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Splanchnic vein thrombosis includes Budd-Chiari syndrome and portal vein thrombosis. These diseases share common features: (i) they are rare diseases and (ii) they can lead to portal hypertension and its complications. Budd-Chiari syndrome and portal vein thrombosis in the absence of underlying liver disease share many risk factors, the most common being myeloproliferative neoplasms. A rapid and comprehensive workup for thrombosis risk factors is necessary in these patients. Long-term anticoagulation is indicated in most patients. Portal vein thrombosis can also develop in patients with cirrhosis, and is associated with a worse course of cirrhosis. Indications for anticoagulation in patients with cirrhosis are increasing. Transjugular intrahepatic portosystemic shunt is a second-line procedure in this setting. Because of the rarity of these diseases, high-level evidence studies are rare. However, collaborative studies have provided a better understanding of their natural history and allowed to improve the management of these patients. This review focuses on the causes, diagnosis, and management of patients with Budd-Chiari syndrome, patients with portal vein thrombosis without underlying liver disease, and patients with cirrhosis and portal vein thrombosis., (Copyright © 2023 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Infective endocarditis is an uncommon, yet serious disease responsible for high morbidity and mortality, its incidence is estimated at 3-10 cases per 100,000 person-years. Most infective endocarditis cases emanate from streptococcus and staphylococcus. The incrimination of Aeroccocus viridans is rarely described in the literature and it has a high rate of embolic complication. We report the case of a 31-year-old male patient, with no prior medical history, who was admitted to the cardiology department of Ibn Rochd university center due to a prolonged fever for over 6 months. At admission, his general condition was preserved, he was febrile at 38.7 °C, claudication in the right lower limb with a decrease in the peroneal artery pulse, a graded 4/6 diastolic aortic murmur on auscultation, and no signs of heart failure. The transthoracic echocardiography revealed a type I bicuspid aortic valve disease, severe aortic regurgitation, moderate aortic stenosis, and vegetation implanted on the ventricular side of the right coronary cusp. CT angiography of the lower limbs revealed a bilateral total occlusion of the tibioperoneal trunks extended to the proximal portions of the posterior tibial arteries and peroneal arteries with collateral circulation, endovascular collection, and occlusive calcified plaque of the proximal part of the right anterior tibial artery and the collateral circle. Blood tests showed an inflammatory syndrome. Blood cultures detected Aerococcus viridans. The patient was first put on ceftriaxone, gentamycin, unfractionated heparin, and analgesic-antipyretic when necessary, he was then transferred to the cardiovascular surgery department for replacement of the aortic valve and permeabilization of the lower limbs by the FOGARTY technique. Post-surgical results were satisfying. In conclusion, infective endocarditis secondary to Aerococcus viridans is rare but appears to be virulent because most often discovered at the stage of complications. Therefore, good antibiotic therapy adapted to the antibiogram results in a good prognosis., Competing Interests: Conflits d'intérêts Les auteurs de cet article n'ont aucun conflit ou intérêts concurrents. Tous les auteurs ont approuvé la version finale du manuscrit., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Behçet disease is a multi-systemic complex vasculitis with unknown etiology characterized by different clinical involvements, including mucocutaneous, ocular, vascular, articular, neurological and gastrointestinal manifestations. Growing evidence supports that different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, the vascular phenotype identifies a specific group of patients who suffer from recurrent inflammatory thrombosis and arterial involvement. Vascular disease develops in up to 40% with a definite male preponderance and is usually an early manifestation. It is one of the main causes of death in Behçet's disease. Venous involvement is significantly more common than arterial disease and lower extremity deep vein thrombosis is its most frequent manifestation. Arterial disease involves mostly pulmonary arteries and aorta and manifests mainly in the form of aneurysms. Glucocorticoids and immunosuppressant's are the recommended first-line treatments in vasculo-Behçet. Furthermore, randomized controlled trials are still needed to assess the role of adding anticoagulation to current standard therapy in venous thrombosis in Behçet's disease and to assess the role of anti-TNF alpha therapy in vasculo-Behçet., (Copyright © 2022 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Purpose: The aim of this study is to describe the role of imaging in the medical care of Lemierre Syndrome and to describe its US, CT and MRI features. Patients and methods: Files of patients diagnosed with Lemierre Syndrome between 2005 and 2011 at CHUV hospital have been analysed retrospectively to define its imaging semiology. Results: IJV thrombosis was demonstrated by US, CT and MRI. Septic pulmonary emboli were detected by CT. Complications of the Lemierre Syndrome were depicted by MR and CT Conclusion: US, CT or MR evidence of IJV thrombosis and chest CT suggestive of septic emboli, should lead the physician to diagnose Lemierre Syndrome, which in case of insufficient therapy can lead to death. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Décrire l’utilisation de facteur VII activé recombinant (rFVIIa) chez des patients sous ECMO centrale veino-artérielle avec une attention particulière sur les complications thrombotiques associées. Conception de l’étude: Étude rétrospective monocentrique. Patients et méthodes: Nous avons étudié les dossiers des 91 patients mis sous ECMO entre 2005 et 2010. Durant cette période, huit patients ont présenté une hémorragie réfractaire et ont reçu du rFVIIa comme thérapeutique de sauvetage. Résultats: Chez six patients, l’hémorragie a été jugulée. Une diminution du saignement a été mise en évidence après l’administration de rFVIIa (pré-rFVIIa : 40,1±33,1mL/kg par trois heures versus 5,4±3,2mL/kg par trois heures (p =0,01). Les besoins transfusionnels ont été diminués après administration de rFVIIa. Aucun évènement thrombotique n’a été détecté. Le fibrinogène, les d-dimères, la numération des plaquettes et les lactates n’ont pas été modifiés par le traitement. Deux patients ont été sevrés de l’ECMO. Un est décédé 17jours après le sevrage. L’autre patient a survécu sans séquelles neurologiques. Conclusion: Le rFVIIa est un traitement d’exception chez le patient traité avec une ECMO centrale veino-artérielle. Il ne doit pas être administré avant que toutes les thérapeutiques conventionnelles n’aient été tentées, mais peut être une solution de sauvetage en présence d’une hémorragie massive. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Despite appropriate therapy 10 to 100% of patients with deep vein thrombosis (DVT) of the lower limbs will develop post-thrombotic syndrome (PTS). The aim of this study was to evaluate the incidence of PTS in the EDITH cohort and to estimate the association between initial patients’ characteristics and the risk of development of PTS. Methods: One hundred and eighty patients included in the EDITH study for a first event of DVT of the lower limbs without clinical signs of venous insufficiency were recalled 4 years after their initial thrombotic event. PTS was diagnosed according to the Villalta score. Results: Ninety-five patients (45 men, mean age 50.7±16.9 years) were evaluated for PTS. Among them, 28.4% (95% CI 19.3–37.5) developed PTS but none had severe PTS. The most frequent clinical signs of PTS were varicose veins (59%), corona phlebectatica (48%), swelling leg (30%) and pigmented dermatitis (26%). No single risk factor was associated with PTS development (age, sex, BMI thrombophilia, etiology, localization, recurrence, symptomatic DVT and familial history of DVT). Conclusion: PTS is a frequent disease. However, lack of uniformity of diagnosis criteria in the different studies does not make possible the estimation of PTS risk factors. [ABSTRACT FROM AUTHOR]

