Successful coiling embolization of an intraparenchymal renal pseudoaneurysm: Case reports.

INTRODUCTION AND IMPORTANCE: Intraparenchymal renal artery aneurysms are a really rare condition that represents <10 % of all renal artery aneurysms. They are more often caused by trauma or iatrogenic injury and their rupture can lead to life-threatening hemorrhage. CASE PRESENTATION: We report the case of a 25-year-old male with history of back stab wound three months before being admitted to our unity. The patient presented a macroscopic hematuria three days after the injury. An abdominal CT angiography revealed an intraparenchymal renal artery aneurysm, and it was successfully treated with super selective endovascular coil embolization, achieving both pseudoaneurysm exclusion and renal preservation. CLINICAL DISCUSSION: Intraparenchymal renal artery aneurysms are rare. They are more often caused by trauma or iatrogenic injury. Renal artery pseudoaneurysms are mainly asymptomatic. Renal pseudoaneurysms can be diagnosed through contrast enhanced CT, renal Doppler ultrasound, or MRI. Super selective embolization of the feeding artery of the pseudoaneurysm using endovascular techniques is the treatment of choice. CONCLUSION: The management of patients with renal pseudo aneurysms should allow to achieve two main goals: Preserving Renal function, and excluding the pseudoaneurysm.

[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.

[Intracardiac migration of the ureteral single-J : A case report and removal techniques]. / Migration intracardiaque de la sonde urétérale mono J : à propos d'un cas et techniques de retrait.

The techniques of derivation of the high urinary tract are indispensable in common practice for the management of ureteral obstructions. Like any surgical gesture, its techniques are not without complications; Among those common are hematuria, urinary incontinence, migration in the bladder and rupture of the probe. However, intracardiac probe migration has rarely been described. We report the case of a 68-year-old patient treated for cervical cancer who benefited from the rise of a bilateral single-J probe, admitted for accidental migration of the left probe into the heart. The diagnosis was made by plain abdominal X-ray and confirmed by thoraco-abdominal CT angiography. The patient benefited, in the catheterization room, from a withdrawal of the probe by endoscopic way and under radioscopic control successfully and without any incident.

Symptomatic subclavian steal syndrome: Report of four Moroccan cases and literature review.

INTRODUCTION: Subclavian steal syndrome (SSS) is the hemodynamic phenomenon of blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal ipsilateral subclavian artery. MATERIALS AND METHODS: Four patients with subclavian steal syndrome were treated in our center. Percutaneous radial approach was used for angioplasty, primary stenting of subclavian artery was performed, surgical techniques in particular carotid-subclavian bypass and carotid-subclavian transposition were used. RESULTS: We report the cases of four patients, three of which are male, with an average age of 60 years. All of them were symptomatic. Diagnosis was made by duplex ultrasound, supplemented by CT-angiography and arteriography. Endovascular treatment was attempted in all four patients, which was successful in two patients, who underwent primary stenting, and failed for the two others, for whom surgical treatment was considered. One had a subclavio-carotid bypass graft with a polytetrafluorethylene (PTFE) prosthesis and the other had a subclavio-carotid transposition. The technical results were satisfactory in all patients with symptoms resolution. The postoperative evolution was without notable complications and the postoperative checkups were satisfactory. DISCUSSION: There are excellent screening tools and effective medical therapies which can be instituted if the SSS is diagnosed early. When the need for revascularization arises, percutaneous modalities are favored given their proven long-term efficacy, decreased morbidity and mortality, and cost-effectiveness. Nevertheless, large, prospective, randomized and controlled trials are needed to compare the long-term patency rates between the endovascular and surgical techniques.

TEVAR for thoracic mycotic aneurysm: Case report.

INTRODUCTION: Mycobacterium tuberculosis is a cause of mycotic aortic pseudoaneurysms, wich are a rare case with high mortality rates. Three types of dissemination hematogenous by contiguity and direct to the aortic wall are possibles. PRESENTATION OF CASE: We report a rare case of tuberculous thoracic aortic pseudo aneurysm, successfully treated endovascularly associated to antituberculosis drugs. DISCUSSION: Classically TB pseudoaneurisms have been treated with open surgical therapy.however, they are associated to high morbidity and mortaity with increased lenghts of hospital stay. Due to advancements of endovascular technology, it be cames a good and successful alternative as a treatment, with a background of medical treatment. CONCLUSION: Thoracic endovascular aneurysm repair (TEVAR) associated to anti-tuberculosis medication have revolutionized the management and improved the prognosis of this pathology.

Technical management of traumatic arteriovenous fistula: Tips and tricks.

INTRODUCTION: Traumatic Arteriovenous Fistulas (AVFs) are a rare complication of vascular injuries and pose a problem of topographic diagnosis and therapeutic management. Delayed treatment may cause cardiac and trophic complications. PRESENTATION OF CASES: We describe 4 cases of AVFs complicating stab wounds of the lower limb, associated in 2 cases with pseudoaneurysms. DISCUSSION: In two cases we performed a surgical repair, whereas in the other 2 patients we choose an endovascular treatment with wall graft stent placement. CONCLUSION: All traumatic AVFs must be treated to avoid vascular, local and general complications. Using both techniques, we had great results with no complications.

Best strategy in managing the association of Horse-shoe-Kidney and Abdominal Aortic Aneurysm: Case report.

INTRODUCTION: Horseshoe Kidney (HSK) is probably the most common of all renal fusion abnormalities. However the association of Abdominal aortic aneurism (AAA) and HSK is rare, and occurred in 0,12% of patient affected by AAA. PRESENTATION OF CASE: We present a patient with the concomitant presence of AAA and HSK treated by open surgical repair with a transperitoneal approach without section of the isthmus with great outcomes after surgery. DISCUSSION: The management of AAA associated with HSK presents a special challenge during vascular surgery, given the close spatial relationship and the frequent renal arterial variations that accompanies HSK. CONCLUSION: Diagnosis and a well designed surgical strategy are required to avoid surgical post operative complications.

False Aneurysm of the Popliteal Artery Complicated by a Deep Venous Thrombosis Revealing an Exostosis in a 20-Year-Old Woman.

Exostoses or osteochondromas are benign osseous tumors that develop on the bone surface and can be sporadic or hereditary. Their evolution is generally benign, but they may be complicated in some patients by conflicts with the surrounding nervous or vascular structures, in particular arteries. We report a case of false aneurysm of the popliteal artery secondary to an isolated exostosis of the left femur in a 20-year-old woman. A delay in the diagnosis allowed the development of the false aneurysm, which was at the origin of a major venous compression. The surgical treatment consisted in aneurysmectomy and reconstruction by end-to-end anastomosis associated with the resection of the osseous tumor, and the deep venous thrombosis was treated medically.