Endovascular and Surgical Management of Subclavian Artery Occlusive Disease: Early and Long-Term Outcomes.

BACKGROUND: The aim of the study was to report early and late outcomes of surgical and endovascular management of subclavian artery atherosclerotic disease (SAAD). METHODS: Data about consecutive patients treated for subclavian artery atherosclerotic occlusive disease between 2001 and 2018 either by open surgical repair (OSR) or by endovascular repair (ER) were retrospectively collected and analyzed. Primary outcomes included 30-day death, as well as cardiac and neurologic events, reported separately for occlusion and stenosis. Secondary outcomes included primary patency in the long term, reported separately for occlusive and stenotic lesions. The Kaplan-Meier analysis with the logrank test was used to estimate long-term primary patency. Chi-squared and t-tests were used as appropriate to compare the outcomes of the 2 groups. A P value < 0.05 was considered statistically significant. RESULTS: Sixty-eight patients were treated using ER (49 patients) and OSR (19). Technical success rate was 100% in both groups. During in-hospital stay, 1 brachial hematoma and 2 acute upper limb ischemia occurred in the ER group and in the OSR group, respectively. At 30 days, no deaths or neurological/cardiac events were recorded in both ER and OSR groups. Symptoms resolution and upper limb salvage were 100% in both groups. In the ER group, primary patency was 100% at 7 years in patients who had been treated for stenotic lesions and 62.5 ± 21.3% in patients who had been treated for occlusive lesions (P = 0.0035). In the OSR group, primary patency was 100% at 7 years in patients treated for stenotic lesions and 25 ± 21.6% in patients who had been treated for occlusive lesions (P < 0.0001). Overall, long-term primary patency in the OSR group was 76.9 ± 11.7% at 7 years, being lower than that reported after ER (93.4 ± 4.5%, P = 0.02). CONCLUSIONS: Both ER and OSR proved to be safe, effective, and durable in the treatment of SAAD. In particular, the primary patency rates at long term for both ER and OSR showed better outcomes for stenotic lesions.

[Revascularization of supra-aortic trunks in Takayasu's arteritis]. / Revascularisation des troncs supra-aortiques au cours de la maladie de Takayasu.

INTRODUCTION: Takayasu's disease is an inflammatory arteritis mainly affecting the aorta, its main divisional branches and pulmonary arteries. The arterial damage during Takayasu's disease is essentially occlusive and preferentially affects supra-aortic trunks. Indications for revascularization of supra-aortic trunks are clear but results are rarely reported. The purpose of this study was to evaluate the results of supra-aortic trunk revascularization in Takayasu's arteritis. PATIENTS AND METHODS: We report a retrospective study conducted between 2012 and 2018 about patients with Takayasu's arteritis who underwent revascularization of supra-aortic trunks. RESULTS: Our series consisted of six patients. All patients were female. The average age was 29 (range 18-48) years. The operative indication was cerebrovascular ischemic symptoms in five patients and intermittent claudication of the upper limb in one. We performed aorto-bi-carotid bypass in four patients, a subclavian artery angioplasty in one and a vertebral artery angioplasty in one. At 1 month, operative mortality was zero and morbidity was marked by hemorrhagic stroke in one patient operated by conventional surgery. The average follow-up was 4 years (1.8). During the follow-up, one patient was reoperated after 18 months for an anastomotic false aneurysm in the ascending aorta. We noted a favorable outcome with total resolution of the symptomatology for the other patients and Doppler ultrasound confirmed patency during follow-up. CONCLUSION: Surgical revascularization of supra-aortic trunks in Takayasu's arteritis can be associated with a risk of stroke and a risk of anastomotic pseudoaneurysms. Endovascular revascularization appears to be less invasive but its long-term results are rarely reported.

Hybrid Repair of a Saccular Aortic Arch Aneurysm Ruptured in the Left Pulmonary Bronchus.

