L'anthropologie de la reconnaissance de Marcel Hénaff et la question du symbolisme : sur la pertinence de relire Mauss après Lévi-Strauss.

Marcel Hénaff's work (1942-2018) can be considered as a nuanced interpretation of modern western societies. The fact that it addresses a wide range of topics tends to mask the articulated thought it bears - in that matter, The Price of Truth: Gift, Money, and Philosophy (2010) is the best example. His thought took this particular form in part because of its genealogical stance, which is informed by social and cultural anthropology, phenomenology and, in some ways Christian theology. But if one wants to get a better grasp of its internal coherence, one must turn to religion as it has been approached by the French School of sociology and anthropology. For Hénaff developed his anthropology of recognition through a dialogue with Claude Lévi-Strauss's thought on symbolism, revisited with Marcel Mauss's own work on ceremonial gift exchange and symbolism.

Extensive Surgical Treatment of Primary Pulmonary Synovial Sarcoma After Recurrent Pneumothorax.

A 26-year-old woman with a history of right-sided recurrent pneumothorax and resection of pulmonary bullae, pleural abrasion, and talc pleurodesis underwent right-sided extensive pleural pneumonectomy for a monophasic primary pleural-pulmonary synovial sarcoma (PPSS). The pathologic diagnosis was predominantly fusiform PPSS with R0 resection. Sixteen months after the operation, she is alive, without signs of new lesions. The extensive tumor resection can achieve a good result for controlling local disease.

Direct percutaneous carotid access for carotid angioplasty and stenting.

PURPOSE: To describe a direct percutaneous carotid access technique for carotid artery stenting (CAS) that circumvents the potential for embolization that can occur during catheter manipulation in the aortic arch during femoral access. TECHNIQUE: After inducing anesthesia, an ultrasound transducer is placed at the base of the neck above the clavicle. A 21-G, 7-cm needle from a micropuncture introducer is used for single-wall puncture of the common carotid artery (CCA). A 0.018-inch guidewire is inserted into the needle for placement of a 4-F, 10-cm introducer. After placing a 0.035-inch angled guidewire in the external carotid artery, the 4-F introducer is exchanged for the closure device sheath (preclose technique). A regular 6-F introducer is then placed inside the closure device sheath, and a low dose (2000 units) of heparin is administered for the brief CAS procedure, which is performed under cerebral protection. After a successful procedure is confirmed, the protection device is retrieved, and the closure device is applied to seal the puncture. CONCLUSION: This approach has a low rate of neurological and access site complications. Percutaneous direct carotid access could extend the indications for CAS to include difficult anatomies, high-risk patients, and certain emergent situations that warrant easy and rapid access to the CCA.

Hybrid repair with antegrade visceral artery debranching: the preferred treatment option for thoracoabdominal aneurysms in high-risk patients.

PURPOSE: To present a hybrid repair technique that may decrease the morbidity and mortality associated with thoracoabdominal aneurysm (TAAA) repair, especially in high-risk patients. METHODS: A retrospective analysis was performed of patients treated for TAAA at a single institution from 2005 to 2010. Nine patients (8 men; mean age 72 years) with Crawford types II or IV TAAAs were treated with a 2-stage hybrid technique consisting of antegrade visceral debranching of the aorta, followed within a month by endovascular deployment of endografts to cover the entire diseased aortic segment. RESULTS: There was no perioperative mortality, paraplegia, or permanent renal failure. Following the debranching procedure, there were 4 cases of transient renal dysfunction, 1 minor stroke (resolved), and 1 low-flow pancreatic fistula that regressed. There were no complications after the endovascular repair. Over a mean follow-up of 28 months (range 8-50), all patients are alive, with good patency of the bypass grafts and endografts. One late type II endoleak is under surveillance. CONCLUSION: This small series shows that the ascending aorta is a safe location for antegrade visceral debranching, which could facilitate hybrid repair in most cases, especially those patients with advanced lesions of the iliac arteries. More patients and longer follow-up are required to draw definite conclusions for the adoption of this treatment in high-risk patients.

Acute carotid stent thrombosis: a case of surgical revascularization and review of treatment options.

