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Purpose: Portosystemic collateral vessels (PSCV) are a consequence of the portal hypertension that occurs in chronic liver diseases. Their prognosis is strongly marked by the risk of digestive hemorrhage and hepatic encephalopathy. Materials and Methods: CT was performed with a 16-MDCT scanner. Maximum intensity projection and volume rendering were systematically performed on a workstation to analyze PSCV. Results: We describe the PSCV according to their drainage into either the superior or the inferior vena cava. In the superior vena cave group, we found gastric veins, gastric varices, esophageal, and para-esophageal varices. In the inferior vena cava group, the possible PSCV are numerous, with different sub groups: gastro and spleno renal shunts, paraumbilical and abdominal wall veins, retroperitoneal shunts, mesenteric varices, gallbladder varices, and omental collateral vessels. Regarding clinical consequences esophageal and gastric varices are most frequently involved in digestive bleeding; splenorenal shunts often lead to hepatic encephalopathy; the paraumbilical vein is an acceptable derivation pathway for natural decompression of the portal system. Conclusion: Knowledge of precise cartography of PSCV is essential to therapeutic decisions. MDCT is the best way to understand and describe the different types of PSCV. [ABSTRACT FROM AUTHOR]

Background:  Management of the aortic root during acute Type A aortic dissection (TAAD) repair remains controversial in term of long-term evolution and reoperation. The aim of this study was to assess the long-term outcomes of the aortic root after conservative management during primary surgery., Methods:  One hundred sixty-four consecutive patients were included in this monocentric retrospective study. The primary endpoint was reoperation on the aortic root during long-term follow-up. Forty-six patients had aortic root replacement (ARR) and 118 had supracoronary aortic replacement (SCR). The 10-year survival, occurrence of significant aortic regurgitation, and radiologic aortic root dilatation in each group were assessed during follow-up., Results:  Patients from ARR group were younger than those from SCR group ( p  < 0.0001). Median follow-ups of ARR group and SCR group are 4.4 (interquartile range [IR]: 2.6-8.3) and 6.15 (IR: 2.8-10.53) years, respectively. Reoperation of the aortic root during long-term follow-up was similar in both groups (ARR group: 5.1%, SCR group: 3.3%, p  = 0.636). The 10-year survivals of ARR and SCR groups were 64.8 ± 12.3% and 46.3 ± 5.8% ( p  = 0.012), respectively. Long-term significant aortic regurgitation occurred in one patient (1.7%) and seven patients (7.6%) of the ARR and SCR groups ( p  = 0.176), respectively. Radiologic aortic root diameters in the SCR group were similar between postoperative period and follow-up studies ( p  = 0.58). Reoperation on the distal aorta ( p  = 0.012) and patent radiologic false lumen of the descending aorta ( p  = 0.043) were independent risk factors of late death., Conclusion:  SCR is an effective technique for primary TAAD surgery and does not increase the rate of late reoperation on the aortic root., Competing Interests: The authors declare no conflict of interest related to this article., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Obliterating arteriopathy of the lower limbs (OALL) is a pathology that manifests itself late in the natural history of an atheromatous patient. It is largely a localised pathology but should be considered as a marker for more generalised disease, for which the prognosis is modified by cardiac and cerebrovascular complications. Measurement of the systolic blood pressure index at the ankles is indispensable for initial management, with measures inferior to 0.90 correlating with an arterial stenosis of more than 50%, even in the absence of symptoms. Although the diagnosis is above-all clinical, further investigations complete the initial management by estimating the severity of the lesions, identifying the threatening lesions, allowing an overview of the general disease and a follow-up of the patient. Undoubtedly, the Doppler ultrasound remains the first-line investigation of choice. Helical computerised tomography and angiography by magnetic resonance imaging complete the initial investigation when a revascularisation procedure is envisaged, their respective indications depending on the protocols of each Vascular Centre. The walking-on-a-rolling-carpet test allows evaluation of residual functional capacity of the patient at the stage of claudication. The discovery of OALL calls for at least coronary screening, whatever be the stage of severity, with one patient in four dying of a coronary complication in 5 years. Other vascular localisations should be screened for depending on the clinical symptomatology. The medico-economic value of an extensive systematic vascular work-up is, in effect, still only demonstrated for the stage of claudication.