[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.

[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.

[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.

[Internal carotid aneurysm of dysphasic origin]. / Un anévrisme de l'artère carotide interne d'origine dysplasique.

Extracranial carotid aneurysms are rare, but are of significant clinical interest due to the high risk of cerebral embolism. Despite considerable progress in endovascular techniques, surgical treatment of these aneurysms remains the golden standard. We report the case of a 50-year-old man who presented an aneurysm of the left internal carotid artery measuring 46 × 26 mm. Resection of the aneurysm with interposition of a prosthetic graft was performed. The postoperative course was uneventful. Pathology reported that the aneurysmal sac probably had a dysplastic origin.

[Exceptional association of bilateral popliteal aneurysm with an abdominal aortic aneurysm in Marfan syndrome]. / Association exceptionnelle d'un anévrysme poplité bilatéral et d'un anévrysme de l'aorte abdominale au cours d'un syndrome de Marfan.

Marfan syndrome is an autosomal dominant disorder with rheumatoid, ophthalmological, neurological, cutaneous and cardiovascular manifestations. Aneurysmal lesions affecting both the abdominal aorta and the peripheral arteries are not often described in the literature. We report a case associating a bilateral popliteal aneurysm and an aneurysm of the infra-renal abdominal aorta.

[Involvement of peripheral arteries in Von Recklinghausen neurofibromatosis]. / L'atteinte des artères périphériques au cours de la neurofibromatose de Von Recklinghausen. Étude de deux cas.

Arterial lesions are relatively rare in neurofibromatosis type I but can have potentially serious consequences for the patient. We report two clinical cases of peripheral arterial involvement in neurofibromatosis type 1. The first case was a 25-year-old female with Von Recklinghausen disease who developed a swollen tender mass around her left arm. The arterial CT scan revealed a false aneurysm of the brachial artery. The surgical procedure involved repair of the false aneurysm, and ligation of the brachial artery. Intra- and postoperative bleeding was severe, leading to hemodynamic instability and impaired hemostasis. The patient died on day 2, postoperatively. The second case involved a 17-year-old male with Von Recklinghausen disease who presented stage II arteritis of the right lower limb. Arteriography revealed a long stenosis of the right superficial femoral artery extending to the popliteal artery and an important collateral circulation in the leg arteries. Medical treatment with regular clinical supervision was recommended in this patient.

[Efficacy of first-line radiation for non-resectable carotid paraganglioma]. / Efficacité de la radiothérapie en première intention d'un paragangliome carotidien non résécable.

BACKGROUND: Carotid paragangliomas are rare. Surgical resection is the primary treatment. However, when surgery is impossible, radiation therapy is an alternative potentially enabling local control with less morbidity. We report a case of good local control of an unresectable paraganglioma after external beam radiation. CASE REPORT: A 72-year-old-woman, had a 4-year history of right facial palsy associated with pulsatile tinnitus, episodic ear bleeding and ipsilateral hearing loss. Physical examination revealed a retro-mandibular and sub-mastoid pulsatile mass. Magnetic resonance imaging showed a large carotid paraganglioma involving the temporal bone. Since surgical resection was impossible, our patient was given external beam radiation therapy at a dose of 60 Gy. At 12 months follow-up, local control was good without significant toxicity. CONCLUSION: External beam radiation therapy seems to be a good alternative therapy for local control of carotid paragangliomas if surgical resection is impossible.

[Rupture of a popliteal artery pseudo-aneurysm revealing a tibial osteochondroma: case report and review of the literature]. / Rupture d'un faux anévrisme de l'artère poplitée révélant une exostose du tibia : à propos d'un cas et revue de littérature.

Osteochondroma constitutes the most frequent bone tumor. It is exceptionally responsible for vascular complications from which pseudo-aneurysms constitute the most frequent entity. We report the case of a 20-year-old patient who presented with acute pain of the left knee following a sports' accident. Vascular ultrasonography showed the rupture of a false aneurysm of the popliteal artery. An arteriography confirmed the diagnosis by showing contrast leakage at the level of the below-knee popliteal artery projecting over an osteochondroma. Surgery was undertaken to close the aneurysm an insert a venous graft. The procedure was completed by excision of the bone tumor. Vascular complications of osteochondroma are rare but should be considered in young patients with a false aneurysm of the popliteal artery. Surgery is required for the treatment of false aneurysms on exostosis.

Post-traumatic arteriovenous fistula of the hepatic pedicle.