The rupture of aortic arch aneurysm is rare but serious and a life-threatening pathologic condition. We report a case of an 80-year-old woman who was admitted to our department for a rupture of a saccular aortic arch aneurysm in the left pulmonary bronchus. There was no landing zone in the aortic arch. First, we performed a total supra-aortic debranching and a bifurcated graft bypass from the ascending aorta to both the innominate artery and the left carotid artery. Then, we implanted in the aortic arch an endoprosthesis covering the origin of all supra-aortic trunks. Final angiography was satisfactory. The patient died 8 days later due to pulmonary-originated septic shock. Aortic arch hybrid procedures show a variety of severe complications associated with a relevant morbidity, mortality, and reintervention rate. Prognosis of rupture depends not only on the hemorrhage caused but also on the potential infection.

Place of endovascular repair in the treatment of abdominal aortic aneurysm.

AIM: Open repair for abdominal aortic aneurysm (AAA) has a significant morbidity and mortality. Since the introduction of endovascular techniques, much progress has been made. The aim of this study is to clarify the feasibility and the results of endovascular aneurysm repair (EVAR) in short and middle terms. METHODS: Between 2008 and 2015, 14 patients underwent EVAR. The average age was 65 years. Comorbidities were found in 7 patients. It was coronary artery disease in 3 cases and severe respiratory failure in 4 cases. The aneurysm was atherosclerotic in 12 cases and inflammatory in 2 cases. The average length of the proximal neck was 29 mm. The mean aneurysm diameter was 65mm. A bifurcated stent graft has been deployed in 12 cases and an aorto-mono-iliac stent graft was deployed in 2 cases. RESULTS: Immediate technical success was achieved in 13 patients. Immediate surgical conversion was performed in 1 case. The average hospital stay was 5 days. We haven't deployed any early death. After a mean follow-up of 3 years, we deployed 3 late deaths; two deaths were not related to the aneurysm and one death was secondary to rupture of the aneurysm caused by a proximal stent graft migration. CONCLUSION: EVAR is actually a therapeutic increasingly used. Its results, especially late, are still being evaluated. Meanwhile, its indications must be selective.

Endovascular repair of inflammatory aortic aneuvrysm.

INTRODUCTION: While open repair was the gold standard treatment of atherosclerotic abdominal aortic aneurysms, its place in the treatment of inflammatory aortic aneurysms remains controversial. AIM: To specify the place of endovascular repair in the treatment of inflammatory aneurysms. OBSERVATION: We report 2 cases of inflammatory aortic aneurysms. The first patient was followed for Behçet's disease and the other patient for Giant Cell arteritis 's disease. We noted a biological inflammatory syndrome. CT scan suggested the diagnosis of inflammatory aortic aneurysm. We have implemented a bifurcated stent graft for the patient with a Behcet's disease. For the second patient, we converted to conventional surgery. Corticosteroid therapy was prescribed in two cases with favorable evolution. CONCLUSION: Endovascular repair is a good alternative to surgery for inflammatory aneurysms. Medical therapy occupies a prominent place in its therapeutic management.

[Prosthetic valve endocarditis: about 14 cases]. / La prise en charge chirurgicale des endocardites infectieuses sur prothese valvulaire: a propos de 14 cas.

BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious complication of valve surgery. AIM: The aim of this study is to determine the diagnostic and therapeutic management for PVE. METHODS: It's a retrospective study about 14 cases of PVE operated in the department of cardiovascular surgery of la Rabta hospital between January 1996 and December 2006. RESULTS: In two cases, surgery was performed emergent, in the remnant cases surgery was elective. The coagulase-negative staphylococcus (CNS) is the predominant cause of these PVE.Surgery consisted on seven mitral prosthesis replacements and seven aortic prosthesis replacements.Hospital mortality was 50%. CONCLUSION: In conclusion attention should be made to prevent endocarditis when possible. In case of PVE, an early diagnosis a leads to earlier application of appropriate therapies and improved outcome.