Service de Chirurgie Vasculaire

Le Touquet – Paris-Plage, France

Service de Chirurgie Vasculaire

Le Touquet – Paris-Plage, France
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Saadoun D.,Service de Medecine Interne 2 | Saadoun D.,Laboratory I3 Immunology | Lambert M.,French Institute of Health and Medical Research | Lambert M.,Lille University Hospital Center | And 12 more authors.
Circulation | Year: 2012

Background-With recent advances in endovascular treatment, percutaneous endoluminal angioplasty has become particularly attractive for arterial lesions of Takayasu arteritis. However, data came from case reports or small series, and the long-term outcome has not been reported. The incidence of potential vascular complications after surgery or endovascular treatment is still to be determined. Methods and Results-This retrospective multicenter study analyzed the results and outcomes of 79 consecutive patients with Takayasu arteritis (median age, 39 years; interquartile range [IQR], 25-50 years; 63 women [79.7%]) who underwent 166 vascular procedures (surgery, 104 [62.7%]; endovascular repair, 62 [37.3%]) for the management of arterial complications. After a follow-up of 6.5 years (IQR, 2.2-11.5 years), 70 complications were observed, including restenosis (n=53), thrombosis (n=7), bleeding (n=6), and stroke (n=4). The overall 1-, 3-, 5-, and 10-year arterial complication-free survival rates were 78% (IQR, 69%-88%), 67% (IQR, 57%-78%), 56% (IQR, 46%-70%), and 45% (IQR, 34%-60%), respectively. Among the 104 surgical procedures, 39 (37.5%) presented a complication compared with 31 of the 62 (50%) with endovascular repair. In multivariate analysis, biological inflammation at the time of revascularization (odds ratio, 7.48; 95% confidence interval, 1.42-39.39; P=0.04) was independently associated with the occurrence of arterial complications after the vascular procedure. Patients who experienced complications had higher erythrocyte sedimentation rates (P< 0.001) and C-reactive protein (P< 0.001) and fibrinogen (P< 0.005) serum levels compared with those without complications. Conclusions-The overall 5-year arterial complication rate was 44%. Biological inflammation increased the likelihood of complications after revascularization in patients with Takayasu arteritis. Copyright © 2012 American Heart Association. All rights reserved.

Pesenti S.,Service de neurochirurgie | Bartoli M.A.,Service de chirurgie vasculaire | Blondel B.,Service dorthopedie | Peltier E.,Service de neurochirurgie | And 2 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Our objective was to describe the management and prevention of thoracic aortic injuries caused by a malposition of pedicle screws in corrective surgery of major spine deformities. Positioning pedicle screws in thoracic vertebras by posterior approach exposes to the risk of injury of the elements placed ahead of the thoracic spine, as the descending thoracic aorta. This complication can result in a cataclysmic bleeding, needing urgent vascular care, but it can also be totally asymptomatic, resulting in the long run in a pseudoaneurysm, justifying the systematic removal of the hardware. We report the case of a 76-year-old woman who underwent spinal correction surgery for thoraco-lumbar degenerative kypho-scoliosis. Immediately after the surgery, a thoracic aortic injury caused by the left T7 pedicle screw was diagnosed. The patient underwent a two-step surgery. The first step was realized by vascular surgeons and aimed to secure the aortic wall by short endovascular aortic grafting. During the second step, spine surgeons removed the responsible screw by posterior approach. The patient was discharged in a rehabilitation center 7 days after the second surgery. When such a complication occurs, a co-management by vascular and spine surgeons is necessary to avoid major complications. Endovascular management of this kind of vascular injuries permits to avoid an open surgery that have a great rate of morbi-mortality in frail patients. Nowadays, technologies exist to prevent this kind of event and may improve the security when positioning pedicle screws. © 2014 Elsevier Masson SAS.

Garot M.,Service de Reanimation Medicale et Maladies Infectieuses | Delannoy P.-Y.,Service de Reanimation Medicale et Maladies Infectieuses | Meybeck A.,Service de Reanimation Medicale et Maladies Infectieuses | Sarraz-Bournet B.,Service de chirurgie vasculaire | And 4 more authors.
BMC Infectious Diseases | Year: 2014

