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Le but de ce travail etait d’evaluer les modifications en terme d'activite et de resultats post-operatoires immediats de notre prise en charge chirurgicale elective des anevrysmes de l'aorte abdominale sous-renale (AAA) induites par l'introduction du traitement endovasculaire par endoprothese aortique suivant les recommandations de decembre 2003 de l'Agence Francaise de Securite Sanitaire des Produits de Sante (AFSSAPS). Cette etude retrospective monocentrique a repris les donnees cliniques des patients operes de facon elective entre janvier 2001 et decembre 2006 pour un AAA asymptomatique. Le traitement endovasculaire des AAA par endoprothese aortique a ete introduit en janvier 2004 dans notre pratique courante, en respectant les indications recommandees par l'AFSSAPS (patients presentant un AAA ≥50mm a risque chirurgical eleve). Le groupe I est compose des patients operes entre janvier 2001 et decembre 2003 selon la technique conventionnelle de mise a plat-greffe chirurgicale. Le groupe II est compose des patients operes entre janvier 2004 et decembre 2006, soit par mise a plat-greffe chirurgicale, soit par technique endovasculaire. Les principaux criteres de jugement etaient le nombre de patients, leur score de risque chirurgical de l'American Society of Anaestesiology (ASA), et la morbi-mortalite intra-hospitaliere. Le nombre de patients traites a augmente de facon significative entre les deux periodes (groupe I : n=49 ; groupe II : n=88, dont 38 traitements endovasculaires ; P

El objetivo de este trabajo fue evaluar, en terminos de actividad y resultados postoperatorios inmediatos, las modificaciones de nuestro tratamiento quirurgico programado de los aneurismas aorticos abdominales (AAA) infrarrenales como consecuencia del uso de endoprotesis para tratar los AAA, siguiendo las recomendaciones publicadas por la French Health Products Safety Agency (AFSSAPS) en diciembre de 2003. Este estudio monocentrico y retrospectivo utilizo los datos clinicos de los pacientes intervenidos por AAA asintomaticos entre enero de 2001 y diciembre de 2006. El tratamiento endovascular de los AAA con endoprotesis aortica fue introducido en nuestra practica actual en enero de 2004, siguiendo las recomendaciones de la AFSSAPS (pacientes de alto riesgo ante cirugia abierta que se presentaron con un AAA ≥ 50 mm). El grupo I estuvo formado por pacientes intervenidos entre enero de 2001 y diciembre de 2003 segun la tecnica abierta estandar. El grupo II estuvo formado por pacientes intervenidos entre enero de 2004 y diciembre de 2006 mediante cirugia abierta estandar o cirugia endovascular. Los principales criterios de valoracion fueron el numero de pacientes intervenidos, la puntuacion de su riesgo quirurgico segun la American Society of Anesthesiology (ASA), y la morbilidad y mortalidad intrahospitalarias. El numero de pacientes tratados aumento de forma significativa entre estos dos periodos (grupo I n = 49, grupo II n = 88, con 38 tratamientos endovasculares; p

Purpose: To report endovascular treatment of 2 patients with aneurysmal deterioration of peripheral arterial allografts. Case Report: Two men (65 and 64 years old) who had undergone an arterial allograft reconstruction for infection of prosthetic infrapopliteal bypass grafts 5 and 7 years ago, respectively, were diagnosed with asymptomatic aneurysmal deterioration of the allografts. Stent-graft repair was successful in both cases, completely excluding the aneurysms. At ≥1 year, continued aneurysm exclusion was confirmed by duplex scan, with no evidence of endoleak, migration, or stenosis. Conclusion: Endovascular treatment may be a useful therapeutic option when treating patients with late peripheral allograft deterioration.

Rupture of abdominal aortic aneurysms (AAA) is responsible for 1–3% of all deaths among the elderly population in developed countries. A novel endograft proposes an endovascular aneurysm sealing (EVAS) system that isolates the aneurysm wall from blood flow using a polymer-filled endobag that surrounds two balloon-expandable stents. The volume of injected polymer is determined by monitoring the endobag pressure but the final AAA expansion remains unknown. We conceived and developed a fully deformable surface model for the comparison of pre-operative sac lumen size and final endobag size (measured using a follow-up scan) with the volume of injected polymer. Computed tomography images were acquired for eight patients. Aneurysms were manually and automatically segmented twice by the same observer. The injected polymer volume resulted 9% higher than the aneurysm pre-operative lumen size (p

