[Contrast induced nephropathy : myth or reality ?] / Néphropathie aux produits de contraste iodés : mythe ou réalité ?

Contrast induced nephropathy has long been considered as the third cause of inpatients acute renal insufficiency after functional renal insufficiency and acute tubular necrosis. This entity is now controversial. Numerous studies failed to show a direct link between intravenous iodinated contrast injection and a worsening of renal function after injected scanners in patients with normal renal function. The notion of contrast induced nephropathy remains integrated in the practice of the majority of physicians, who often overestimate this risk.

La néphropathie induite par l'injection de produits de contraste iodés (PCI) a longtemps été considérée comme étant la 3e cause d'insuffisance rénale aiguë intrahospitalière, derrière l'insuffisance rénale fonctionnelle et la nécrose tubulaire aiguë. Aujourd'hui, cette entité est toutefois de plus en plus controversée. Plusieurs méta-analyses récentes n'ont pas pu démontrer de lien entre l'injection intraveineuse de PCI et une altération de la fonction rénale après scanners injectés, chez des patients ayant une fonction rénale normale. Malheureusement, cette notion de néphropathie aux PCI reste bien ancrée dans la pratique médicale de la majorité des médecins qui ont tendance à surestimer ce risque.

[Intermittent claudication and critical limb ischemia : from diagnosis to management]. / Patient claudicant et ischémie critique : du diagnostic à la prise en charge.

In case of atheromatous disease, the practitioner should be part of a multidisciplinary decision due to the associated comorbities. The angiologic assessment is of paramount importance in the diagnosis of peripheral artery disease even when the diagnosis seems clear. Unfortunately the patient is very often straightforward sent to radiological investigations who are faster. In all stages of peripheral artery disease, the medical treatment should be tried first except in case of critical limb ischemia where an invasive approach must be performed for revascularisation. In case of lifestyle-limiting symptoms and only after failure of medical treatment a revascularisation strategy is then indicated.

Chez le patient athéromateux, le médecin traitant est souvent au centre d'une prise en charge qui doit être pluridisciplinaire en raison des comorbidités associées. L'examen angiologique est d'une importance primordiale dans le diagnostic de l'insuffisance artérielle des membres inférieurs, même lorsque le diagnostic semble évident. Le patient est malheureusement trop souvent adressé à tort directement en radiologie pour bénéficier d'examens plus rapides. Quel que soit le stade de l'insuffisance artérielle des membres inférieurs, le traitement est toujours médical en première intention sauf au stade d'ischémie critique où un geste invasif de revascularisation est indiqué d'emblée. En cas de symptômes altérants la qualité de vie et seulement après l'échec d'un traitement médical, un geste de revascularisation pourra être proposé.

Pancreaticoduodenal Artery Pseudoaneurysm Associated with Pancreatic Fibroinflammatory Mass and Duodenal Obstruction.

BACKGROUND When people in their 60s experiences abdominal pain, vomiting, and unexplained weight loss without a history of abdominal surgery, the usual diagnosis is obstruction caused by a neoplastic mass. Nevertheless, in exceptionally rare cases, these symptoms arise from complications linked to a visceral artery aneurysm. CASE REPORT We present a case of a 60-year-old man with immunodeficiency and Sneddon-Wilkinson disease (a rare subcorneal pustular dermatosis), who developed a pancreaticoduodenal aneurysm of uncertain origin, associated with pancreatic mass, retroperitoneal hematoma, and duodenal obstruction. The treatment approach included transcatheter arterial coil embolization with supportive measures such as parenteral nutrition, a nasogastric tube, octreotide administration, and antiemetics. Despite these interventions, persistence gastrointestinal symptoms prompted an endoscopic ultrasound fine-needle aspiration to rule out malignancy. The biopsy confirmed localized fibro-inflammation. Although he was initially considered for a gastro-jejunal bypass, conservative management effectively improved the pancreatic lesion and duodenal obstruction, leading to discontinuation of parenteral nutrition. The patient was able to resume a regular diet 4 weeks after embolization. CONCLUSIONS Pancreaticoduodenal artery aneurysm is a rare visceral aneurysm with multiple etiologies and potentially fatal consequences. We report an unusual case of a pancreaticoduodenal artery aneurysm associated with pancreatic mass and duodenal obstruction. This diagnosis warrants consideration when an immunodeficient patient presents symptoms of abdominal pain and vomiting. Early endovascular embolization, combined with conservative approaches, effectively alleviated the symptoms in our patient.

Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm.

Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment.

Varicocele percutaneous embolization outcomes in a pediatric group: 7-year retrospective study.

PURPOSE: Percutaneous embolization and surgical repair are the current treatment options for varicocele, but determining method superiority remains controversial. In this retrospective study, we evaluate the technical success, complication and recurrence rates following percutaneous embolization in a pediatric group, which were compared to reported outcomes for surgical repairs. METHODS: Thirty children treated for percutaneous varicocele embolization were recruited. The side and grade of varicocele, symptoms, testicular asymmetry, mean recurrence time, total radiation dose and complications were evaluated. Recurrence and follow-up complications due to embolization were also reviewed. RESULTS: The venography showed retrograde filling of the internal spermatic vein with the identification of aberrantly fed vessels in 23 % of patients. None of the patients suffered from procedure complications except one who had venous injury which was treated with a sclerosing agent. The technical success rate was 93 % (28 patients) with a recurrence rate of 13 % (4 patients). Interestingly, the mean radiation dose used was 862.5 µGy m(2), 3 times lower than abdominal CT. CONCLUSION: Considering the intravascular nature of embolization, which aims to avoid testicular artery and spermatic cord damage (difficult to avoid with the surgical method), and consequently a lower complication rate, along with the same success rate and recurrence rate, our study supports that embolization is a superior method to surgical interventions.