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COVID-19 infection is associated not only with venous thromboses but also with arterial thromboses (COV-ATs) in relation with an endothelial dysfunction, a coagulopathy and rhythm disorders. The incidence, the topography, and the prognosis of COV-ATs remain poorly known. The objective of this study was to report the overall experience of the Greater Paris University Hospitals (Assistance Publique - Hopitaux de Paris, AP-HP) during the first pandemic wave of COVID-19 infection.After approval by the ethics committee, a study using the AP-HP clinical data warehouse was carried out between March and May 2020. Overall, 124,609 patients had a polymerase chain reaction for COVID-19 in our hospitals, of which 25,345 were positive. From 20,710 exploitable stays, patients tested positive for COVID who presented an episode of acute COV-AT (except coronary and intracranial arteries) were selected on the basis of the French medical classification for clinical procedures codes. The data are presented as absolute values with percentages and/or means with standard deviation.Over the studied period, 60 patients (aged 71±14 years, 42 men) presented a COV-AT at the time of their hospitalization, an incidence of 0.2%. The arterial complication occurred 3±7 days after the COVID infection and was inaugural in 30% of the cases (n = 18). The sites of COV-AT were the lower extremities (n = 35%, 58%), the abdominal aorta (n = 10%, 17%), the thoracic aorta (n = 7%, 12%), the upper limbs (n = 7%, 12%), the cerebral arteries (n = 7%, 12%), the digestive arteries (n = 6%, 10%), the renal arteries (n = 2%, 3%), and the ophthalmic artery (n = 1%, 2%). Multiple COV-ATs were observed in 13 patients (22%). At the time of diagnosis, 20 (33%) patients were in intensive care, including six (10%) patients who were intubated. On computed tomography angiography, COVID lesions were classified as moderate and severe in 25 (42%) and 21 (35%) cases, respectively. Revascularization was attempted in 27 patients (45%), by open surgery in 16 cases, using endovascular techniques in 8 cases and with a hybrid approach in three cases. Six patients (22%) required reinterventions. The duration of hospitalization was 12±9 days. Early mortality (in-hospital or at 30 days) was 30% (n = 18). Nine (15%) patients presented severe nonlethal ischemic complications.Arterial involvement is rare during COVID-19 infection. The aorta and the arteries of the limbs are the privileged sites. The morbi-mortality of these patients is high. Future studies will have to determine if the systematization of anticoagulation therapy decreases the incidence and the severity of the condition.

Complete eversion of the femoral tripod is interesting to reduce clinical consequences of wound infection, in particular for patients at a high risk (e.g., obese, diabetics, cancer). Experience and follow-up of this technique are scarce. The different technical possibilities and results are reported here.A single-center prospective study including patients operated on for femoral occlusive lesions using eversion of the common femoral artery and its bifurcation. Clinical and imaging preoperative data, surgical technique, and follow-up are detailed.Thirty five patients (37 limbs) have been included between June 2014 and April 2016. The mean Rutherford index was 3.6 and 65% of the patients were claudicants. Lesions were limited to the common femoral artery in 14 (38%) of the cases and spread to the superficial femoral artery in 2 (7%) and to the 3 branches in 21 (57%) of the cases, respectively. Postoperatively, one death, one major amputation, and 3 reinterventions were noted, resulting in an 8% rate of major complications. The mean follow-up was 37 months. At this time, 11 major adverse cardiovascular events, 9 deaths, and no additional major amputation were noted. The mean Rutherford index was 1.7 (P 0.001) and 3 reinterventions were necessary (one for septic occlusion at 3 months and 2 for restenosis at 12 and 42 months), translating into primary and secondary patency rates of 93.3% and 96.1%, respectively.This work further confirms that eversion of the femoral tripod is safe and effective. This experience adds to the existing body of the literature and describes alternative techniques of eversion. The technique should be considered when treating patients at a high risk of postoperative infection.

When best medical treatment fails to relieve symptoms of aorto-iliac occlusive disease, endovascular treatment or conventional open surgery are the remaining options depending on lesions and patients' characteristics. However, in certain situations both endovascular tools and abdominal aorta to bifemoral bypass (TFB) are not an option and the use of the descending thoracic aorta may be considered as an inflow site for revascularization.This work is a single-center retrospective study. Between 2008 and 2020, 27 patients were identified who were treated with descending thoracic aorta to TFB for severe aorto-iliac occlusive disease. Primary end point was 30-day postoperative mortality and major cardiovascular events. Secondary end points were primary patency, secondary patency, and all-cause mortality.The mean age of patients was 68 years and the majority (88.9%) presented with severe claudication. Eighteen patients underwent isolated TFB and 9 had TFB and concomitant visceral vessel revascularization. The mean length of stay was 14 days and there was no postoperative death. Complications, mainly pulmonary, occurred in 29.8% of the cases. After a mean of 26 months of follow-up, survival rate was 95% and primary and secondary patency rates were 92.6% and 96.3%, respectively. Mean Rutherford index shifted from 3.1 to 1.2 (P 0.001).TFB is an invasive procedure which provides high clinical improvement and patency rates. This procedure should remain part of the vascular surgeon portfolio.

Aneurysms of the arteries of the upper limbs represent a rare pathology. Apart from the risk of rupture and according to their localization, they can be responsible for nervous or venous compression, for embolism and for ischemia. Axillary localization is particularly rare apart from an iatrogenic context. Open surgery and more recently endovascular techniques can be proposed, but real guidelines are lacking. We report the case of a patient presenting a Marfan syndrome and bilateral axillary aneurysms, with symptoms on the right side due to a nervous compression responsible for paresthesia. Aneurysms were treated in 2 stages by open surgery, starting on the symptomatic side.