Background— The atheromodulating activity of B cells during the development of atherosclerosis is well documented, but the mechanisms by which these cells are regulated have not been investigated. Methods and Results— Here, we analyzed the contribution of Qa-1–restricted CD8 + regulatory T cells to the control of the T follicular helper–germinal center B-cell axis during atherogenesis. Genetic disruption of CD8 + regulatory T cell function in atherosclerosis-prone apolipoprotein E knockout mice resulted in overactivation of this axis in secondary lymphoid organs, led to the increased development of tertiary lymphoid organs in the aorta, and enhanced disease development. In contrast, restoring control of the T follicular helper–germinal center B-cell axis by blocking the ICOS-ICOSL pathway reduced the development of atherosclerosis and the formation of tertiary lymphoid organs. Moreover, analyses of human atherosclerotic aneurysmal arteries by flow cytometry, gene expression analysis, and immunofluorescence confirmed the presence of T follicular helper cells within tertiary lymphoid organs. Conclusions— This study is the first to demonstrate that the T follicular helper–germinal center B-cell axis is proatherogenic and that CD8 + regulatory T cells control the germinal center reaction in both secondary and tertiary lymphoid organs. Therefore, disrupting this axis represents an innovative therapeutic approach.

Secure proximal fixation of endografts to the infrarenal aortic neck is known to be important in the short- and long-term success of endovascular aneurysm repair. We sought to determine the relative importance of distal iliac fixation in preventing endograft migration and adverse clinical events after endovascular aneurysm repair.We reviewed the outcome of 173 patients treated from 1996 to 2003 at Stanford University Medical Center with an externally supported stent graft. Quantitative image analysis of the postimplantation computed tomography scan was performed to determine the proximal aortic and distal iliac fixation lengths and the proximity the distal end of the stent graft to the iliac bifurcation. Subsequent follow-up computed tomography scans were reviewed for evidence of stent graft migration. Patients were grouped according to good (15 mm), intermediate, or bad (10 mm) aortic fixation and good (iliac fixation lengthor =25 mm and iliac limbs10 mm from iliac bifurcation), intermediate, or bad (25-mm fixation length) iliac fixation.Stent graft migration of 10 mm or more was seen in 17 patients (10%) during the 23 +/- 19-month follow-up period. Patients with no migration had a greater iliac fixation length (30 +/- 12 mm) than those with migration (22 +/- 8 mm; P = .01), and the distal ends of the iliac limbs were closer to the iliac bifurcation (15 +/- 12 mm) than in patients with migration (25 +/- 10 mm; P.001). Patients with no migration also had a greater proximal aortic fixation length (23 +/- 12 mm) than migration patients (13 +/- 7 mm; P = .001). There were no migrations among patients with good iliac fixation whether aortic fixation was good, intermediate, or bad (0/63; 0%). Among patients with bad/intermediate iliac and good aortic fixation, there were 5 (9%) of 58 patients had migrations. Patients with both bad/intermediate iliac and bad/intermediate aortic fixation had the highest migration rate (12/52; 23%). Cox proportional hazards regression modeling revealed that the significant factors predicting migration were poor proximity of the distal end of the iliac limbs to the iliac bifurcation (odds ratio 17.2; P = .01) and aortic fixation length (odds ratio 2.0; p = 0.007 for each centimeter). Iliac extender modules were placed in 9 patients with bad iliac fixation and migration, with no further migration during a mean follow-up of 12 months. Patients with good iliac and aortic fixation and no endoleak on the initial postprocedure computed tomography scan (n = 43) had no migrations, secondary procedures, or adverse clinical events over a 2-year follow-up period.Iliac fixation, along with proximal aortic fixation, is an important factor in preventing the migration of stent grafts that have longitudinal columnar support. Patients with good iliac fixation did not experience migration even in the presence of suboptimal proximal aortic fixation. Close proximity of the distal end of the stent graft to the iliac bifurcation seems to provide stability against migration.