Abstract: We report the case of a stroke due to a ballistic thoracic traumatism. The vascular injury, provoked by the passage of the bullet, associated to a procoagulating state led to the formation of a thrombus in the ascending aorta. The migration of this thrombus caused a stroke, finally reversible upon medical treatment only. [Copyright &y& Elsevier]

Summary: Introduction: Venous thromboembolic complications are well-known in patients with nephrotic syndrome. Arterial thrombosis has rarely been reported and is mainly observed in adults. Case report: A 9-year-old patient with a history of steroid-dependent nephrotic syndrome was admitted after foot trauma. He presented with severe pain in his right foot, which was cold and mottled, with reduced sensation and motor activity. No pulse was palpable in his right foot. Doppler''s ultrasonography confirmed the thrombosis of anterior and posterior tibial arteries in their distal portions. The patient received treatment with an arterial vasodilator and heparin, followed by antivitamin K therapy. Conclusion: Arterial thrombosis is a rare complication in children with nephrotic syndrome. It is presumably attributable to a hypercoagulable state and trauma. [Copyright &y& Elsevier]

Introduction: This is a clinical case illustrating a diagnosis of an IgG4 related-disease (IgG4-RD) diagnosed in a vascular context., Case Report: A 47-year-old man with no past medical history consulted for a recent and disabling Raynaud phenomenon without trophic disorder. Vascular examinations revealed multiple arterial thromboses with no abnormal finger and toe pressures. Secondly, weight loss and submandibular glands enlargement appeared, leading to the diagnosis of IgG4-RD without a link being able to be established with vascular involvement. This is the second observation of this association. A French translation of the new classification criteria for IgG4-RD published in 2019 by the American College of Rheumatology and European Ligue Against Rhumatism (ACR/EULAR) is offered with direct application to the clinical case., Conclusion: A Raynaud phenomenon with distal arterial thrombosis is rarely observed in the IgG4-RD., (Copyright © 2020. Published by Elsevier Masson SAS.)