Carotid artery stenting is considered to be an alternative to carotid endarterectomy for selected patients by many vascular specialists around the world. Acute stent thrombosis following the procedure, although very infrequent, can risk the survival of the patient. In this report, we present a case of acute stent thrombosis 24 hours following the procedure. After a slow deterioration of the clinical state of the patient, he was urgently subjected to thrombectomy with extraction of the stent, with eventual resolution of his symptoms. A review of the current literature is presented together with all the possible treatment options of this serious complication. In conclusion, several neurorescue procedures are available for the vascular surgeon who has to act urgently and, in some cases, aggressively, when stent thrombosis is diagnosed.

Staged hybrid repair of thoracoabdominal aortic aneurysm after chronic type B aortic dissection.

The purpose of this study was to evaluate clinical outcomes of combined endovascular and open techniques to eradicate false lumen dilatation in the visceral aortic segment after type B aortic dissection associated with aortic aneurysm. We reviewed eight patients with distal thoracic and abdominal false lumen dilatation treated with a staged procedure. These included arch debranching as needed, proximal thoracic endovascular repair, and open surgical correction with abdominal aortic replacement of the visceral and infrarenal aorta. False lumen eradication was successful in all patients. There were no operative deaths, and paraplegia or paraparesis occurred in two patients. During a mean follow-up of 30 months, no complications or secondary interventions were necessary. The thoracic false lumen remained thrombosed in all patients, with no evidence of aortic dilatation or stent graft complications. Complete thrombosis and eradication of the false lumen can be achieved through a three-stage repair of chronic type B aortic dissection with aneurysmal dilatation. A prospective randomized trial is needed to establish the viability of this approach versus standard open repair of type II thoracoabdominal aortic aneurysms.

The French National Authority for Health reports on thoracic stent grafts.

OBJECTIVE: This study was conducted to determine the efficacy and safety of stent grafts in the treatment of thoracic aortic aneurysms and dissections. METHOD: Our health technology assessment method combined a critical review of the literature with experts' opinions. Several databases, useful Web sites, and the gray literature were searched from January 1995 to December 2004. Some manually retrieved major articles published in 2005 were also included. The draft report was submitted to and discussed by a working group of 12 members nominated by relevant medical societies. The amended report was submitted to a multidisciplinary group of 12 peer reviewers for comment. RESULTS: Endovascular stent grafting (ESG) repair for lesions of the thoracic aorta, including aneurysms, dissections, and aortic isthmus ruptures, is probably beneficial in terms of operative mortality and severe morbidity, with an incidence of paraplegia of 2.1% (range 0%-7%) for ESG vs 5% (range, 3%-15%) for surgery, provided that there is a rigorous medium-term assessment and that anatomic factors are favorable. A proximal neck length of at least 2 cm is needed to insert the stent graft. Indications for ESG in thoracic aortic aneurysm and dissection are similar to those for surgery. Endovascular stent grafting is particularly appropriate in patients with multiple traumas to the thoracic aorta in whom concomitant lesions are a contraindication to open surgery. Endovascular stent graft repair can only be done in public or private centers with expertise in both endovascular and surgical procedures and with adequate technical facilities. Patients should be informed of the advantages and drawbacks of both methods. A multidisciplinary discussion should address risks of converting to open surgery and possible need for a cardiopulmonary bypass. Patients should be monitored annually by computed tomography scan or magnetic resonance imaging and plain radiographs because long-term results are uncertain (possible stent graft deterioration, onset of aortic disease). They should be told of the need for surveillance and possible further treatment. CONCLUSIONS: A prospective registry of all thoracic aorta procedures (endovascular treatment, open surgery, thoracic ESG plus extra-anatomic bypass) needs to be set up. All practitioners and stent graft manufacturers should contribute to this registry. It should include information on patient monitoring in order to (1) select patients who could be treated by ESG repair, (2) assess the feasibility of a randomized controlled study comparing ESG and surgery, (3) assess the medium-term outcome of different devices, and (4) obtain a better understanding of the health economics aspects.

Influence of wall compliance on hemodynamics in models of abdominal aortic aneurysm.

PURPOSE: To determine complementary criteria to existing morphological criteria, which are not reliable but are used to justify surgical intervention to treat abdominal aortic aneurysm (AAA). METHODS: An experimental study was conducted in which 2 models of AAA, 1 rigid and 1 soft, were used to study the influence of compliance on aneurysm dynamics. The heart rate was 70 beats per minute, and the mean flow rate was 1.02 L/min. Velocity measurements were made with particle image velocimetry in 2 planes parallel to flow (1 vertical and 1 horizontal). RESULTS: The general flow patterns generated in the rigid AAA model were in agreement with the literature. In both models, a vortex occurred at the beginning of systolic deceleration in the proximal part of the AAA, near the anterior wall. The vortex remained confined to the proximal part during the entire cycle in the rigid model, whereas in the soft model, the vortex migrated to the distal segment during the cycle and impacted the AAA walls. This impact generated a local pressure increase on the wall. In the soft model, another vortex was created near the posterior wall. These vortices eroded and weakened the walls of the distal segment, which can cause rupture. CONCLUSION: Compliance of the aneurysm wall might become another criterion to justify surgical intervention.