ObjectiveTo determine the impact on late postoperative renal function of suprarenal and infrarenal fixation of endografts used to treat infrarenal abdominal aortic aneurysm (AAA).MethodsRetrospective analysis of 277 patients treated from 2000 to 2003 with three different endografts at two clinical centers. Five patients on dialysis for preoperative chronic renal failure were excluded. Group IF of 135 patients treated with an infrarenal device (Medtronic AneuRx) was compared with group SF of 137 patients treated with a suprarenal device (106 Cook Zenith and 31 Medtronic Talent). Renal function was evaluated by calculating preoperative and latest postoperative creatinine clearance (CrCl) using the Cockcroft formula. Patients who developed a >20% decrease in CrCl were considered to have significantly impaired renal function.ResultsThere were no significant differences in patient age, sex, aneurysm size, preoperative risk factors, dose of intra- and postoperative contrast, or baseline CrCl (IF: 69.3 mL/min, SF: 71.7 mL/min, P = .4). Follow-up time of 12.2 months was the same in both groups. CrCl decreased significantly during the follow-up period in both groups (IF: 69.3 mL/min to 61.7 mL/min, P < .01; SF: 71.7 mL/min to 64.9 mL/min, P < .03). Postoperative CrCl (IF: 61.7 mL/min, SF: 64.9 mL/min, P = .3), and the rate of CrCl decrease during the follow-up period (IF: −10.9%, SF: −9.5%, P = .2) was not different between the two groups. The number of patients with a >20% decrease in CrCl was not different between the two groups (IF: n = 35 [25.9%], SF: n = 41 [29.9%], P = .46). However, the magnitude of decrease in CrCl in patients with renal impairment was greater in patients treated with suprarenal fixation endografts (SF: −39%) compared with those treated with infrarenal endografts (IF: −31%, P = .005). This greater degree of renal impairment was not due to identifiable differences in preoperative risk factors, age, or baseline CrCl. No patients in these series required dialysis.ConclusionsRegardless the type of endograft used, there is a 10% decrease in CrCl in the first year after endovascular aneurysm repair. Suprarenal fixation does not seem to increase the likelihood of postoperative renal impairment. Decline in renal function over time after endovascular aortic repair is probably due to multiple factors, and measures known to be effective in protecting kidneys should be considered for these patients. Long-term follow-up with measurement of CrCl, along with renal imaging and regular blood pressure measurements, should be performed to detect possible late renal dysfunction. Prospective studies comparing suprarenal versus infrarenal fixation are needed to confirm those results.

PurposeMigration of endovascular stent grafts has been related to the security of proximal device fixation to the aortic neck. This study evaluated the importance of iliac fixation in preventing longitudinal in vivo device displacement of a modular, externally supported stent graft.MethodsExperimental ovine infrarenal aneurysms (n = 8) were treated with a fully supported, modular, bifurcated stent graft (AneuRx, Medtronic, Santa Rosa, Calif). Minimum iliac fixation length (1 cm) was used in four animals and iliac extender modules were used to achieve maximum iliac fixation in four animals. Suture anastomosis of bifurcated polyester grafts to the infrarenal aorta served as controls (n = 8). Aortic grafts were displaced in vivo by applying downward traction to a guidewire that was passed over the iliac flow divider and brought out both femoral arteries. The displacement force needed to initiate stent-graft migration was recorded and compared with the force needed to disrupt the sutured anastomosis.ResultsThere was no difference in animal weight (88.8 ± 2.5 kg vs 87.5 ± 2.9 kg), aortic neck diameter (12.7 ± 0.9 mm vs 13.4 ± 1.1 mm), aortic neck length (23.2 ± 0.9 mm vs 21.8 ± 2.4 mm), experimental aneurysm size (24.7 ± 1.1 mm vs 24.2 ± 2.0 mm), or iliac artery diameter (9.0 ± 1.5 mm vs 9.3 ± 0.5 mm) among the groups. Iliac fixation length was 31.0 ± 0.3 mm in the maximum iliac fixation group and 11 ± 0.25 mm in the minimum fixation group (P < .0001). Peak displacement force to initiate migration was 30.2 ± 5.5 N (range, 25 to 38) in animals with maximum iliac fixation compared with 18.1 ± 3.7 N (range, 13 to 21) in those with minimum fixation (P = .01). The force needed to disrupt the control surgical anastomosis was 40.6 ± 7.5 N (range, 31 to 50) (P < .01).ConclusionsMaximizing iliac fixation length increases the longitudinal in vivo force needed to displace a fully supported stent graft by 67%. This suggests that increasing iliac fixation length may reduce the long-term risk of migration in patients undergoing endovascular aneurysm repair.

