Comparison of ECG Saline-Conduction Technique and ECG Wire-Based Technique for Peripherally Inserted Central Catheter Insertion: A Randomized Controlled Trial.

(1) Background: The peripherally inserted central catheter (PICC) is commonly used in medicine. The tip position was shown to be a major determinant in PICC function and related complications. Recent advances in ECG guidance might facilitate daily practice. This study aimed to compare two ECG techniques, in terms of their tip-position accuracy, puncture site layout, and signal quality; (2) Methods: This randomized open study (1:1) included 320 participants. One PICC guidance technique used ECG signal transmission with saline (ST); the other technique used a guidewire (WT). Techniques were compared by the distance between the catheter tip and the cavoatrial junction (DCAJ) on chest X-rays, insertion-point hemostasis time, and the extracorporeal catheter length between the hub and the insertion point; (3) Results: The mean DCAJs were significantly different between ST (1.36 cm, 95% CI: 1.22-1.37) and WT (1.12 cm, 95% CI: 0.98-1.25; p = 0.013) groups. When DCAJs were classified as optimal, suboptimal, or inadequate, the difference between techniques had limited clinical impact (p = 0.085). However, the hemostasis time at the puncture site was significantly better with WT (no delay in 82% of patients) compared to ST (no delay in 50% of patients; p < 0.001). Conversely, ST achieved optimal and suboptimal extracorporeal lengths significantly more frequently than WT (100% vs. 66%; p < 0.001); (4) Conclusions: ECG guidance technologies achieved significantly different tip placements, but the difference had minimal clinical impact. Nevertheless, each technique displayed an important drawback at the PICC insertion point: the extracorporeal catheter was significantly longer with WT and the hemostasis delay was significantly longer with ST.

Virtually Augmented Self-Hypnosis in Peripheral Vascular Intervention: A Randomized Controlled Trial.

PURPOSE: Hypnosis is useful for diminishing distress during medical procedures. This study investigated the efficacy of virtually augmented self-hypnosis as an adjunctive non-pharmacological method for procedural pain and anxiety relief during endovascular interventions (EVI). METHODS: We compared an immersive distraction experience (clinicaltrials.gov identifier NCT04561596) featuring virtual reality (VR) using a head-mounted display versus treatment as usual (TAU). Patients followed the "Aqua" module (Oncomfort™) consisting of a scuba dive and breathing exercises. They experienced a self-induced dissociative state similar to clinical hypnosis without direct intervention of a professional. Enrollment followed a 1:1 randomized open study (VR or TAU). Patients' feelings were evaluated just before and after the procedure, and 3 months following intervention. Anxiety was evaluated using the State Trait Anxiety Inventory (STAI) and pain (sensory, emotional, and memory) with a visual analogue scale (VAS). RESULTS: This study included 100 patients. Mean anxiety (pre-post) was significantly reduced within groups and between groups (difference of 4.2 points, p = 0.016). The percentage of responders to anxiety lowering were 76 and 46% for VR and TAU, respectively (p = 0.004). The two groups did not significantly differ in mean sensory-intensity and affective emotional pain (pre-post) using VAS, in negative memories concerning remembered pain at 3 months (difference > 1 from immediate post-procedural reported pain intensity), mean procedural time, or the need for analgesic or sedative drugs. CONCLUSIONS: VR self-hypnosis has the potential to improve the management of patients' distress during radiological procedures. It is safe and effective for reducing anxiety during EVI.

Diagnostic performance of angiography-derived fractional flow reserve in patients with NSTEMI.

