the natural history and prognosis of experimental AAA, suggesting that global loss of autophagy is unlikely to be a causal factor in the development of aortic aneurysms. Manipulation of autophagy as a mechanism to reduce AAA may need re-evaluation.

[Treatment of pseudoaneurysm following partial nephrectomy]. / Prise en charge des faux anévrismes rénaux après néphrectomie partielle.

BACKGROUND: Partial nephrectomy (PN) has become the gold standard for the treatment of small tumors confined to the kidney. As result, the number of PN procedures increased during the last years. Subsequently, we have more often to deal with the complications of this surgery. Among these, pseudoaneurysms are rare but potentially life-threatening due to a risk of bleeding. Therefore, pseudoaneurysms have to be treated according to a relevant strategy. METHODS: We performed a literature review of the cases of pseudoaneurysm after PN was reported as well as a focus on the different treatment strategies and their outcomes. RESULTS: The incidence of pseudoaneurysm is low, ranging from 0.5% to 4%. Radio-embolization represents the gold standard treatment, used in 98% of the cases reported in the literature, allowing high success rate and rare morbidity. However, in some selected cases, surveillance could be an alternative.

[Cerebrovascular malformation revealed during the prethrombolysis workup in acute ischemic stroke. Impact on therapeutic decision making]. / Malformation vasculaire cérébrale découverte dans le bilan pré-thrombolyse d'un infarctus cérébral. Impact sur la décision thérapeutique.

Intravenous recombinant tissue plasminogen activator for acute ischemic stroke is contraindicated in patients harboring an asymptomatic intracranial vascular malformation, whether it is incidentally discovered at the time of the initial cerebral imaging or previously known. Because thrombolysis is associated with a risk of serious intracerebral hemorrhage, it is theoretically possible that this treatment increases the risk of bleeding or rupture of these malformations. However, this risk seems very low in clinical practice. We report two cases, one with a probable brainstem cavernous malformation treated with alteplase for a supratentorial ischemic stroke who developed just after treatment a fatal brainstem hemorrhage, and another one with asymptomatic dural arteriovenous fistula, treated by endovascular thrombectomy solely. This approach was safe and effective, and the patient had an endovascular embolization of the fistula one month later as it became symptomatic. Based on the literature, we discuss the bleeding risk of asymptomatic intracranial vascular malformations in acute ischemic stroke patients treated with alteplase, depending on the type of malformation (intracranial aneurysm, arteriovenous and cavernous malformation or fistula), and the alternative therapeutic options.

[Case report : Rare case of a spontaneous pseudoaneurysm of the superficial femoral artery revealing Behçet's disease in a young patient]. / Cas clinique : cas rare d'un faux anévrisme spontané de l'artère fémorale superficielle révélant une maladie de Behçet chez un jeune patient.

Behçet's disease is a chronic inflammatory vascular disorder that can affect arteries and veins of various sizes. Arterial involvement, which plays a significant prognostic role, requires a treatment approach involving corticosteroids, immunosuppressants, and potentially surgical or endovascular procedures. This article presents the case of a young man diagnosed with Behçet's disease, manifested by a spontaneous pseudoaneurysm in the superficial femoral artery. The patient underwent surgical intervention to remove the pseudoaneurysm and restore circulation using a venous graft. This case underscores the importance of considering Behçet's disease in vascular manifestations.

[Aortitis]. / Aortites.

Aortitis is a rare disease entity of unknown prevalence. Primary aortitis mainly affects the thoracic aorta. They are most often diagnosed on imaging by grade III 18-FDG uptake of the aortic wall on PET, or by circumferential thickening>2.2mm on CT or MRI with late-stage contrast. More rarely, aortitis is histologically proven, as in some cases of clinically isolated aortitis discovered after planned aortic aneurysm surgery or during aortic dissection surgery. The most common histological types are granulomatous/giant cell or lymphoplasmacytic. Clinical signs associated with aortitis are often non-specific: asthenia, fever, dry cough, chest, back, lumbar or abdominal pain. Aortitis can be divided into different etiological categories: primary aortitis, which includes vasculitis with a preferential or exclusive tropism for the aortic wall, aortitis secondary to systemic or iatrogenic diseases, and infectious aortitis. The main etiologies of primary aortitis are giant cell arteritis (GCA), Takayasu arteritis (TA) or clinically isolated aortitis. Aortitis secondary to systemic diseases is seen in atrophying polychondritis, systemic lupus and inflammatory rheumatic diseases such as spondyloarthropathy and rheumatoid arthritis. In both ACG and AT, aortitis is a negative factor, characterized by a higher risk of relapse, cardiovascular complications and increased mortality. The management of aortitis is insufficiently codified, and relies on the control of cardiovascular risk factors, with particular monitoring of blood pressure and LDL cholesterol, and on corticosteroid therapy and immunosuppressive drugs, the use of which will depend on the disease associated with the aortitis, the initial severity and comorbidities.