Hepatico-portal fistula (HPF) is a rare condition, most often of post-traumatic or iatrogenic origin and occasionally secondary to a ruptured aneurysm of the hepatic artery into the portal vein. HPF in extrahepatic locations often results in portal hypertension (PHT). While Doppler ultrasound, CT angiography, and magnetic resonance angiography are usually demonstrative, arteriography remains indispensable to clarify the exact anatomical configuration. In the treatment of these arteriovenous (AV) fistulas, open surgical approaches have increasingly given way to radiological embolization techniques, especially in intrahepatic locations, but surgery remains indicated for AV fistulas of the hepatic pedicle where maintenance of hepatic arterial flow is a priority of treatment. We report a patient who had an AV fistula of the hepatic pedicle with resultant PHT presenting 5 years after open abdominal trauma. Treatment was surgical; the immediate and long-term postoperative course was uneventful with regression of PHT. Through analysis of this case and a review of the literature, we discuss the clinical, paraclinical, therapeutic, and prognostic features of this lesion.

[Limb traumatic arteriovenous fistula: experience of 26 cases]. / Fistules artérioveineuse post-traumatiques des membres : expérience de 26 cas.

INTRODUCTION: Posttraumatic arteriovenous fistulas are not a rare event in military facilities during periods of armed conflicts, but are seldom seen in the civilian health care system. PATIENTS AND METHOD: We report our approach to the management of 26 cases of posttraumatic limb arteriovenous fistulas colligated from 1996 to 2006. RESULTS: The main cause of our posttraumatic arteriovenous fistulas is the penetrating traumatism. Arteriography was the mostly used imaging exploration. The treatment was surgical for 24 patients. One case of thrombosis was reported. CONCLUSION: Our series of posttraumatic fistulas is characterized by a particularly high rate of penetrating trauma, in which case intervention is the rule. Our study shows that, in our experience, surgical treatment is still a safe and efficient therapeutic attitude.

[Acute lower limb ischemia revealing acute leukemia. Case report and review of the literature]. / Ischémie aiguë du membre inférieur révélant une leucémie aiguë. A propos d'un cas et revue de la littérature.

Large vessel thrombosis is a very rare clinical presentation of acute leukemia which is usually revealed by hemorrhagic complications or thrombosis of small vessels. We present here the case of a patient with previously undiagnosed acute myeloid leukemia who was referred to our hospital with symptoms of acute ischemia of the left lower limb. Occlusion of the left popliteal artery due to a leucostasis was noted and successfully treated with emergency surgical thromboembolectomy and chemotherapy.

[Left atrial myxoma: a rare cause of acute occlusion of the aorta. Case report and review of the literature]. / Myxome de l'oreillette gauche : une cause rare d'occlusion aiguë de l'aorte. A propos d'un cas et revue de la littérature.

We present an observation of a 42-year-old patient admitted in urgency for lower limbs weakness followed by paralysis. At physical examination the lower limbs were cold. Pulses of the lower limbs could not be palpated. Color Duplex ultrasonography revealing an embolus occluding both the infrarenal aorta and bilateral iliac arteries. The aortoiliac embolus was removed by balloon endarterectomy through the femoral arteries with evacuation of a transparent, gelatinous embolus followed by extensive fasciotomies. Two-dimensional echocardiography showed a mass in the left atrium. Pathological examination of the material embolic confirmed the diagnosis of the cardiac myxoma. The clinical course was marked by the development of a syndrome of revascularization; death occurred the fourth day of hospitalization. This case highlights the need for pre- and perioperative measures to be taken to overcome hyperkalemia and acute renal failure when revascularizing acute, massive, prolonged ischemia of the lower body.

[Limb arteritis in Horton disease: five cases]. / Atteinte des artères des membres et maladie de Horton: à propos de cinq cas.

INTRODUCTION: Giant cell arteritis of the limbs is rarely reported. It may be underestimated because it is usually asymptomatic. The aim of this study was to describe the distinctive features of this involvement. METHODS: Retrospective study of 50 patients with giant cell arteritis diagnosed from January 1985 to December 2007, satisfying the American college of rheumatology (ACR) classification criteria. All five patients had typical lesion at examination of temporal artery biopsy. Among these patients, those with ischemic manifestations of the limbs were selected. All patients disclosed elevated acute phase reactants and typical radiological findings. Temporal artery histopathology was made necessary to select patients. RESULTS: Five female (mean age: 66.8 years) out of 50 patients (10%) with temporal arteritis presented with symptomatic limb arteriopathy. Limb arteritis was the presenting feature in four patients. Clinical presentation was similar to other non-inflammatory arteritis. One patient presented with involvement of her four limbs. Typical arteriographic abnormalities were presents in all patients (occlusion or moniliform stenosis without atheromatous lesions). Despite therapy with corticosteroids associated to anticoagulants or antiplatelet drugs, four amputations were necessary. CONCLUSION: Specific limb involvement may be the presenting feature of temporal arteritis. It can mimic arteriosclerosis vascular disease, particularly prevalent in this age group.

[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.

[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.