Noninvasive methods of estimating invasively measured fractional flow reserve (FFRinvasive ) are actively being explored, aiming to avoid the use of an invasive pressure wire and the administration of hyperemia-inducing drugs. Coronary angiography-derived FFR (FFRangio ) has already demonstrated its diagnostic performance in the context of stable coronary artery disease. However, its applicability in the context of non-ST-segment elevation myocardial infarction (NSTEMI) has yet to be established. We sought to determine the diagnostic performance of FFRangio exclusively in patients presenting with NSTEMI. We performed a prospective, single-center, single-arm, double-blinded study comparing FFR calculated by FFRangio to FFRinvasive in NSTEMI patients. FFRinvasive was measured in all angiographically intermediate lesions (30%-70% stenosis) and was then compared to FFRangio which was calculated at the same position, by a blinded operator. The primary endpoints were the sensitivity and specificity of FFRangio for predicting FFRinvasive using a cut-off value of ≤0.80. Among 100 NSTEMI patients who were screened, 46 patients with 60 vessels in total underwent FFRinvasive and were included in the study. The mean value of FFRinvasive was 0.83 ± 0.3 with 22 (36%) being ≤0.80 while the mean FFRangio was 0.82 ± 0.1 with 22 (36%) being ≤0.80. FFRangio exhibited a sensitivity of 95.5%, a specificity of 97.4%, and a diagnostic accuracy of 96.7%. FFRangio can precisely and noninvasively estimate FFRinvasive in acute coronary syndromes and may have a role in guiding treatment decisions related to angiographically intermediate coronary lesions in this context. WHAT IS KNOWN: FFRangio has demonstrated its diagnostic performance in validation studies, as a noninvasive and cost-effective method in the context of stable coronary artery disease but its performance has never been exclusively evaluated in NSTEMI patients. WHAT IS NEW: The present prospective single-center study demonstrates the excellent diagnostic performance of FFRangio in detecting functionally significant coronary artery stenosis in the setting of NSTEMI, providing more confidence in utilizing FFRangio in this population, avoiding the risk of an invasive pressure wire and the administration of hyperemia-inducing drugs. WHAT IS NEXT: Future randomized trials evaluating FFRangio -guided treatment of coronary artery disease (stable or ACS) are now needed to definitively establish the role of FFRangio in the physiological assessment of coronary lesions.

Computed tomography reference dimensions for identification of stented surgical mitral bioprostheses valve size.

BACKGROUND: Selection of the transcatheter heart valve size for a mitral valve-in-valve procedure is based on the type and manufacturer's labelled size. However, accurate information of surgical heart valve (SHV) size may not be available in the patient's medical record. The purpose of this study is to establish reference data for computed tomography (CT) dimensions of commonly used mitral SHV in order to determine the manufacturer's labelled size from a cardiac CT data set. METHODS: CT datasets of 105 patients with surgical mitral bioprosthesis and available manufacturer labeled datasets were included in the analysis. CT derived valve dimensions were assessed by two observers using multiplanar reformats aligned with the basal sewing ring. A circular region of interest was used in a standardized fashion to minimize influence of image acquisition and reconstruction parameters. Interobserver variability was assessed by Bland-Altman analysis. RESULTS: The CT-derived dimensions were stratified by valve size and type, and SHV properties were demonstrated for 5 common valve types. Variability of measurements was small and inter-observer limits of agreement were narrow. Stratified by SHV type, no overlap was noted for CT-derived dimensions among different SHV sizes . A reference table of CT characteristics of surgical mitral bioprosthesis types was created. CONCLUSION: The study provides reference CT data for determining the manufacturers' labeled SHV size across a range of commonly used mitral SHVs. The findings will be important to help identify types of surgical mitral bioprosthesis utilizing CT characteristics for patients without SHV size documentation.

Pulmonary Blood Volume Measured by Dual-Energy Computed Tomography Can Help Distinguish Patients With Pulmonary Hypertension.