The floating mural thrombus of abdominal aorta is a rare and serious pathology detected as cause of peripheral and visceral embolism. Isolated aortic mural thrombosis is an unusual pathology occurring in an apparently normal aorta. A thorough search of embolic source must be initiated. Therapeutic management is based on systemic anticoagulation with the use of surgical approach in some cases., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Carpal tunnel syndrome is a common peripheral neuropathy, usually idiopathic or post-traumatic due to the compression of the median nerve. Numbness and paresthesias in the median nerve distribution are the most common symptoms associated with this condition. Persistent median artery is a rare anatomic variation, thrombosis of this additional artery can be responsible for an acute carpal tunnel syndrome, and patients frequently complain about coldness and acute hand swelling. These unusual features must lead clinicians to think of a vascular cause. The diagnosis can be easily confirmed by using ultrasound doppler, but CT-scan and MRI are sometimes helpful. We describe 2 cases of acute carpal tunnel syndrome due to thrombosed persistent median artery, including a case of thromboangiitis obliterans. These thrombosis might also be due to traumatic causes. No guidelines are currently available to help physicians for the management of carpal tunnel syndrome from thrombosed persistent median artery. Antiplatelet therapy, statin, anticoagulant might be helpful, and surgery has sometimes be reported as effective., (Copyright © 2019 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Many factors can contribute to the risk of venous thrombosis observed in hemolytic diseases. Some mechanisms are related to hemolysis by itself, while others seem more specific to each disease. Despite recent advances in the quantification of this risk and in understanding its physiopathology, the association of hemolysis with venous thrombosis is often unknown. The purpose of this general review is to clarify the main pro-thrombotic mechanisms during hemolysis and to synthesize the clinical data currently available. We will focus on the main types of hemolytic pathologies encountered in current practice, namely paroxysmal nocturnal hemoglobinuria, hemoglobinopathies, auto-immune hemolytic anemia and thrombotic microangiopathies., (Copyright © 2018. Published by Elsevier Masson SAS.)

Objective: To describe the management and evolution of high risk of death pulmonary embolism associated with right heart thrombi., Material and Methods: We conducted a prospective cohort survey over a 54 month-period, from March 1st, 2012 to September 30th 2015. Were included all patients with pulmonary embolism and having high or intermediate-high risk of death. Patients were divided into two groups according to whether cardiac Doppler-echography found a thrombus in the right chambers or not (ICT+ vs. ICT-). The survival curves for the patients were obtained using the software STATA., Results: The prevalence of pulmonary embolism associated with right heart thrombi was 4% in our study. Thrombi were mobile, straight localization in all cases. The ICT+group was characterized by a significantly higher proportion of congestive heart and chronic lung disease. The proportion of patients' thrombolysis was significantly higher in the ICT-group. In the ICT+group, thrombolysis significantly reduced mortality giving a 30-day survival of 80% against 20% among patients receiving only heparin., Conclusion: Pulmonary embolism associated with right heart thrombi including the atrium are not exceptional. These patients are at high risk of early death. Thrombolysis is significantly improving the mortality of pulmonary embolism associated with right-sided heart thrombi., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

The Persistent Sciatic Artery (PSA) is an unusual anatomical variation due to the persistence of an embryological artery, which should disappear before the 3rd month of intrauterine life. The reported case is that of a woman who developed an acute ischemia of the right lower limb, revealing the presence of persistent sciatic artery. Diagnosis was made only belatedly by means of angio-CT. The amputation was the inevitable choice of treatment., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

A man presents an atypical neurological disorder. The diagnosis of aortic dissection is evoked with anisotension, but it consists in a paradoxical embolism in the presence of a permeable foramen oval since he presents with a proximal pulmonary embolus and a thrombus in the humeral artery.