Objectifs Des les annees 2000, le robot est entre au bloc operatoire pour faciliter les interventions cœlioscopiques mises en echec par une courbe d’apprentissage et une execution difficile. Va-t-il permettre de relancer la chirurgie aorto-iliaque mini-invasive ? L’objectif est d’examiner l’activite nationale en chirurgie robotique vasculaire. Materiel et methode Recensement des equipes francaises utilisant un robot, avec leur activite en detail. Les deux robots actuellement disponibles sont le Da Vinci (Intuitiv Surgical™) concu pour les techniques laparoscopiques, et le Magellan (Hansen™) pour les techniques endovasculaires. Resultats Au 1er novembre 2015, 7 equipes francaises realisent une activite de chirurgie robotique : – CHU de Strasbourg : depuis septembre 2006, le Da Vinci a ete utilise dans 135 procedures aorto-iliaques : 94 pontages aorto-bifemoraux pour maladie occlusive ; 41 anevrysmes de l’aorte abdominale ont ete traites, avec 8 pontages aorto-bifemoraux, 16 pontages aortiques et 17 pontages aorto-biiliaques. Sept anevrysmes spleniques ont ete traites avec le Da Vinci et 4 cas de Nutcracker syndrome avec transposition de la veine renale gauche par une anastomose reno-cave. Le robot Magellan a permis la realisation de 62 procedures endovasculaires ; – Clinique du Tonkin, Lyon : depuis septembre 2010, le Da Vinci a ete utilise dans 97 procedures aorto-iliaques : 58 pontages aorto-bifemoraux pour maladie occlusive, 39 pontages aortiques pour anevrysmes. Deux cas de Nutcracker syndrome ont ete traites avec le Da Vinci ; – CHU de Nancy : depuis novembre 2010, le Da Vinci a ete utilise pour realiser 35 pontages aorto-bifemoraux pour maladie occlusive aorto-iliaque et traiter 1 anevrysme de l’artere renale, 1 anevrysme iliaque et 1 anevrysme splenique ; – CHU hopital europeen Georges-Pompidou, Paris : depuis fevrier 2014, le Da Vinci a ete utilise pour realiser 35 pontages aorto-bifemoraux pour maladie occlusive aortoiliaque. – CHU de Toulouse : depuis juillet 2013, le Da Vinci a ete utilise pour realiser 12 pontages aorto-bifemoraux pour maladie occlusive aorto-iliaque ; – CHU de Brest : en 2012, le Da Vinci a ete utilise pour realiser 3 pontages aorto-bifemoraux pour maladie occlusive aorto-iliaque ; – Clinique de l’Infirmerie Protestante, Lyon : depuis mai 2015, 2 cas de Nutcracker syndrome ont ete traites avec le Da Vinci. Conclusion Un nombre croissant d’equipes francaises utilisent le robot pour traiter les pathologies arterielles et veineuses. Les principaux avantages sont une precision et une facilite technique pour reussir lorsque la cœlioscopie est tenue en echec.

Background Closure of the proximal tear by thoracic endovascular aortic repair (TEVAR) at the acute phase appears to be a safe effective treatment to prevent aneurysmal degeneration type B dissection. However, it appears to be inefficient in up to a third of the patient. We report the technical aspects of our experience with patients undergoing secondary open repair after TEVAR for dissecting thoracoabdominal aneurysm despite early closure proximal tear by TEVAR. Methods During a period of 5 years, 96 patients presenting acute type B aortic dissections were treated by TEVAR and followed-up in our institution. Among them, 5 patients experienced an evolution to a dissecting thoracoabdominal aortic aneurysm. Their demographic data and initial medical conditions, delay to reintervention, operative technical details, perioperative and mid-term outcomes were collected and analyzed. Results All 5 patients (4 male, mean age 58 ± 9) were operated under peripheral normothermic bypass without deep circulatory arrest using the thoracic stent graft as an elephant trunk for completion of the proximal anastomosis. In cases of patency, the false lumen was reapproximated in the anastomosis, 6 visceral arteries were revascularized selectively. One patient died at day 1 of perioperative ventricular fibrillation due to an acute myocardial infarction. The 4 others are alive without complication after a median of 30 months, range (13–22). Conclusions In our experience, TEVAR was not only efficient at the acute phase to deal with complications, but in cases of subsequent aneurysmal evolution, it made open repair even easier by avoiding very proximal cross-clamping/anastomosis and circulatory arrest.