Purpose: To evaluate the correlation between whole lung enhancement (WLE) and pulmonary blood volume (PBV) obtained through dual energy computed tomography pulmonary angiography (DECTPA) and echocardiography-derived systolic pulmonary arterial pressure (SPAP). Methods: Sixty-eight patients who underwent DECTPA were enrolled in the study after giving informed consent. A transthoracic echocardiography was performed for all the subjects within 48 h of their DECTPA study to measure SPAP. The correlation of the two DECTPA-derived parameters, WLE and PBV, with SPAP was assessed. In addition, the predictive strength of these parameters was compared with that of traditional computed tomography (CT) signs of pulmonary hypertension (PH). Results: The SPAP value showed a moderate correlation with main pulmonary artery (MPA) diameter (r = 0.48, P < 0.001), while having a weak correlation with WLE (r = -0.33, P = 0.007), PBV (r = -0.31, P = 0.01) and MPA/ascending aorta (MPA/AA) ratio (r = 0.26, P = 0.03). On regression analysis, MPA diameter (B ± SE: 1.8 ± 0.6, P = 0.004) and WLE (B ± SE: -0.5 ± 0.3, P = 0.042) had significant association with SPAP. In addition, SPAP ≥30 mmHg was related to the right to left ventricular diameter (RV/LV) ratio [OR (CI 95%): 24.39 (1.3-573.2), P = 0.04] and reversely associated with PBV [OR (CI 95%): 0.96 (0.93-0.98), P = 0.005]. Acquired cutoff value of 83% for PBV showed sensitivity and specificity of 73% to identify SPAP ≥30 mmHg [AUC (CI 95%):0.727 (0.588-0.866), P = 0.008]. Conclusions: Automated postprocessing calculation of iodine distribution analysis by DECTPA could be considered as an adjunctive tool to investigate for PH.

Three-Dimensional Adaptive Image Compression Concept for Medical Imaging: Application to Computed Tomography Angiography for Peripheral Arteries.

Advances in computed tomography (CT) have resulted in a substantial increase in the size of datasets. We built a new concept of medical image compression that provides the best compromise between compression rate and image quality. The method is based on multiple contexts and regions-of-interest (ROI) defined according to the degree of clinical interest. High priority areas (primary ROIs) are assigned a lossless compression. Other areas (secondary ROIs and background) are compressed with moderate or heavy losses. The method is applied to a whole dataset of CT angiography (CTA) of the lower extremity vasculature. It is compared to standard lossy compression techniques in terms of quantitative and qualitative image quality. It is also compared to standard lossless compression techniques in terms of image size reduction and compression ratio. The proposed compression method met quantitative criteria for high-quality encoding. It obtained the highest qualitative image quality rating score, with a statistically significant difference compared to other methods. The average compressed image size was up to 61% lower compared to standard compression techniques, with a 9:1 compression ratio compared with original non-compressed images. Our new adaptive 3D compression method for CT images can save data storage space while preserving clinically relevant information.

Appropriateness of Replacing Fluoroscopic Guidance With ECG-Electromagnetic Guidance for PICC Insertion: A Randomized Controlled Trial.

OBJECTIVE. Coupled ECG-electromagnetic (EM) guidance shows promise for use in placement of peripherally inserted central catheters (PICCs) when compared with the classic blind technique. However, ECG-EM guidance has not been appropriately compared with the reference standard of fluoroscopy (FX) guidance. Here, we aimed to compare ECG-EM guidance with FX guidance with regard to the final tip position of PICCs. SUBJECTS AND METHODS. A total of 120 patients (age range, 19-94 years) referred for PICC placement were randomized to the ECG-EM or FX group. All interventions were performed by PICC team members who had the same standardized training and experience. Final tip position was assessed using chest radiography and was classified as optimal, suboptimal, or inadequate requiring repositioning on the basis of the distance from the PICC tip to the cavoatrial junction (CAJ). Statistical analyses were performed using the Mann-Whitney U test for final catheter tip position (mean distance from CAJ) and Fisher and chi-square tests for proportions. RESULTS. PICCs were successfully inserted in 118 patients (53 men and 65 women). Catheter tip positions were optimal or suboptimal in 100% of the FX group and 77.2% of the ECG-EM group. Furthermore, precision of placement was significantly better (p = .004) in the FX group (mean distance from the PICC tip to the CAJ = 0.83 cm) than in the ECGEM group (mean distance from the PICC tip to the CAJ = 1.37 cm). Thirteen (22.8%) of the PICCs placed using ECG-EM guidance, all of which were inserted from the left side, were qualified as inadequate requiring repositioning and required another intervention. CONCLUSION. Our results revealed significant differences in final tip position between the ECG-EM and FX guidance techniques and indicate that ECG-EM guidance cannot appropriately replace FX guidance among unselected patients. However, ECGEM guidance could be considered as an acceptable technique for patients in whom the PICC could be inserted from the right side. TRIAL REGISTRATION. ClinicalTrials.gov NCT03652727.