[The persistent sciatic artery aneurysm. A rare and painful buttock mass]. / Anévrisme de l'artère sciatique persistante. Une cause rare de masse fessière douloureuse.

The persistent sciatic artery is a rare cause of painful buttock mass with L5-S1 radicular signs. A 56-year-old man presents a right painful buttock mass with L5-S1 radicular symptoms for 3 years. The surgical exploration found a pulsatile vascular mass like a persistent sciatic artery aneurysm. This vascular pathology is a misunderstood embryogenesis anomaly. The treatment aims to avoid serious complications. This pathology must be known from plastic surgeon.

[Tuberculosis aneurysm of descending thoracic aorta treated by covered stent graft : A case report]. / Anévrisme tuberculeux de l'aorte thoracique descendante traité par endoprothèse : à propos d'un cas.

Tuberculous aneurysm is a rare but lethal disease. It preferentially affects the aorta. The contamination occurs either secondarily to a tuberculosis site in contact with the aorta or by blood contamination. It presents an increased and unpredictable risk of rupture, hence the interest of urgent diagnostic and therapeutic management. His treatment was long based on surgery, but currently the endovascular approach is increasingly used. The treatment, whatever its type, will always be associated with a medical treatment for tuberculosis. We report the case of a patient with a descending thoracic aortic aneurysm considered tuberculous on the basis of epidemiological, clinical and biological arguments; who was treated by deployment of an endoprosthesis with good clinical and radiological evolution.

[Delayed renal infectious aneurysm 3 months after cardiac surgery for a Streptococcus pyogenes infective endocarditis ; case report and literature review]. / Anévrysme rénal infectieux retardé, 3 mois après chirurgie cardiaque pour une endocardite infectieuse à Streptococcus pyogenes ; cas et revue de la littérature.

Infective endocarditis (IE) due to Streptococcus pyogenes (SP) (Group A Streptococcus) is uncommon and infectious renal artery aneurysm (IRAA) is an exceptional complication of IE, with few cases reported in the literature. We describe a case of SP native mitral valve IE in a 58-year-old man, presenting with large valve vegetations, abscess and severe regurgitation. Initial CT-angiography showed bilateral kidney and splenic infarcts. He underwent successful emergent bioprosthetic valve replacement. Antibiotic regimen consisted in linezolid and rifampicin for 8 weeks. Three months later, CT-angiography for feet gangrene revealed a 16mm aneurysm of the left intraparenchymal renal artery, which was occluded by coil-embolization. This case shows that an infectious aneurysm may develop several months after antibiotic treatment and emergent valve replacement for IE.

The thrombosis of a 13 years old aneurysmal arteriovenous fistula.

A 46 years old female, with chronic stage renal failure for 15 years, presents to the emergency room with a thrombosis of her brachiocephalic arteriovenous fistula (functional for 13 years). The cephalic vein was aneurismal (6cm diameter) and the brachial artery was not dilated. After proximal and distal control of the brachial artery and the proximal cephalic vein, the aneurismal arteriovenous fistula was excise, the cephalic vein was ligatured, and the brachial artery was repaired with an end to end anastomosis.

Is malignant edema and hemorrhage after occlusion of high-flow arteriovenous malformation related to the size of feeding arteries and draining veins?