Background: Mortality associated with aortic graft infection is considerable. The gold standard for surgical treatment remains explantation of the graft. However, prognostic factors associated with early mortality due to this surgical procedure are not well-known.Methods: Retrospective analysis of patients admitted in our center between January 2006 and October 2011 for aortic graft infection. The primary endpoint was in-hospital mortality. A bivariate analysis of characteristics of patients associated with in-hospital outcome was performed.Results: Twenty five evaluable patients were studied. All patients were male. Their mean age was 67 ± 8.4 years. Most of them (92%) had severe underlying diseases. An in situ prosthetic graft replacement, mainly using cryopreserved arterial allografts, was performed in all patients, excepted one who underwent extra-anatomic bypass. Causative organisms were identified in 23 patients (92%). The in-hospital mortality rate was 48%. Among pre-operative characteristics, age ≥ 70 years, creatinine ≥ 12 mg/L and C reactive protein ≥ 50 mg/L were significantly associated with in-hospital mortality. Hospital mortality rates increased with the number of risk factor present on ICU admission, and were 0%, 14.3%, 85.7% and 100% for 0, 1, 2 and 3 factors, respectively. The only intra-operative factor associated with prognosis was an associated intestinal procedure due to aorto-enteric fistula. SAPS II, SOFA score and occurrence of medical or surgical complications were postoperative characteristics associated with in-hospital mortality.Conclusion: Morbidity and mortality associated with surgical approach of aortic graft infections are considerable. Age and values of creatinine and C Reactive protein on hospital admission appear as the most important determinant of in hospital mortality. They could be taken into account for guiding the surgical strategy. © 2014 Garot et al.; licensee BioMed Central Ltd.

Legout L.,Coty | D'Elia P.V.,Center hospitalier Dron | Sarraz-Bournet B.,Center hospitalier Dron | Haulon S.,Service de chirurgie vasculaire | And 3 more authors.
Medecine et Maladies Infectieuses | Year: 2012

Prosthetic vascular graft infection is a rare but very severe complication with a high death rate. Its optimal management requires appropriate surgical procedures combined with adequate antimicrobial treatment in reference center. The authors wanted to focus on the management of prosthetic vascular graft infection and define the clinical, microbiological, biological, and radiological criteria of vascular graft infection. Complementary investigations, although these are small series, include CT scan, the gold standard for the diagnosis of acute infection with a sensitivity and specificity reaching 100%, but decreased to 55% in case of chronic infection. More recently, PET-scanning was studied and yielded good results in chronic infections (sensitivity 98%, specificity 75.6%, positive predictive value 88.5%, and negative predictive value 84.4%). Managing prosthetic vascular graft infection, as with the orthopedic and vascular infections, requires replacing the vascular prosthesis. There is no correlation between the microbiological data and the location or type of vascular infection. Thus, the postoperative intravenous antibiotherapy should be bactericidal with a broad-spectrum. After obtaining intra-operative microbiological results, de-escalation therapy must include at least one anti-adherence agent, such as rifampicin in staphylococcal infections. © 2012 Elsevier Masson SAS.

Leroy O.,Service de Reanimation et Maladies Infectieuses | Meybeck A.,Service de Reanimation et Maladies Infectieuses | Sarraz-Bournet B.,Service de Chirurgie Vasculaire | D'Elia P.,Service de Chirurgie Vasculaire | Legout L.,Service University des Maladies Infectieuses et du Voyageur
Current Opinion in Infectious Diseases | Year: 2012

PURPOSE OF REVIEW: This review provides a focus on infections of prosthetic vascular grafts used to treat peripheral arterial diseases. RECENT FINDINGS: The incidence of infections varies between 1 and 6%. Risk factors of infection are not well identified. Main causative pathogens are Gram-negative bacilli, Staphylococcus aureus, and coagulase-negative staphylococci, without clear differences according to location of graft and time of onset of infection. There is no consensual diagnostic criterion. The basic principles for management of graft infections have been known for many years. A surgical approach combining graft excision, complete debridement, and maintaining distal vascular flow is required. Antimicrobial therapy is always instituted to reduce sepsis and prevent secondary graft infection, but there are no evidence-based data to recommend any regimen. However, antibiotics should have bactericidal activity whatever the bacteria growth phase, reduce the microbial burden, penetrate within the biofilm, and prevent further biofilm formation. Mortality and morbidity from these infections remain significant. SUMMARY: A multidisciplinary approach with a limited number of reference centres, recruiting sufficient numbers of patients to perform controlled trials, and to provide expert recommendations, could be the best way to answer unresolved questions and improve the prognosis. © 2012 Lippincott Williams & Wilkins, Inc.