Computed Tomography Angiography for the Diagnosis of Coronary Artery Disease Among Patients Undergoing Transcatheter Aortic Valve Implantation.

BACKGROUND: Computed tomography angiography (CTA) is used to plan TAVI procedures. We investigated the performance of pre-TAVI CTA for excluding coronary artery disease (CAD). METHODS: In total 127 patients were included. CTA images were analyzed for the presence of ≥ 50% (significant CAD) and ≥ 70% (severe CAD) diameter stenoses in proximal coronary arteries. Results were compared with invasive coronary angiography (ICA) at vessel and patient levels. Primary endpoint was the negative predictive value (NPV) of CTA for the presence of CAD. RESULTS: A total of 342 vessels were analyzable. NPV of CTA was 97.5% for significant CAD and 96.3% for severe CAD. Positive predictive value and accuracy were 44.8% and 87.1% for significant CAD and 56.3% and 94.4% for severe CAD. At patient level, NPV for significant CAD was 88.6%. CONCLUSION: Pre-TAVI CTA shows good performance for ruling out CAD and could be used as a gatekeeper for ICA in selected patients.

Type A aortic dissection in aneurysms having modelled pre-dissection maximum diameter below 45 mm: should we implement current guidelines to improve the survival benefit of prophylactic surgery?

OBJECTIVES: Current guidelines recommend prophylactic replacement of the ascending aorta at an aneurysmal diameter of >55 mm to prevent acute Type A aortic dissection (TAAD) in non-Marfan patients. Several publications have challenged this threshold, suggesting that surgery should be performed in smaller aneurysms to prevent this devastating disease. We reviewed our experience with measuring aortic size at the time of TAAD to validate the existing recommendation for prophylactic ascending aorta replacement. METHODS: All patients who had been admitted for TAAD to our emergency department from 2014 to 2019 and underwent ascending aorta replacement were included. Marfan patients were excluded. The maximum diameter of the dissected aorta was measured preoperatively using CT scan. We estimated the aortic diameter at the time of dissection to be 7 mm smaller than the measured maximum diameter of the dissected aorta (modelled pre-dissection diameter). RESULTS: Overall, 102 patients were included. Of these, 67 were male (65.6%) and 35 were female (34.4%), and the cohort's mean age was 65 ± 12.1 years. In addition, 66% were treated for arterial hypertension. The mean maximum modelled pre-dissection diameter was 39.6 ± 4.8 mm: 39.1 ± 5.1 mm in men and 40.7 ± 2.8 mm in women (P = 0.1). The cumulative 30-day mortality rate was 19.6% (20/102). CONCLUSIONS: TAAD occurred at a modelled aortic diameter below 45 mm in 87.7% of our patients. Therefore, the current aortic diameter threshold of 55 mm excludes ∼99% of patients with TAAD from prophylactic replacement of the ascending aorta. The maximum diameter of the ascending aorta warrants reappraisal and this parameter should be a distinct part of a personalized decision-making process that also takes into account age, gender and body surface area to establish the surgical indication for preventive aorta replacement aimed to improve the survival benefit of this procedure.