The presence of a right intraventricular thrombus is a marker of severity of pulmonary embolism (PE), and is associated with high mortality. We report the case of a young patient with a PE postoperative of patellar tendon surgery. The cardiac echocardiography at its admission revealed a voluminous mobile thrombus of 1.7cm diameter located on the pulmonary trunk. Systemic thrombolysis was performed because of respiratory deterioration allowing a rapid disappearance of the thrombus and recovery. Our case emphasizes the value of a complete ultrasound analysis centered on the pulmonary trunk in the case of intermediate-risk PE. No recommendation exists on the management of these right ventricular thrombi, thrombolysis appearing to be the first-line treatment., (Copyright © 2017. Published by Elsevier SAS.)

All biological risk factors that have been previously identified to increase the risk of thrombosis in adults, have also been studied in neonates with arterial Ischemic Stroke (NAIS), but most studies were retrospective and included relatively low numbers of affected children. We therefore could not suggest recommendations with a strong level of evidence and only expert proposals potentially useful for clinical practice will be presented in this text. Despite these limitations, the extensive analysis of published data supported that factor V Leiden (FVL) and increased levels of Lp(a) could be significant risk factors for NAIS. Importantly, these 2 risk factors cannot be considered as having provoked NAIS, and moreover, they do not influence the prognosis and the immediate treatment. However, since the FVL may have an impact for the prescription of a thromboprophylaxis when the neonate will become adult, to look for its presence in affected patients may be justified. For clinical practice, the following propositions can be applied: 1. Routine testing for thrombophilia (AT, PC PS deficiency, FV Leiden or FII20210A) or for detecting other biological risk factors such as antiphospholipid antibodies, high FVIII, homocystein or Lp(a) levels, MTHFR thermolabile variant, should not be considered in neonates with NAIS. 2. Testing for FV Leiden can be performed in case of documented family history of venous thromboembolic disease. 3. Testing neonates for the presence of antiphospholipid antibodies (APA) is mandatory in case of clinical events suggesting antiphospholipid syndrome in the mother (vascular thrombosis, and/or pregnancy morbidity). 4. Routine testing for thrombophilia is not proposed in both parents in case of early death of the neonate, apart from APA in the mother., (© 2017 Elsevier Masson SAS. Tous droits réservés.)

Neonatal arterial thrombosis is unusual and generally associated with an arterial umbilical catheter. Spontaneous aortic thrombosis is exceptional but its severity is related to high mortality rate and renovascular morbidity. We report here the observation of a 10-day-old term infant showing a large abdominal aortic thrombosis revealed by cardiogenic shock induced by systemic arterial hypertension. The resolution was fast following anticoagulant and antihypertensive therapy. Etiologic investigations showed renal failure and moderate hyperhomocysteinemia controlled by a vitamin supplement. Following this observation, we did a brief review of the neonatal spontaneous arterial thrombosis literature to discuss the neonatal hemostasis specific aspects. Management of infants presenting an arterial thrombosis varies depending on the hospital and there are no guidelines at this time concerning the etiologic investigation and treatment in France or internationally., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Introduction: Rupture is the worst outcome of abdominal aortic aneurysm (AAA). The decision to operate should include counterbalancing the risk of aneurysm rupture against the risk of aneurysm repair, within the context of a patient's overall life expectancy. Current surgical guidelines are based on population studies, and important variables are missed in predicting individual risk of rupture., Methods: In this literature review, we focused on the contribution of biomechanical and mathematical models in predicting risk of AAA rupture., Results: Anatomical features as diameter asymmetry and lack of tortuosity are shown to be anatomical risk factors of rupture. Wall stiffness (due to modifications of elastin and collagen composition) and increased inflammatory response are also factors that affect the structural integrity of the AAA wall. Biomechanical studies showed that wall strength is lower in ruptured than non-ruptured AAA. Intra-luminal thrombus also has a big role to play in the occurrence of rupture. Current mathematical models allow more variables to be included in predicting individual risk of rupture., Conclusion: Moving away from using maximal transverse diameter of the AAA as a unique predictive factor and instead including biological, structural and biomechanical variables in predicting individual risk of rupture will be essential in the future and will help gain precision and accuracy in surgical indications., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

The hemorrhoidal thrombosis is an acute complication with no gravity but an emergency because of the severe pain. Oral or local medical treatments are rarely effective; they poorly relieve the pain. The realization of an incision with removal of the blood clot or of an excision is an easy procedure to perform in the consultation room. She brings an almost immediate pain relief. It only takes a few minutes and requires minimal equipment.