Endovenous laser ablation has become a very popular technique in the treatment of saphenous vein reflux. Even if this treatment obtains high occlusion rates, still some side-effects can be expected. Certain problems such as postoperative ecchymosis, bruising and pain jeopardise the recovery. In the past ten years, the endovenous technique evolved quickly and became more performant. Adaptions in protocol, energy use, laser wavelength and new fibres was been proposed. These in order to prevent some of the known complications. First there has been a switch from the use of lower wavelength lasers to higher wavelength lasers. The emitted light energy of lower wavelength lasers (810, 940, 980 nm) is less specific absorbed by their chromophores (hemoglobin, water, proteins)compared to higher wavelength lasers (1320,1470,1500nm). The clinical use of higher wavelength lasers should result in equal occlusion rates and less postoperative pain. Unfortunally there is only one trial comparing the use of lower versus higher wavelength lasers. Also most studies publishing results of the use of higher wavelengths report the use of lower energy deposits compared to the use of lower wavelength lasers. This makes it difficult to make any conclusions regarding the post procedural sequelae. In our opinion most of the side-effects of EVLA are due to the use of a bare fibre. The direct contact between the 'bare' fiber-tip and the vein wall causes a very uneven energy distribution to the vein wall. This results in a destruction and ulceration or perforation of the vein while other parts of the vein wall are unaffected. The resulting uneven application of energy may be the cause of some of the complications of EVLA, such as postoperative ecchymosis, inflammation around the treated vein and pain. In order to have a more even energy distribution to the vein wall, several new fibre designs have been developed. First the "Tulip-tip" was developed to eliminate contact of the tip from the vein wall by means of geometric constraints. The 'Tulip-like petals act as an elastic resistance against the vein wall and center the fiber-tip intraluminal. A histological study showed that avoiding the direct contact between the fibre tip and the vein wall, and centring the fibre tip intraluminally, results in a more homogeneous vein wall destruction, fewer vein wall perforations and less perivenous tissue destruction. The "NeverTouch™ fiber" is similar to the bare fiber except a tube with a lens has been placed over the distal tip. This causes the light to be more divergent thus lowering the energy density. The claim is that it diffuses the energy over a 2.2x larger area, causing a 56% lower energy density. Finally the "Radial tip", is a quartz tip with a cone shape inside in order to reflect the laser light in a radial direction and broaden the area. In some studies it has been shown that the use of those new fibers results in less side-effects, such as less postoperative ecchymosis, bruising and pain. However, for most new fibre-types, there still is a lack of randomized comparative clinical trials necessary to make any final conclusion.

Rhissassi B.,Service de Chirurgie Vasculaire | Bahnini A.,Service de Chirurgie Vasculaire | Kieffer E.,Service de Chirurgie Vasculaire
Annals of Vascular Surgery | Year: 2011

Although congenital abnormalities of the inferior vena cava (IVC) are rare, they can lead to serious hemorrhagic complications, especially during aortoiliac surgery. The most frequent complications include the double IVC, left-sided IVC, and the left retroaortic renal vein isolated or associated with a preaortic renal vein forming a periaortic venous collar. Preaortic primitive iliac vein represents an exceptional anatomic entity and only a few cases have been reported in previously published data (Ruemenapf et al., J Vasc Surg 1998;27:767-771; Schiavetta et al., J Vasc Surg 1998;28:719-722; Shindo et al., Ann Vasc Surg 2000;14:393-396; Balbridge and Canos, Arch Surg 1987;122:1184-1188; Honkasalo et al., Acta Chir Scand 1983;149:717-719; Brener et al., Arch Surg 1974;108:159-165; Vohra and Leiberman, Eur J Vasc Surg 1991;5:209-211; McClure and Huntington, Am Anat Memoirs 1929;15:1-55). In this study, we report two cases of preaortic left primitive iliac vein. The first patient was a male who was operated on for an aortobiiliac aneurysm. The second was of a female patient who was operated on for an interaortocaval lymphadenopathy that resulted from ganglion curettage performed for ovarian cancer. © Annals of Vascular Surgery Inc.

Abissegue Y.,Service de Chirurgie Vasculaire | Lyazidi Y.,Service de Chirurgie Vasculaire | Chtata H.T.,Service de Chirurgie Vasculaire | Taberkant M.,Service de Chirurgie Vasculaire
Annals of Vascular Surgery | Year: 2014

Femoral false aneurysms are rare. They are one of the main complications of femoral catheterization, trauma of this area, or the use of intravenous drugs. They usually occur in the days after femoral puncture, and only rarely occur years after the procedure or incident. Treatment often requires complex surgical methods. We report the management of a patient with a ruptured infected femoral false aneurysm that was diagnosed 4 years after a femoral puncture performed in intensive care unit to perform peripheral arterial catheter hemodynamic monitoring. The patient was operated with exclusion of the aneurysm and prosthetic bypass, associated with intravenous antibiotics adapted to the bacterial strain grown from the operative site, which resulted in a favorable outcome. © 2014 Elsevier Inc. All rights reserved.