Predicting Venous Thromboembolic Events in Patients with Coronavirus Disease 2019 Requiring Hospitalization: an Observational Retrospective Study by the COVIDIC Initiative in a Swiss University Hospital.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can result in profound changes in blood coagulation. The aim of the study was to determine the incidence and predictors of venous thromboembolic events (VTE) among patients with COVID-19 requiring hospital admission. Subjects and Methods. We performed a retrospective study at the Lausanne University Hospital with patients admitted because of COVID-19 from February 28 to April 30, 2020. RESULTS: Among 443 patients with COVID-19, VTE was diagnosed in 41 patients (9.3%; 27 pulmonary embolisms, 12 deep vein thrombosis, one pulmonary embolism and deep vein thrombosis, one portal vein thrombosis). VTE was diagnosed already upon admission in 14 (34.1%) patients and 27 (65.9%) during hospital stay (18 in ICU and nine in wards outside the ICU). Multivariate analysis revealed D-dimer value > 3,120 ng/ml (P < 0.001; OR 15.8, 95% CI 4.7-52.9) and duration of 8 days or more from COVID-19 symptoms onset to presentation (P 0.020; OR 4.8, 95% CI 1.3-18.3) to be independently associated with VTE upon admission. D-dimer value ≥ 3,000 ng/l combined with a Wells score for PE ≥ 2 was highly specific (sensitivity 57.1%, specificity 91.6%) in detecting VTE upon admission. Development of VTE during hospitalization was independently associated with D-dimer value > 5,611 ng/ml (P < 0.001; OR 6.3, 95% CI 2.4-16.2) and mechanical ventilation (P < 0.001; OR 5.9, 95% CI 2.3-15.1). CONCLUSIONS: VTE seems to be a common COVID-19 complication upon admission and during hospitalization, especially in ICU. The combination of Wells ≥ 2 score and D - dimer ≥ 3,000 ng/l is a good predictor of VTE at admission.

Interventional radiology workflow during the COVID-19 pandemic: recommendations of the Swiss Society of Vascular and Interventional Radiology.

Given the importance of continuum in providing services and exigence of protecting health care professionals during this period, the Swiss Society of Vascular and Interventional Radiology (SSVIR) is releasing guidance for interventional radiologists as preparedness to manage COVID-19 patients, the workflow of non-COVID-19 patients and optimize interactions with other healthcare professionals.

Ability of FFR-CT to detect the absence of hemodynamically significant lesions in patients with high-risk NSTE-ACS admitted in the emergency department with chest pain, study design and rationale.

BACKGROUND: In the era of High-sensitive troponin (hs-Tn), up to 50% of patients with a mild increase of hs-Tn will finally have a normal invasive coronary angiogram. Fractional Flow Reserve (FFR) derived from coronary computed tomographic angiography (FFR-CT) has never been used as a non-invasive tool for the diagnosis of coronary artery disease in patients with high-risk acute coronary syndrome without ST segment elevation (NSTE-ACS). AIMS: The study aims to determine the role of coronary CT angiography and FFR-CT in the setting of high-risk NSTE-ACS. METHODOLOGY: We will conduct a prospective trial, enrolling 250 patients admitted with high-risk NSTE-ACS who will rapidly undergo a coronary CT angiography and then a coronary angiography with FFR measurements. Results of coronary CT, FFR-CT and coronary angiography (± FFR) will be compared. POTENTIAL SIGNIFICANCE: In conclusion, non-invasive identification of patients with high-risk NSTE-ACS who could avoid coronary angiography would reduce procedure related risks and medical costs.

Why optional inferior vena cava filters are not always retrieved? A real world 19 years experience in a Swiss tertiary care university hospital.