OBJECTIVE: Our study aimed to identify predictive factors for malignant post-treatment edema and hemorrhage in patients who underwent microsurgical treatment of arteriovenous malformation (AVM) in our institution. METHODS: The study included 72 patients treated by microsurgery for cerebral symptomatic and/or ruptured AVM between 2010 and 2020. Six patients developed postprocedural malignant edema and hemorrhage (group M); the other 66 patients had no malignant edema and hemorrhage (group NM). In each patient, flow was assessed indirectly by summing the diameters of all feeding arteries to obtain an overall diameter (ODA), and similarly for draining veins (ODV). High-flow was defined as a delay between feeding artery injection and draining vein injection (DAV)<1 second on dynamic digital subtraction angiography. Univariate analysis was performed. RESULTS: Mean ODA and ODV were respectively 11mm (±8.2) and 11mm (±5.3) in group M and 2.9mm (±1.4) and 3.7mm (±1.3) in group NM (P=0.001). High-flow AVM was demonstrated in 4 out of 5 patients (85%) in group M and in 14 out of 55 (25%) in group NM (P=0.02). Associated aneurysm was seen in 5 patients in group M (83%) and in 11 in group NM (17%) (P=0.001). CONCLUSION: High-flow AVM may be associated with higher risk of postoperative edema and hemorrhage. Multidisciplinary discussion is mandatory in these cases, to define a pre-therapeutic plan for progressive staged vascular malformation occlusion.

[Compressive false aneurysm of the brachial artery in a hemodialysis patient: Always superficialize the basilic vein of the arm!] / Faux anévrisme compressif de l'artère brachiale chez un hémodialysé : toujours superficialiser la veine basilique du bras !

The creation and preservation of vascular accesses, in patients with end-stage renal failure, remains a challenge for nephrologists and vascular surgeons. Native fistula is the best vascular access, humeral-basilic fistula is a precious access in patients who have exhausted their venous capital in the forearm and in whom the cephalic vein of the arm is small or damaged. Given its deep location, any puncture of this vein is prohibited before its superficialization, even if it is of good caliber, because it can have dramatic consequences, in particular the loss of the limb or even death. We report the case of a patient undergoing hemodialysis for seven years with a non-superficialized humeral-basilic fistula, admitted for an iatrogenic false aneurysm of the brachial artery following a puncture for dialysis, with compression of the median nerve, treated surgically.

[Aneurysm of the inferior vena cava : A case report]. / Anévrisme de la veine cave inférieure : à propos d'un cas.

Venous aneurysms in general, and of the inferior vena cava in particular (IVC), are rarely reported in the literature because they are generally asymptomatic and detected incidentally following complications such as thrombosis and pulmonary embolism, an Inferior vena cava (IVC) aneurysm is detected by imaging examinations performed for other causes. We report a case of IVC aneurysm classified as type I according to Gradman and Steinberg discovered incidentally during a follow-up CT scan in an asymptomatic woman followed for endometrial adenocarcinoma treated 6 years ago.

[Thoracic manifestations of Behcet's disease]. / Atteintes thoraciques de la maladie de Behçet.

Behcet's disease (BD) is a multisystemic vasculitis involving arteries and veins of all sizes. While joint and dermatological manifestations are the most common features of BD and are associated with a good prognosis; vascular involvement, remains the principal cause of death. Arterial manifestations occur in 5-10% of cases and manifest as occlusion/thrombosis or aneurysms. Arterial aneurysms are likely multiple and the most common sites are pulmonary arteries, aorta and arteries of lower limbs. Parenchymal involvement is less frequent and may manifest as consolidation or nodules, which may evolve to excavation. Aneurysms may occur at the sites of arterial puncture; then, non-traumatic techniques are favored. Patients with arterial manifestations may present with fever and increased inflammatory markers. Artery damage is rare, serious, and may result in massive hemoptysis. The prognosis of pulmonary artery aneurysms is severe (mortality estimated up to 26%) but has been improved by earlier diagnosis and the introduction of immunosuppressants. Treatment of severe arterial manifestations is based on high-dose corticosteroids along with cyclophosphamide or anti-TNF antagonists. Anticoagulation could be added to immunosuppressants in case of venous thrombosis if a coexisting pulmonary aneurysm is ruled out. Endovascular treatment should be performed in case of severe symptomatic pulmonary aneurysms, along with an adequate medical management. Long-term maintenance therapy of these severe forms is of paramount importance because of relapse risk (40% at five years).

[Brachial artery aneurysm in kidney transplant patient after distal fistula closure]. / Anévrisme de l'artère brachiale chez un patient transplanté rénal après fermeture de fistule distale.