Malikov S.,Service de Chirurgie Vasculaire | Thomassin J.M.,Service dOto Rhino Laryngologie | Magnan P.E.,Service de Chirurgie Vasculaire | Keshelava G.,Service de Chirurgie Vasculaire | And 2 more authors.
Journal of Vascular Surgery | Year: 2010

Objectives: Aneurysms of the internal carotid artery (ICA) at the base of the skull are uncommon dangerous lesions whose management remains unclear. The aim of this retrospective study is to report a standardized surgical technique of ICA reconstruction with long-term results. Methods: Between 1988 and 2005, 13 patients (11 men; age 18 to 76 years, mean 42.6 years) underwent lateral skull base approach with cervical-to-petrous carotid artery bypass for repair of ICA aneurysms. Principal elements of the technique were: partial resection of the parotid gland without rerouting of the facial nerve; luxation of mandibula; drilling of the bone. Results: The 13 patients had unilateral aneurysm of the ICA at the base of the skull. Four aneurysms were of atherosclerotic origin; six fibromuscular dysplasia; two post-traumatic; one cause was undetermined. The mean diameter of the aneurysms was 12 mm (range, 7-21 mm). Twelve patients were symptomatic: six presented neurological events (four strokes, two transient ischemic attack [TIA]); two retinal events; three compressive symptoms (two Horner's syndrome and one paralysis of the glossopharyngeal nerve); one patient presented a visible pulsatile mass in the neck. One patient was asymptomatic. There were no post-operative deaths, one TIA, 13 transient palsies of the lower facial nerve, and one transient palsy of accessory nerve. Palsy of cranial nerves was partial and disappeared within a mean of 5.6 months (range, 1-10 months). The postoperative angiogram showed patency in all but one case (one asymptomatic thrombosis). During follow-up (mean, 152 months), there was one unrelated death, one focal epileptic seizure, and one controlateral TIA. In November 2008, duplex showed patency of all 11 grafts (one death, one thrombosis). At 10 years, the survival, cumulative stroke-free survival, ipsilateral stroke-free, and patency rates was were 90.9%, 100%, 100%, and 92.3%. Conclusion: Venous graft bypass from the cervical-to-petrous ICA can be performed safely with such an approach and produces durable satisfactory results. © 2010 Society for Vascular Surgery.

Arsicot M.,Service de Chirurgie Vasculaire | Lathelize H.,Service de Chirurgie Vasculaire | Martinez R.,Service de Chirurgie Vasculaire | Marchand E.,Service de Chirurgie Vasculaire | And 2 more authors.
Annals of Vascular Surgery | Year: 2014

Background The long-term follow-up of patients with endovascular aneurysm repair (EVAR) and a normal surgical risk was defined by the French National Authority for Health (Haute Autorité de Santé) in 2009. The monitoring of the volume of the aneurysm sac theoretically avoids the bias related to the measurement of its diameter alone. The objective of this study was to evaluate how reliable and reproducible the volumetric measurement of the aneurysm sac by ultrasound was compared with computerized tomography angiography (CTA).Methods We carried out a retrospective diagnosis study of 75 consecutive patients treated with EVAR in our institution who were monitored with 3-dimensional ultrasonography (3DU) and CTA between January 2010 and December 2012. The measurement of the volume (cm3) of the aneurysm sac with a Toshiba Aplio XG ultrasound system equipped with a 3-MHz 3-dimensional probe was compared with the volume obtained by CTA. Interoperator reproducibility was studied in the last 45 enrolled patients; 2 different blinded operators made 2 volumetric measurements on the same patients, on the same day. An analysis of a 48-patient subgroup in which at least two 3DU were performed during follow-up was also carried out to determine the threshold value of the increase in the volume of the aneurysm sac, making it possible to suspect the presence of an endoleak.Results A total of 116 pairs of examinations were compared (the patients who had the longest postoperative follow-up had 4 pairs of compared examinations). The correlation between volumetric ultrasound and CTA measurements was excellent (r = 0.931; P < 0.0001) in the 116 pairs of examinations, and so was the reproducibility of volumetric echography (r = 0.949; P < 0.0001) in 45 patients. The subgroup study highlighted the fact that a 6.5-cm3 increase of the aneurysm sac made it possible to suspect the presence of an endoleak in comparison with CTA as the gold standard (sensitivity and specificity were 85.7% and 85.3%, respectively). The area under the curve was 0.854 (95% confidence interval, 0.793-0.915). In the 116 examinations, a good correlation between volume and diameter was calculated with CTA (r = 0.733; P < 0.0001) and between ultrasound volumetric and CTA diameter (r = 0.660; P < 0.0001).Conclusions Volumetric echography is comparable with CTA for the evaluation of the aneurysm sac after EVAR, reproducible and inexpensive. When a significant increase of the volume of the sac is detected by ultrasound, the examination can be supplemented by an injection of ultrasound contrast agent or by CTA to visualize an endoleak. © 2014 Elsevier Inc. All rights reserved.

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