BACKGROUND: inferior vena cava filters (IVCF) are widely used to prevent thromboembolic events in patients not suitable for anticoagulation (AC). Although new generations of filters are optional and therefore retrievable, most of them become permanent. Aim of our study was to evaluate real life IVCF management in a tertiary hospital including retrieval rates and reasons for permanent filtering. MATERIALS AND METHODS: Electronic charts from patients receiving IVCF in a Swiss university hospital, during 1999-2017, were retrospectively identified. Patients were classified in two groups, according to filter retrieval (RG) or not (NRG). Type and reasons of filter placement were assessed. Retrieval, complications, and mortality rates were calculated. Reasons of non-retrieval were analyzed. RESULTS: 920 patients received an IVCF during 1999-2017. Filters were retrieved in 372 patients (40.65%). Subjects in the NRG were significantly older, more chronically ill, and presented higher mortality rate at 12 months following filter insertion (29.60% vs. 4.30%; p < 0.001). Reasons for non-retrieval included lack of follow-up (22.34%), persistent contraindications to AC (20.51%), technical issues (17.40%), and severe morbidity with short life expectancy (17.22%). Overall, complication rates after filter placement was 18.58%. Most reported complication was filter thrombosis (15.60%). CONCLUSIONS: In a real life setting, optional IVCF are still too often left in place indefinitely. Need for a systematic follow-up to ensure prompt filter retrieval is warranted. IVCF are not retrieved mostly in chronically and more severely ill patients, likely accounting for higher mortality in these subjects.

Total Endovascular Repair of Post-Trauma Ascending Aortic Pseudoaneurysm and Secondary Superior Vena Cava Syndrome.

BACKGROUND: Clavicular fracture or sternoclavicular luxation is observed in 10% of all polytrauma patients and is frequently associated with concomitant intrathoracic life-threatening injuries. Posterior sternoclavicular luxation is well known to induce underlying great vessels damage. The gold standard treatment usually is a combined orthopedic and cardiovascular surgical procedure associating vascular repair, clavicular open reduction, and internal fixation. METHODS: A 59-year-old wheelchair ridden, institutionalized woman, known for psychiatric disorder, severe scoliosis, malnutrition, and chronic obstructive pulmonary disease was admitted in our hospital for chronic chest pain 3 months after a stairway wheelchair downfall. A thoracic computed tomography (CT) scan revealed a voluminous ascending aortic pseudoaneurysm (63 × 58 mm, orifice 5 mm) consecutive to perforation following posterior sternoclavicular luxation. The patient refused all therapies and was lost to follow-up. Six months later, she was readmitted for a symptomatic superior vena cava syndrome. Thoracic CT scan revealed pseudoaneurysm growth with innominate vein thrombosis and superior vena cava subocclusion. Pseudoaneurysm orifice was stable. In the presence of symptoms with massive facial edema and inability to open her eyelids, the patient accepted an endovascular treatment. RESULTS: The procedure was performed under general anesthesia using both fluoroscopic and transesophageal echocardiographic guidance. Through a femoral arterial access, a 10-mm atrial septal defect occluder device was used to seal successfully the pseudoaneurysm orifice. The superior vena cava was then opened with a 26-mm nitinol high radial force stent through a femoral venous access. Postoperative course was uneventful. At 3-month follow-up, the patient remains symptom free and a CT scan confirmed pseudoaneurysm thrombosis and superior vena cava permeability. CONCLUSION: Post-traumatic sternoclavicular posterior luxation is a cause of great vessels and ascending aorta injuries. Minimally invasive endovascular approaches can be considered to treat vascular injuries and their consequences, especially in elderly patients and those at high risk for surgery.

[Cardiac CT in cardiology in 2019†: major role and extended applications]. / CT-scan en cardiologie en 2019†: un rôle central et des applications étendues.

This article aims to clarify the value of cardiac CT as well as its new applications in the different areas of cardiology for both diagnosis and pretreatment evaluation, including stable coronary artery disease, acute coronary syndrome, valvular disease and the functional and morphological evaluation of the heart.

Cet article a pour objectif de préciser l'intérêt du CT-scan cardiaque et de ses nouvelles applications dans les différents domaines de la cardiologie aussi bien pour le diagnostic que pour l'évaluation préthérapeutique, notamment la maladie coronarienne stable, le syndrome coronarien aigu, les maladies valvulaires ainsi que l'évaluation fonctionnelle et morphologique du cœur.