Brachial artery aneurysmal degeneration is an exceptional complication of distal native fistulas. Chronic mechanical stresses due to high flow, as well as immunosuppressants drugs following renal transplantation, are the mains factors implicated in the pathophysiological mechanism. We report a case of a transplant patient with a true, symptomatic, brachial artery aneurysm, 8 years after transplantation and 5 years after radiocephalic wrist fistula ligation. The patient underwent open surgical repair, with aneurysm resection and end-to-end anastomosis. We present a literature review of the different therapeutic strategies of this unusual entity.

Is physical activity a trigger factor for subarachnoid hemorrhage?

INTRODUCTION: Subarachnoid hemorrhage (SAH) is a serious pathology, associated with 43% mortality and significant disability. In the absence of relevant guidelines, some teams advocate that patients harboring an unruptured intracranial aneurysm (ICA) abstain from all sports activity, as a prophylactic precaution. The aim of the present study was to evaluate the impact of physical activity as a risk factor for SAH, through a review of the literature. METHOD: A systematic literature review was performed for the period 2000 to 2020 in accordance with the PRISMA guidelines. Prospective and retrospective articles reporting more than 50 patients whose physical activity was associated with onset of SAH were included. The main end-point was prevalence of SAH occurring after physical activity. For comparison purposes, the prevalences of other circumstances were calculated to establish a range of frequency. RESULTS: Physical activity appeared to be quite rarely associated with onset of SAH, with a prevalence of 3%, compared to 30% at rest, 7.3% in association with defecation and 4.5% in association with sexual activity. Age under 60 years, male gender (M/F ratio 1.38) and smoking (67.1%) were associated with onset of SAH during physical activity. CONCLUSION: Physical activity appears to be a rare trigger factor for SAH. These results are in contrast to the idea that physical activity should, as a precaution, be avoided in patients with unruptured ICA. There is at present no scientific evidence of an association with aneurysmal SAH.

[Hybrid repair of aortic arch aneurysm]. / Traitement hybride des anévrismes de l'arche aortique.

BACKGROUND: The management of aortic arch aneurysms is challenging. If conventional surgery cannot be performed in high risk patients, endovascular treatment is confronted to the problem of endoleaks at long term. However, the hybrid repair combining a first surgical step and a second endovascular step is a new technique recently introduced in the therapeutic alternatives of aortic arch aneurysm but its long-term results are not well known. METHODS: We report a series of four patients who received hybrid treatment for aortic arch aneurysms in our department between 2016 and 2018. RESULTS: These were 3 men and 1 woman with an average age of 63 years [55-80 years]. All were hypertensive and only one patient had diabetes. The aneurysm was symptomatic of chest pain in all cases and it was ruptured in only one case. Preoperatively, the hemodynamic state was stable in the four patients with a mean aneurysm diameter of 60 mm [48-79 mm] on CT angiography and the landing zone was zone 0 in all cases. Under general anesthesia, the 1st step was surgical with the performance of an aorto-bicarotid bypass associated with a re-implantation of the left subclavian artery and a disconnection of the supraortic trunks. The 2nd stage was endovascular by the femoral route; with release of an aortic stent graft covering the ostia of all supraortic trunks. The final angiographic check-up showed complete exclusion of the aneurysm in all cases. The immediate postoperative follow-up was straightforward except for the onset of septic shock and death in a patient with an aneurysm ruptured in the left pulmonary branch initially. The mean follow-up was 12 months with a CT scan control which confirms the complete exclusion of the aneurysm and the absence of endoleak.

[Ruptured sinus of Valsalva aneurysm presenting as an idiopathic pericardial effusion]. / Rupture colmatée d'un anévrisme de valsalva d'évolution favorable après chirurgie.

Aneurysm of the sinus of Valsalva is a rare cardiac condition, which could be either acquired or congenital. The most frequent complication is a rupture into right cavities or more rarely into left cavities or pericardium. Rupture could be either asymptomatic or poorly tolerated with hemodynamic instability, acute heart failure or sudden death. We report the case of a 24-year-old patient with no past medical history presenting with a partially ruptured sinus of Valsalva into the pericardium and in whom the initial diagnosis was idiopathic pericardial effusion; we describe diagnostic modalities and management.