[Percutaneous angioplasty of the infra-renal aorta. Report of 9 cases]. / Angioplastie endoluminale de l'aorte abdominale sous-rénale. A propos de 9 cas.

Between June 1996 and September 2000, nine angioplasties of the infra-renal aorta were performed in two Surgical Vascular Centers (Hospital Saint-Joseph, Paris, Polyclinic La Baule), in 6 men and three women age ranged from 36 to 72 years (middle age 48 years and 2 months). Eight of these patients presented important stenoses of the middle infra-renal aorta, or in the aortic bifurcation, one of them presented an occlusion, leading to severe intermittent claudication, and rest pain. After endoluminal kissing balloon angioplasty, five aortic stents (five patients), and six iliac primitive arteries stents (in three patients), extended beyond the aorta, were placed. One isolated angioplasty was also performed. All the procedures were performed in the operative room, with good results, except for one patient requiring emergency aorto-bi-femoral by-pass, because of acute leg ischemia, immediately following the procedure. Follow-up was clinical, with Us-Doppler scan, and angiogram in all cases. After 36 months follow-up (4-52), all patients are asymptomatic, with permeable stents. This technique is well-known since 1980, without excessive morbidity. Aortic angioplasty represents the right technique, with good long-term results, for middle or terminal aorta atheromatous stenosis, according to classical aorto-bi-femoral by-passes. Final result depends on associated iliac arteries stenoses.

[Carotid stenosis: indications and therapeutic approach]. / La stenose carotidienne: indications et conduite therapeutique.

There has not been a peripheral vascular surgical procedure subject to as exquisite scruting as carotid endarterectomy. The last decade gave a new attitude after the analysis and conclusions of the North American Symptomatic Carotid Endarterectomy Symptomatic extracranial lesions were best managed with operative intervention rather than antiplatelet treatment alone. Now, in the first decade of the new millenium, we are embarking on yet another test of carotid endarterectmy--a comparison with percutaneous angioplasty and stenting, which is a most rigorous contest because endarterectomy must now withstand comparison with another "active treatment" rather than the more passive observational modality of antiplatelet therapy. The topic of the authors was to provide a panorama of the contemporay treatment of carotid disease at this pivotal point in the life cycle carotid endarterectomy.

[Epidemiology of chronic arteritis of the lower limbs: multicenter study: report of 531 cases]. / Epidemiologie de l'arterite chronique des membres inferieurs: etude multicentrique: à propos de 531 cas.

Arteritis is a local finding of a general disease: atherosclerosis. To define the risk factors of this disease in Tunisia, 531 patients were collected by a multicenter retrospective study between January 1998 and December 1999. Most of our patients were male with a mean age of 62 years. The most important risk factor was tobacco with an incidence of 90%. Lipids and diabetes were less common. The association of risk factors is particularly dangerous.

[Arterial aneurysms and Behçet's disease: apropos of 3 cases]. / Anévrismes artériels et maladie de Behçet: à propos de trois cas.

PURPOSE: Results that were obtained from three patients and a literature review allow the authors to better define the place of medical and surgical treatments according to the different locations of arterial aneurysm occurring in the course of Behcet's disease. METHODS: Retrospective report of five cases of arterial aneurysm that occurred during Behcet's disease in three patients. RESULTS: Due to the unusual symptoms, diagnosis can be hampered. Though lesions may be observed in various areas, they were mostly aortic (two patients). Surgical revascularization was done in all three patients. It mainly involved prosthetic grafts. Two patients were subsequently treated by postoperative immunosuppressive drugs. The mean follow-up was 22 months. Relapsing aneurysm was observed in one patient, while in another patient aneurysm developed in a new location. CONCLUSION: These types of arterial lesions respond poorly to medical treatment when a combination of colchicine and intermittent intravenous bolus of cyclophosphamide is used. Surgical indications should be given great yet selected weight, using prosthetic rather than venous autologous grafts (due to the risk of spontaneous venous involvement). Since either complication or recurrence is possible, prolonged monitoring is required.

[Iatrogenic intra-arterial injection during sclerotherapy of the external saphenous vein]. / Injection intra-artérielle iatrogène au cours d'une sclérose de veine saphène externe.

Inadvertant intra-arterial injection is a rare complication of sclerotherapy of varicose veins. We report one case of accidental popliteal injection complicated by acute ischemiae of the posterior compartment of the leg who needed fasciotomy and Achillus tendum elongation. There is no practical "step-by-step" guide of these complications and the best treatment is the prevention by respect of contraindications and the injection of sclerosing agent under ultrasonographic control.

[Arterial lesions of the upper limbs in Horton disease. Surgical revascularization by bilateral carotid-humeral bypass]. / Lésions artérielles des membres supérieurs dans la maladie de Horton. Revascularisation chirurgicale par pontage carotido-huméral bilatéral.

BACKGROUND: While external carotid lesions predominate, giant cell arteritis (Horton's disease) involves the arteries of the upper limbs in 7.7 to 16% of the patients. CASE REPORT: We cared for one patient with clinically and biologically proven Horton's disease. The patient was given corticosteroid therapy, but although general health status improved and markers of the inflammatory reaction returned to normal levels, exertion-induced ischemia progressively worsened. Due to the length of the arterial lesions, we performed bilateral carotid-humeral bypass surgery. DISCUSSION: Clinical expression of Horton's disease is often quiescent even in cases with extensive anatomic lesions. When clinical signs do appear, they generally respond well to corticosteroid therapy. In certain cases, as reported here, improvement can only be obtained by surgical revascularization.

[Extra-renal retroperitoneal angiomyolipoma]. / Angiomyolipome rétropéritonéal extra-rénal.

Angiomyolipoma is a benign kidney tumour. Its extrarenal, retroperitoneal site is exceptional. The authors report a case and emphasise the value of ultrasonography and computed tomography in the diagnosis of these tumours with a marked fatty component, without neglecting the contribution of arteriography which can be useful in the diagnosis of the origin of very large retroperitoneal tumours.