Case report of an unusual combination of purulent pericarditis and false aneurysm of the ascending aorta.

BACKGROUND: Purulent pericarditis is an uncommon entity, which is, in very rare cases, associated to infection of the aorta. CASE PRESENTATION: We present the case of a 42-year-old male patient, who was admitted to hospital complaining of tiredness, diarrhea and leg edema. Clinical examination revealed a hypotensive and obviously shocked patient. He was ultimately diagnosed with a rare combination of purulent pericarditis followed by false aneurysm of the ascending aorta. He was successfully treated by surgical pericardial drainage, replacement of the ascending aorta and antibiotics. CONCLUSION: Mycotic aneurysms can rarely be associated with purulent pericarditis. Our literature review shows that there are two mechanisms explaining this association and that in most of the published cases infective endocarditis could not be demonstrated.

[Rare vascular diseases, building dedicated multidisciplinary specialized center]. / Maladies vasculaires rares, mise en place d'un centre multidisciplinaire spécialisé au CHUV.

Rare Vascular Diseases (RVD) encompass different types of vessel involvement. Some cause a dilation, others a weakening or tortuosity of the arterial wall, others an obstruction or excessive calcification of arterial walls. Clinical pathway of patients with RVD to diagnosis is often long and complex. Thus, in order to allow early diagnosis and coordinated multidisciplinary management and follow-up, a specialized RVD centre has been set-up at the CHUV, following the framework of the national concept of rare diseases.

Les maladies vasculaires rares (MVR) englobent différents types d'atteintes des vaisseaux. Certaines engendrent une dilatation ou une tortuosité de la paroi artérielle, d'autres une fragilisation de la paroi, d'autres encore entraînent une obstruction du vaisseau, une calcification excessive des parois, ou des malformations vasculaires. Comme pour toutes les maladies rares, le parcours des patients vers un diagnostic est souvent long et complexe. Afin de permettre un diagnostic le plus précoce possible, ainsi qu'un suivi coordonné et une prise en charge multidisciplinaire médicale et sociale, un centre des MVR a été mis en place au CHUV, dans le cadre du concept national des maladies rares.

[Deep vein thrombosis in uncommon localisations]. / Thromboses veineuses profondes de localisation inhabituelle.

Venous thromboembolism (VTE) with its two components, deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common disease with an incidence of 0,75­2,69/1000. Deep vein thrombosis is localized in unusual sites in about 10 %, and rare DVT's have specific symptoms and risk factors. Uncommon DVT's are often related to local factors, inflammation, cancer, hematologic diseases and thrombophilia. Their diagnostic workup is less straightforward than in suspected VTE of lower limbs and PE, and rare DVT's are often unexpected findings of imaging studies. By extrapolating evidence of lower limbs VTE, most rare DVT are treated by anticoagulants, except retinal vein thrombosis. However, evidence for the type and duration of anticoagulation is limited.

La maladie thromboembolique veineuse avec ses deux facettes, la thrombose veineuse profonde et l'embolie pulmonaire (EP), est fréquente (incidence 0,75­2,69 ‰). Environ 10 % des thromboses ont des localisations inhabituelles et sont caractérisées par des symptômes et étiologies spécifiques. Les thromboses rares sont souvent liées à des facteurs locaux, inflammatoires, des néoplasies, des maladies hématologiques ou une thrombophilie. La démarche diagnostique est moins standardisée par rapport à celle pour les thromboses des membres inférieurs et souvent il s'agit de découvertes fortuites d'imagerie. Avec l'exception de la thrombose rétinienne, une anticoagulation thérapeutique est instaurée dans la majorité des cas, en analogie au traitement des autres thromboses, cependant avec un faible niveau d'évidence quant au choix et à la durée de l'anticoagulation.