Venous malformation (VM) is a frequent soft tissue mass in children that should not be confused with vascular tumors. We report the case of a 10-year-old boy with a bulky thrombosed VM of the shoulder with functional disability. D-dimer levels were high. Pathognomonic phleboliths were demonstrated on conventional x-rays. Echo-doppler confirmed the venous nature of the lesion and areas without flow suspicious for thrombosis. MRI provides the deep extension and can show non-calcified thrombi that are difficult to see with ultrasound. Localized intravascular coagulopathy is often associated with thrombosis phenomena and has to be confirmed by measurement of D-dimer levels in order to initiate anticoagulation quickly with low-molecular-weight heparin. Follow-up includes measurement of D-dimer levels and potentially MRI to evaluate the anticoagulation efficacy and tailor treatment duration., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Abstract: Essential thrombocythemia is a myeloproliferative disorder responsible for both hemorrhagic and thrombotic complications mostly venous but also arterial, especially of the microcirculation. We report a 64-year-old female who presented with an aortic thrombus and splenic infarcts indicating essential thrombocythemia. Outcome was favourable with medical treatment combining low-molecular-weight heparin secondarily switched to warfarin, associated with aspirin and hydroxyurea. [Copyright &y& Elsevier]

Superior mesenteric artery aneurysms are rare. Diagnosis and treatment are a real challenge. We report two cases of this type of vascular anomaly revealed by spontaneous rupture. The diagnosis was made by abdominal computed tomography angiography and treatment consisted in aneurysmorraphy in one case and bowel resection with the distal aneurysm in the second., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

This observation relates to the discovery of native coronary paradoxical embolism secondary to thrombus adherent to the right atrium through a patent foramen ovale (PFO). A patient of 64 years, with a history of mitral regurgitation not followed, was hospitalized for acute respiratory distress due to a mitral insufficiency (MI) with a ruptured chordae and pulmonary embolism. Coronary angiography was performed and revealed two typical images of coronary embolism associated to a non-atheromatous coronary tree. The patient underwent a mitral valve replacement. After the establishment of cardiopulmonary bypass, adherent fibrin and cruoric thrombus of the right atrium and a PFO were found. The analysis of the valves did not reveal any arguments for infective endocarditis. A CT scan, performed as the patient remained unconscious after surgery, showed several cerebral infarcts. Paradoxical embolism coronary was diagnosed in front of the combination of adherent thrombus in the right atrium, pulmonary embolism and systemic coronary and cerebral embolism with a PFO. Coronary embolism rarely happens. It is mainly due to three causes: iatrogenic origin in most cases, direct causes due to micro emboli, particularly from infectious endocarditis and paradoxical embolic origin. There are two types of right atrial thrombus; the most common is the mobile thrombus from the peripheral venous system. The other one, which is more rare, is the adherent thrombus, which occurs in situ. Coronary embolism of paradoxical origin represents a small proportion of the causes of coronary embolism. However, this diagnosis must be considered., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Atherosclerotic renal artery stenosis is frequent and is associated with a high incidence of morbidity and mortality, with a strong correlation with coronary artery disease, (Kalra et al., 2005; Cheung et al., 2002; Guo et al., 2007 [1-3]). The atherosclerotic renal artery stenosis is an independent predictive factor of death (Conlon et al., 1998 [4]). The treatment of this lesion does not have strong evidence. A lot of studies in this area suggest the angioplasty is superior in a big majority between surgery, and angioplasty with stent is superior between balloon angioplasty, but some studies fail to prove the superiority of angioplasty versus medical treatment. These studies have sadly a lot of mistakes and nowadays we don't know what is the treatment for our patients in a lot of cases. The angioplasty is indicated when there is a failure of antihypertensive medications for control of blood pressure, when it is associated with a renal insufficiency quickly progressive or when there is a lesion on each renal artery. Other studies must be organized for prove the superiority of angioplasty when there is a real stenosis, maybe with the use of fractional flow reserve., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Purpose: Thrombotic events may occur in celiac disease. In this study, we analyzed clinical features and risk factors for thrombosis in seven patients who had celiac disease and thrombosis., Methods: We retrospectively studied 87 patients with adult celiac disease and identified seven cases of thrombosis. We searched if risk factors for thrombosis were identified and tested retrospectively antiphospholipid antibodies on the serum., Results: In our study, the global prevalence of thrombosis was 8 %, and 5.7 % for spontaneous thrombosis, with venous thrombosis (n=5) or arterial thrombosis (n=1) or both (n=2). The seven patients consisted in six women and one man with a mean age of 44.8 years at time of thrombosis. Thrombotic events occurred before the diagnosis of celiac disease in four cases. In three cases, venous thrombosis was in unusual sites: portal (n=2), splenic vein thrombosis (n=1). In six cases, we identified risk factors for thrombosis, which could be linked to celiac disease: hyperhomocysteinemia (n=1), protein C and S deficiency due to vitamin K deficiency (n=3) and antiphospholipid antibodies (n=2)., Conclusion: Such risk factors for thrombosis should be identified in patients in adult celiac disease in order to correct them and add a thromboembolic prophylaxis., (Copyright © 2011 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

