Subintimal recanalization plus stenting or bypass for management of claudicants with femoro-popliteal occlusions.

OBJECTIVE: To assess a practice of claudicant revascularization with either subintimal angioplasty (SIA) plus stenting or femoropopliteal bypass. METHODS: All claudicants related to femoropopliteal occlusions treated either with above-the-knee femoropopliteal (AKFP) bypass (group 1) or SIA and stent (group 2) between 2004 and 2011 were reviewed. The two groups were analyzed with regard to patency and freedom from re-intervention. RESULTS: One hundred and fifty limbs were consecutively treated with AKFP bypass (n = 82), SIA plus stenting (n = 58), or SIA (n = 10). Bypasses were performed with synthetic grafts in 49 limbs (59.7%). Covered stents were used in 34 limbs (63%) and self-expandable stents in the remainder. Mean follow-up was 26 and 36 months, respectively, in group 1 and 2. At 24 months, primary, primary-assisted, and secondary patency for bypass versus SIA + stent groups was, respectively, 66.6 versus 70.1%, 76.5 versus 90.1%, and 88.2 versus 90.1%. Freedom from re-intervention rates at 12 and 36 months were, respectively, 78.8 and 68.4% for group 2 and 86.4% and 65.2% for group 1. CONCLUSION: SIA plus stenting is an effective and useful option for the management of claudicants with femoropopliteal occlusions, and can be considered as complementary to surgical bypass.

External jugular vein aneurysm: a rare cause of neck swelling. A report of three patients.

Venous aneurysms are a relatively rare pathology, far less common than arterial aneurysms. Unrelated to either age or gender, they can affect any vein, including cervical, thoracic, visceral, and lower limb veins. Aneurysmal dilatations in cervical veins are rare due to low pressure in the vena cava system; they can involve any vein but most frequently are observed on the internal and external jugular veins. This report of three patients highlights some of the specific diagnostic and therapeutic features of this pathology.

[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.

[Vascular type of Ehlers-Danlos syndrome: a rare cause of spontaneous pseudo-aneurysms]. / Syndrome d'Ehlers-Danlos de type vasculaire : une cause rare de faux-anévrismes artériels spontanés.

We report a case of a 20-year-old-man who was admitted to our hospital through the emergency room for a swelling of the right thigh, which had appeared spontaneously without fever. The physical exam was highly suggestive of a vascular mass. The arterial CT scan of the right lower limb revealed a pseudo-aneurysm of a branch of the deep right femoral artery. The diagnosis of vascular type of Ehlers Danlos syndrome was established on clinical criteria. The successful management was surgical by the excision of the pseudoaneurysm and the ligation of the feeding branch that supplied the pseudoaneurysm. The postsurgical follow-up was uneventful and the clinical course was smooth with no further complications.

[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.

[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.

Arteritis de células gigantes evidenciada por ulceraciones de la mano / giant cell arteritis detected through ulcerationts of the hand

Introducción. La arteritis de células gigantes es una vasculitis crónica de arterias de gran y mediano calibre,que por lo general afecta a pacientes añosos. La participación de las arterias craneales explica los síntomas clásicos decefalea, el engrosamiento doloroso de la arteria temporal, la claudicación mandibular y la pérdida visual. Puede asociarsea complicaciones necróticas del cuero cabelludo y la lengua, pero excepcionalmente induce la necrosis de la mano.Caso clínico. Mujer de 74 años admitida por úlceras de la mano izquierda. El examen físico reveló la ausencia de pulsoen los miembros superiores. La ecografía Doppler de vasos del cuello mostró una afectación homogénea con rasgosinflamatorios. Se realizó una biopsia de la arteria temporal. El examen reveló un infiltrado inflamatorio denso de la capamedia, con linfocitos y células gigantes, que confirmaron el diagnóstico de arteritis de células gigantes (enfermedadde Horton). Realizado el diagnostico, se trató a la paciente con corticosteroides y anticoagulantes, mostrando un seguimientosatisfactorio, marcado por la mejoría de los síntomas y la cicatrización de la úlcera a los cuatro meses(AU)

Introduction. Giant cell arteritis is a chronic vasculitis of large and medium-sized arteries that usually affectselderly patients in the majority of cases. Involvement of the cranial arteries leads to the classic symptoms of headache,painful thickening of the temporal artery, jaw claudication, and visual loss. It could be complicated of necrosis of scalpand tongue but exceptionally it induce necrosis of hand. Case report. A 74-year-old woman admitted for ulcer of the leftarm. Physical exam revealed the absence of pulse of upper limbs. The Duplex ultrasonography of cervical arteritisshowed a homogeneous thickening with inflammatory features. The biopsy specimens were taken from the temporalartery. Histologic examination revealed a dense infiltrate of the media with lymphocytes and giant cells, whichconfirmed the diagnosis of Horton disease. The patient was treated by corticosteroids and anticoagulation drugsimmediately after diagnosis was proven and their symptoms improved with healing of lesions; the follow-up wasuneventful with improvement of symptoms and disappearance of the ulcer that healed after four months(AU)

[Coeliac trunk aneurysm revealing Behçet disease (2 case reports)]. / Anévrisme du tronc coeliaque révélant la maladie de Behçet. A propos de deux cas.

The Behçet's disease is a vasculitis of an unknown origin. Vascular inflammatory lesions predominantly affect veins, potentially leading to superficial or deep thrombophlebitis. Arterial involvement is rare, mainly aneurysms. We display two case reports of patients where Behçet's disease is revealed by celiac trunk aneurysm. The symptoms are nonspecific. Ultrasound Doppler and angioscan are a key to the diagnosis. The two patients received medical and surgical treatment. By these two case reports, we insist that the diagnosis of Behçet's disease should be evoqued in any young patient with arterial aneurysm.