Aortic arch aneurysm and patent left internal mammary artery: technique of transposition of supra-aortic vessels and embolization of the subclavian artery.

Endovascular treatment of aortic arch aneurysms poses unique problems because of vascularization of the carotid arteries. Transposition of supra-aortic vessels is becoming an established and accepted strategy for expanding the applicability of stent graft repair. left subclavian artery (LSA) is not usually transposed because its overstenting does not produce relevant complications. Nevertheless, some selected cases need high-pressure revascularization of the LSA, such as in the presence of a patent left internal mammary artery. We present a technique of revascularization of supra-aortic vessels and "balloon protected" embolization of the origin of the LSA.

Long-term results of carotid stenting are competitive with surgery.

OBJECTIVE: The feasibility of carotid stenting (CS) is no longer questionable, although its indications remain debatable. Until the results of randomized trials are available, personal series and registries should help in the comparison of long-term results of CS with those of endarterectomy. We report here the long-term results of a large series of CS in our department with a long follow-up. This retrospective study reviews a single surgeon's 11-year experience with CS. Our results are compared with those of conventional surgery emanating from our own series and the North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trial (ECST), and Asymptomatic Carotid Atherosclerosis Study (ACAS). MATERIALS AND METHODS: CS has been performed in our department in a single, semi-private institution for 12 years. Patients with high lesions, and postradiotherapy and postendarterectomy stenoses were treated with CS, as were patients at high risk for surgery. The others were operated on with conventional endarterectomy. During the study, we performed 221 CS procedures on 193 patients (150 men and 43 women). The average follow-up was 2.7 years (1 month to 9.3 years). We analyzed the late results in terms of prevention from stroke, the freedom from new neurologic events, and also patency rates of the treated carotid vessels. We also identified predictors for neurologic complication and in-stent restenosis by using univariate analysis. RESULTS: Life-table analyses at 10 years gave a 96% (confidence interval [CI] = 3%) rate for stroke freedom, a 98% (CI = 2%) rate for fatal stroke freedom, and a primary assisted patency rate of 95% (CI = 3%). Predictors for neurologic complication were [corrected] age >70 ( P = .041), and [corrected] potential renal insufficiency ( P = .056 [corrected] In-stent restenosis occurrence extended from 2 months to 4.5 years after the procedure. The restenosis rates at 6 months, 1, 2, and 4.5 years were, respectively, 1.4%, 2.3%, 3.7%, and 5.9% (13/221). No factors were found to be strong predictors of in-stent restenosis [corrected] CONCLUSION: These long-term results show that CS is competitive with conventional surgery. A more accurate selection for CS or surgery might reduce the rate of complications after carotid stenosis repair.

Long-term results of endovascular exclusion of extracranial internal carotid artery aneurysms and dissecting aneurysm.

OBJECTIVES: Surgery remains the standard option to treat symptomatic or complicated aneurysms of the extracranial internal carotid arteries (EICA). When located more distally to the EICA, surgery appears to be very invasive and disabling. Endovascular treatment of high aneurysmal EICA has been poorly reported. We report our experience in this particular field. METHODS: We treated five EICA endovascularly, using covered stents and stentgrafts in four patients, two males and two females. One male was treated bilaterally. The average age was 59.2 years (39-80). Three patients were symptomatic (two transient ischemic attack and one stroke). Patients were followed by duplex scan, CT scan, or angio MR. RESULTS: Protecting devices were used in two cases. No in-hospital complication was observed. During follow-up (3.6 +/- 1.3 years), no adverse event was observed and all devices remained patent at duplex scan and angiography. One early endoleak was observed and treated with covered stent extension. No sign of in-stent stenosis was observed. All the aneurysmal sacs thrombosed. CONCLUSION: Covered stents and stentgrafts allow a less invasive approach to treat highly located internal carotid aneurysms. Larger series are needed to assess the role of covered stents in treating aneurysmal EICA as first choice.