The prevalence of significant splanchnic arterial stenoses is increasing, but remains mostly asymptomatic due to abundant collateral circulation. Acute insufficiency of mesenteric arterial blood flow accounts for 60 to 70% of cases of mesenteric ischemia and results mostly from a superior mesenteric embolus. Despite major advances have been achieved in understanding the pathogenic mechanisms of bowel ischemia, its prognosis remains dismal with mortality rates about 60%. The diagnosis of acute mesenteric ischemia depends upon a high clinical suspicion, especially in patients with known risk factors. Rapid diagnosis is essential to prevent intestinal infarction. However, early signs and symptoms of mesenteric ischemia are non specific, and definitive diagnosis often requires radiologic examinations. Early and liberal implementation of angiography has been the major advance over the past 30 years which allowed increasing diagnostic accuracy of acute mesenteric ischemia. CT and MR-based angiographic techniques have emerged as alternatives less invasive and more accurate to analyse splanchnic vessels and evaluate bowel infarction. The goal of treatment of patients with acute mesenteric ischemia is to restore intestinal oxygenation as quickly as possible after initial management that includes rapid hemodynamic monitoring and support. Surgery should not be delayed in patients suspected of having intestinal necrosis., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Primary angioplasty is the gold standard for myocardial reperfusion in patients with acute myocardial infarction with ST elevation (STEMI). Fast normalization of infarct-related coronary artery flow and no reflow prevention are correlated with clinical outcomes. Over the last years, many antithrombotic regimens have been evaluated in this setting. The use of a combined pharmacological and mechanical strategy with abciximab, and thromboaspiration of atherothrombotic debris is associated with coronary flow improvement, improvement of myocardial perfusion, and, in fine a better clinical outcome. In this respect, the current guidelines recommend a systematic manuel catheter thromboaspiration of the culprit lesion in STEMI with a class IIa, level of evidence A indication., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

The association of cholelithiasis and portal cavernoma is rarely described in adult or pediatric patients. We report 2 cases of gallstone associated with portal cavernoma in 2 girls. The first one suffered from Evans syndrome associated with congenital immune deficiency. The portal cavernoma was discovered with gallstone after splenectomy indicated because of high steroid dependence. In the second case, the cavernoma complicated neonatal umbilical catheterism. The gallstone was asymptomatic and discovered on annual ultrasonography. Septicemia, profound thrombocytopenia, and acute anaemia led to rapid death in the first case. However, the progression was favourable under celioscopic treatment in the second one. Our original observations suggest systematically searching for gallstone in children with portal cavernoma., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Lower limb arterial disease has unusual features when occurring before 50 years old. The most important one is the number of causes: atherosclerosis in 2/3 cases, Leo Buerger's disease in 1/4, but also sometimes embolic cardiopathies, antiphospholipid syndrome, myeloproliferative disorders, genetic or compressive diseases, inflammatory arterial disease. When peripheral arterial disease occurs before 50, explorations have to be performed according to anamnesis: duplex echography, EKG, blood sample. Afterwards other explorations may be performed such as other vascular imaging techniques, echocardiography or more complete biological investigation. Results from an ongoing multicenter study should be soon available and give more knowledge about these special peripheral arterial diseases., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Acute testicular pain is frequent in urology. If torsion of the spermatic cord and orchiepididymitis are usual, varicocele thrombosis is an unusual clinical entity we reported.

