[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.

[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.

[Juxta-anastomotic venous aneurysm of a fistula in the anatomical snuffbox: An atypical location]. / Anévrisme veineux juxta-anastomotique d'une fistule au niveau de la tabatière anatomique : une localisation atypique.

Native arteriovenous fistula is the best available vascular access for hemodialysis in end-stage renal failure. It is characterized by higher patency rates and lower rates of morbidity, mortality and complication compared to prosthetic bypass grafts and central venous catheters. Aneurysmal complications remain the main complications of these access with a high risk of rupture and fatal hemorrhage. Their management varies from case to another and several methods are reported in the literature. We describe a case of an atypical localization of a juxta-anastomotic venous aneurysm in the anatomical snuffbox, treated by resection with proximal reimplantation of the cephalic vein at the wrist.

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.

[Iatrogenic carotid-jugular arterio-venous fistula: a rare complication associated with jugular venous catheterization (a case report)]. / Fistule artério-veineuse iatrogène carotido-jugulaire: une complication rare du cathétérisme de la veine jugulaire (à propos d'un cas).

Catheterization of the internal jugular vein is widely performed by both nephrologists and surgeons. It has become a routine procedure, but can be associated with serious complications. Carotid-jugular arterio-venous fistula (CJAVF) is a rare but potentially fatal complication. Very few cases have been reported in the literature. This study involved a patient with iatrogenic CJAVF following hemodialysis catheter placement performed three weeks earlier. The diagnosis was clinically suspected based on the discovery of laterocervical thrill and confirmed by echo-Doppler and angiography. The patient underwent successful open surgery. Operator experience and trainees support, in addition to the use of ultrasound guidance, can significantly reduce the occurrence of complications during jugular venous catheterization.

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.

True Aneurysm of the Left Internal Thoracic Artery.

Aneurysms of the internal thoracic artery (ITA) are rare and can have many etiologies. Hyperflow is an exceptional etiology. We report the case of a 56-year-old woman who presented with a stress-induced ischemia of the left arm. Computed tomography angiography showed occlusion of the subclavian artery and a true aneurysm of the ITA. The ITA aneurysm was resected without restoration of the ITA continuity and a carotid-subclavian bypass was performed. Pathological examination of the aneurysm sac was not specific.

Successful endovascular management of postoperative arterio portal fistula.

Arterioportal fistulas are rare and mostly a result of late complication of gastric and biliary surgery. Surgical excision has been the therapy of reference. Endovascular treatment is emerging as a real alternative to surgery. The present study reports a case of postsurgical arterioportal fistula involving the gastroduodenal artery, the cause of portal hypertension, which was successfully treated by transarterial embolization using embospheres. Portal hypertension improved dramatically.

Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in an university hospital of Morocco.

BACKGROUND: The first case of 2009 pandemic influenza A (H1N1) virus infection in our center was documented on June 15. Subsequently, persons with suspected cases of infection and contacts of those with suspected infection were tested. Persons in whom infection was confirmed were hospitalized and quarantined, and some of them were closely observed for the purpose of investigating the nature and duration of the disease. The aim of the present study was to describe baseline characteristics, treatment, outcomes, hospital length of stay and mortality of the first 186 cases of influenza A (H1N1) virus infection, with special interest in those developing severe respiratory failure with intensive care unit (ICU) care requirement. METHODS: observational study of 186 consecutive cases of influenza A (H1N1) virus infection admitted in 3 departments that were reference centers for the care of patients with influenza A and 4 ICU in Ibn Sina university hospital (Rabat, Morocco) between June and December 2009. Real time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection. Demographic data, symptoms, comorbid conditions, illness progression, laboratory and chest radiologic findings, treatments, clinical outcomes and ICU care requirement were closely monitored. RESULTS: The mean age of the 186 patients was 17.6 ± 14.8 years, 47.8% had less than 14 years and 57% were male. The median duration of symptoms before hospital admission was 3 days (interquartile range (IQR): 2-5). The most common symptoms were fever (in 91.5% of the patients), cough in 92.5%, and nasal congestion in 62.4%. Twenty four percent of patients had comorbid respiratory disorders and 7.5% were pregnant. Abnormalities in chest radiography were detected in 26.3% of 186 patients on admission or after hospitalization. Twenty patients have required ICU care and 10 have required mechanical ventilation. The hospital length of stay was 5 days (IQR: 4-5). The following were risk factors of ICU admission: older age (p = 0.03), long duration of symptoms (p = 0.07), asthma (p = 0.01), obesity (P < 0.001), abnormalities of chest radiography (P < 0.001), leukocytosis (p = 0.005), and higher C-reactive protein (CRP) (P < 0.001). The ICU length of stay was 4 days (IQR: 3-6.7). The mortality rate was 3.5% among all patients and 30% among ICU patients. CONCLUSIONS: Close observation of patients infected with the 2009 pandemic influenza A (H1N1) virus infection provided us with several information. The influenza A (H1N1) virus infection affected young people particularly, with comorbid respiratory disorders. Risk factors of ICU admission were older age, long duration of symptoms, asthma, obesity, abnormalities of chest radiography, leukocytosis and higher CRP. Clinicians should be aware of complications of influenza A (H1N1) virus infection, particulary in patients with risk factors.

[Hepatic artery aneurysm]. / Anévrisme de l'artère hépatique.

INTRODUCTION: Aneurysms of the hepatic artery are relatively rare. Diagnosis often occurs only after rupture, and mortality is substantial. We report two new cases. CASES: The first patient was a 70-year-old woman whose asymptomatic aneurysm of the common hepatic artery was identified during ultrasound for vomiting and abdominal pain. Open aneurysm repair and a hepatosplenic bypass led to a favorable outcome. The second patient was a 54-year-old man; his right hepatic artery aneurysm was diagnosed after it ruptured in the gall bladder. DISCUSSION: We review the literature about hepatic artery aneurysms and discuss the clinical features and methods for diagnosis and treatment of these uncommon lesions.

Extracranial carotid aneurysm in Behçet disease: Report of two new cases.

Extracranial carotid aneurysm due to Behçet disease is extremely rare. To our knowledge, this complication has been previously reported in only 12 cases. We report two new cases of extracranial carotid aneurysm in Behçet disease and discuss the clinical features, therapeutic modalities, and postoperative complications of these uncommon lesions.