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Venous thromboembolism (VTE) rarely occurs during childhood and, with few exceptions, should be considered as a disease of sick children. Current recommendations concerning the duration of anticoagulant treatment for paediatric VTE are essentially based on the results of clinical trials conducted in adults. Yet the underlying medical conditions, incidence, and anatomical locations of the disease, as well as the rates of unprovoked VTE, morbidity, and mortality, differ between adults and children. Unprovoked VTE is uncommon in childhood. Most children experiencing VTE present risk factors, such as the presence of a central venous catheter (CVC), cancer, chemotherapy (in particular with asparaginase or steroids), obesity, severe infection, congenital cardiopathy (notably in conjunction with hepatic venous stasis), serious trauma, an anatomical venous anomaly (such as atresia or agenesia) or a nephrotic syndrome (inducing a deficit in antithrombin or protein S), premature birth, or maternal combined oral contraception. The recent possibility of administering direct oral anticoagulants (DOAC) to children undoubtedly constitutes the greatest change in the treatment of paediatric VTE. The advantages of this therapy include the possibility of its oral administration, even in infants, the absence of any need for laboratory follow-up, and the lack of food interactions. With the approval of the direct factor Xa inhibitor rivaroxaban (by the European Medicines Agency and Health Canada), and the direct thrombin inhibitor dabigatran (by the European Medicines Agency and the US Food and Drug Administration), paediatric anticoagulant therapy is changing. Only rivaroxaban currently has a Marketing Authorisation in France for the treatment of childhood VTE., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Objective: Numerous guidelines have been published on the management of venous thromboembolism (VTE). However, therapeutic decision-making may prove challenging in routine clinical practice. With this in mind, multidisciplinary team (MDT) meetings have been set up in Rennes University Hospital, France. This study sought to describe the situations discussed during MDT meetings and to assess whether the meetings bring about changes in the management of these patients., Materials and Methods: A retrospective single-center study conducted at the Rennes University Hospital included cases presented from the beginning of the MDT meetings (February 2015) up to May 2017., Results: In total, 142 cases were presented in 15 MDT meetings, corresponding to a mean of 10±4 cases per meeting. Of these, 129 related to VTE patients: 33 provoked VTEs, 22 unprovoked VTEs, 49 cancer-related VTEs, and 25 unspecified VTEs. MDT meetings led to significant changes in the anticoagulation type (therapeutic, prophylactic, or discontinuation) and duration, but not in the anticoagulant choice (direct oral anticoagulants, vitamin K antagonists, heparins, etc.)., Conclusion: Requests for MDT meetings are made for all VTE types, and these meetings have an impact on VTE management., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Venous insufficiency is a very common disease affecting about 25% of the French population (if we combine all stages of its progression). It is a complex disease and its aetiology has not yet been fully elucidated. Some of its causes are well known, such as valvular dysfunction, vein wall defect, and the suctioning effect common to all varicose veins. These factors are generally associated and together lead to dysfunction of one or more of the saphenous veins. Saphenous vein dysfunction is revealed by ultrasound scan, a reflux lasting more than 0.5 seconds indicating venous incompetence. The potential consequences of saphenous vein dysfunction over time include: symptoms (heaviness, swellings, restlessness, cramps, itching of the lower limbs), acute complications (superficial venous thrombosis, varicose bleeding), chronic complications (changes in skin texture and colour, stasis dermatitis, eczema, vein atresia, leg ulcer), and appearance of unaesthetic varicose veins. It is not possible to repair an incompetent saphenous vein. The only therapeutic options at present are ultrasound-guided foam sclerotherapy, physical removal of the vein (saphenous stripping), or its thermal ablation (by laser or radiofrequency treatment), the latter strategy having now become the gold standard as recommended by international guidelines. Recommendations concerning thermal ablation of saphenous veins were published in 2014 by the Société française de médecine vasculaire. Our society has now decided to update these recommendations, taking this opportunity to discuss unresolved issues and issues not addressed in the original guidelines. Thermal ablation of an incompetent saphenous vein consists in destroying this by means of a heating element introduced via ultrasound-guided venous puncture. The heating element comprises either a laser fibre or a radiofrequency catheter. The practitioner must provide the patient with full information about the procedure and obtain his/her consent prior to its implementation. The checklist concerning the interventional procedure issued by the HAS should be validated for each patient (see the appended document)., (Copyright © 2020. Published by Elsevier Masson SAS.)

Leg pain is a common debilitating symptom in athletes. Vascular disease is not often proposed as a possible cause. Maximal exercise with measure of the ankle-brachial index after exercise can be an interesting diagnostic test. We report an illustrative case where an athlete presented leg pain revealing arterial disease disclosed by exercise. Interestingly, sub-maximal exercise did not cause pain, causing a delay in diagnosis. The vascular origin of leg pain can be detected with a maximal exercise test that induces the symptomatic pain or at least clinical discomfort., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Objectives: Cardiovascular diseases are strongly related to dietary habits. Diet can be assessed using dedicated questionnaires that can be self-completed by subjects but with the risk of errors., Aim: To compare the completion error rate of two questionnaires designed to assess dietary pattern linked to cardiovascular diseases and to study the correlation between the two questionnaires., Materials and Methods: Two questionnaires were used to assess dietary patterns of students: the 14-item Food-Frequency-Questionnaire (FFQ) that was validated against biomarkers, and the Cardiovascular-Dietary-Questionnaire 2 (CDQ2), which is a 19-item-FFQ derived from the previous 14-item FFQ. Both questionnaires assessed the intake of various food groups associated with either favourable or unfavourable effects on cardiovascular risk. A global dietary score was calculated for each questionnaire., Results: FFQ and CDQ2 were completed by 150 sport degree students. In the case of FFQ, 111 questionnaires out of 150 (74.0%) were incomplete compared to only 1 CDQ2 out of 150 (0.7%) (P<0.001). The correlation coefficient between the overall CDQ2 score and the FFQ dietary score was 0.53 (P<0.01)., Conclusion: The self-completion of CDQ2 compared to FFQ was associated with far less errors. There was a significant correlation between CDQ2 and FFQ. Preference should be given to CDQ2 in clinical practice and in studies where dietary pattern are evaluated without any interviewer., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Lower extremity peripheral artery disease is a frequent disease. Arterial Doppler waveforms analysis is a key element in vascular medicine, especially to diagnose lower peripheral artery disease. Although Doppler waveforms are often used, descriptions are highly heterogeneous. This review presents the simplified Saint-Bonnet classification that is tought to vascular medicine residents in order to homogenize arterial flow description., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)