Introduction: Antiphospholipid antibodies (aPL) can be associated with numerous infectious and particularly Q fever. Data on the pathogenicity of aPL in the course of acute Q fever are scarce., Case Report: We report the case an acute Coxiella burnetii infection associated with clinical and biological manifestations of the aPL syndrome, including a renal infarction. Along with antibiotic treatment, anticoagulation and intravenous immunoglobulins, the clinical outcome was favourable. Antiphospholipid antibodies and Q fever antibody titers had a closely related evolution., Conclusion: Arterial thrombosis associated with Q fever and aPL is exceptional. The nosology and potential mechanisms are discussed.

Thoracic aortic mural thrombus is a rare entity and potential source of serious systemic emboli. The progress of computed tomography (CT) angiography and the current use of transesophageal echocardiography (TEE) after any embolic event have considerably increased the frequency of diagnostic and there is a growing interest about the etiopathogenesis, which is still widely misunderstood. Therapeutic management remains controversial. We present a case of floating thrombus in the thoracic aorta detected by contrast-enhanced CT scan. This thrombus was responsible for two close major embolic events and was therefore managed surgically. Finally, outcome was favorable.

The association between thrombosis and cancer, initially evidenced in metastatic patients is well recognized and now described in patients with occult cancer where venous thrombosis may be the first clinical manifestation (Trousseau's syndrome). In this review, clinical and epidemiological interactions between thrombosis and cancer are described in five distinct step: venous thrombosis during malignancy and occult cancer, period of large increased in the risk for diagnosis of cancer, patients or venous thrombosis with increased risk for occult cancer, extensive or not extensive screening for occult cancer, earlier occult cancer detection associated or not with improved treatment possibilities and thus prognosis.

We report the case of a 22-year-old woman who presented a violent epigastric pain at eight-weeks gestation. Superior mesenteric vein thrombosis was detected, with an extension to portal vein and remaining blood flow. Screening for thrombophilia revealed a heterozygote prothrombin gene mutation. Portal vein thrombosis is uncommon and difficult to diagnose. Diagnosis is made by Doppler ultrasound, a second intention test to be done in case of unusual upper abdominal pain during pregnancy.

Unlabelled: Intracardiac thrombus is a rare manifestation of Behcet's disease., Observation: we report the case of a 60 year old male patient with Behçet's disease who presented with dyspnea and haemoptysis. CT angiography and echocardiography was performed allowing the identification of right heart thrombus associated with pulmonary artery aneurysm. The outcome was favourable with medical management., Conclusion: Intracardiac thrombus is a rare complication of Behcet's disease, but the diagnosis should be sought early in order to allow medical management to be considered.

Preretinal arterial loops are congenital vascular anomalies that originate from a main branch of the central retinal artery on the optic disc. These arterial loops are usually unilateral and asymptomatic, but they can be associated with retinal artery branch occlusion. We report one case of inferior temporal retinal artery occlusion in a patient with preretinal arterial loops. Two different mechanisms are thought to be the cause of occlusion: twisting of the loop or thrombosis.

The authors report the case of a 65 year old man who presented with an acute coronary syndrome without ST elevation due to acute stent thrombosis 12 hours after implantation. Recent reports in the literature suggest the role of resistance to antiplatelet drugs in acute, subacute or late stent thrombosis. This patient was included in a protocol studying the response to antiplatelet drugs in patients undergoing coronary stenting and fulfilled the criteria of resistance to clopidogrel. This clinical case illustrates the possible role of "resistance" to antiplatelet drugs in stent thromboses.

The authors report the case of a 47-year old man, admitted for syncope and left-sided motor deficit. Diagnostic investigations revealed a right middle cerebral artery embolic stroke, secondary to a critical stenosis of the arterial brachiocephalic trunk, harboring a floating thrombus. The treatment options for occlusive lesions of the brachiocephalic trunk are discussed, as well as the optimal delay between stroke and brain revascularization.

Twenty four patients (18 males, 6 females, Mean age 50 years) with acute non traumatic limb ischemia were operated on in our institution. The ischemia has been observed after 24 hours in 15 patients (62,5 % versus 7 patients (37,5 %) within 24 hours. The arterial femoral was often (54,1 %) the site of occlusion. Embolism (29,2 %) and thrombosis (54,2 % were the cause of acute limb ischemia. All patients were treated by embolectomy or thrombectomy. The overall mortality was 29,2 % with a limb salvage rate of 45,8 % and secondary amputation rate of 29,2 %. According to our experience, the diagnosis of acute non traumatic limb ischemia is not instituted early and the rate of hospital mortality and morbidity remain high.