The aim of this case study is to report a case of unusual manifestation of ruptured abdominal aortic aneurysm (AAA) involving an aortocaval fistula (ACF) as phlegmasia cerulea dolens (PCD). A 58-year-old male presented with acute signs of PCD of the right lower limb, confirmed on duplex ultrasonography. Computed tomography angiography revealed a 65-mm ruptured AAA with a large ACF. Successful emergent surgical repair was performed, using implantation of an aortobi-iliac graft with primary closure of the fistula and associated venous thrombectomy. PCD revealing a ruptured AAA with ACF is rare. Knowledge of this original entity might be the most important factor on the outcome.

Background: Current treatment for extensive thoracoabdominal aortic aneurysms (TAAAs) involves high-risk surgical and endovascular repairs, with a hospital mortality exceeding 20%, and a postoperative paraplegia rate beyond 10.5%. Objectives: The aim of this study was to present an estimation of the economic impacts of surgical and endovascular treatments of types II and III TAAAs in the US as well as the economic consequences of the elimination of spinal cord injury and mortality via an endovascular repair of extensive TAAAs (1). Materials and Methods: We compared the current hospital charges of endovascular and surgical repair of extensive TAAAs, also provided a cost analysis of health care charges resulting from paraplegia in the United States, and determined the prevalence of extensive TAAAs found yearly during autopsies in the U.S. Based on the figures gathered and the frequency of Thoracic Aortic Aneurysms per year, we were able to calculate the nationwide inpatient hospital charges, the total average expenses affected by paraplegia during the first 12 months after the repair, the total average expenses after paraplegia for each subsequent year, mortality rate at 30 days and one year, and the number of extensive TAAAs ruptures. Results: The current nationwide inpatient hospital charges for type II or III TAAA repair cost $12484324 and $37612665 for endovascular repair and surgical repair respectively, and the total average expenses for patients affected by paraplegia during the first 12-month were $4882291 and $23179110 after endovascular repair and surgical repair respectively. The nationwide average expense after 10 years for patients undergoing surgical repair and affected by paraplegia is $33421910 and $6,316,183 for patients undergoing endovascular repair. Moreover, 55 patients with a type II or type III TAAA died after 30 days, and 100 after 1 year. The potential risk of type II or III TAAA ruptures is totally 1637 in a year. Conclusions: Major economic impacts of type II or III TAAA repairs in the United States have been identified. An endovascular repair excluding spinal cord injury and mortality with the same average costs as present endovascular treatments makes it possible to save at least $53189742 after one year, 100 lives of operated patients would be saved after one year, and 1637 type II and III TAAA ruptures would be avoided yearly.

Aneurysm is associated to a complex remodeling of arteries that affects all their layers. Although events taking place in the intima and the media have received a particular attention, molecular and cellular events taking place in the adventitia have started to be deciphered only recently. In this study, we have precisely described the composition and distribution of stromal and hematopoietic cells in human arterial adventitia, both at steady state and in the setting of aortic aneurysm. Using polychromatic immunofluorescent and flow cytometry analyses, we observed that unlike the medial layer (which comprises mostly macrophages and T cells among leukocytes), the adventitia comprises a much greater variety of leukocytes. We observed an altered balance in macrophages subsets in favor of M2-like macrophages, an increased proliferation of macrophages, a greater number of all stromal cells in aneurysmal aortas. We also confirmed that in this pathological setting, adventitia comprised blood vessels and arterial tertiary lymphoid organs (ATLOs), which contained also M-DC8(+) dendritic cells (slanDCs) that could participate in the induction of T-cell responses. Finally, we showed that lymphatic vessels can be detected in aneurysmal adventitia, the functionality of which will have to be evaluated in future studies. All together, these observations provide an integrative outlook of the stromal and hematopoietic cell network of the human adventitia both at steady state and in the context of aneurysm.

Objective Restenosis is a limitation of endovascular interventions performed in the superficial femoral artery (SFA). Preclinical studies have demonstrated that the perivascular delivery of tissue-engineered allogeneic aortic endothelial cells (PVS-10200) reduced stenosis in porcine models of SFA revascularization. The purpose of this study was to investigate the safety and feasibility of percutaneous PVS-10200 delivery after angioplasty and stenting in the SFA of patients with peripheral artery disease. Methods In this phase I open-label trial, 21 patients (average lesion length of 10.10 ± 2.36 cm and ≥70% stenosis) were treated with PVS-10200: 11 in a low-dose cohort (cohort A) and 10 in a high-dose cohort (cohort B). The primary objective was to demonstrate the safety (incidence of major adverse events) of PVS-10200 within 4 weeks after surgery. Secondary end points included assessments of resting ankle-brachial index (ABI) in the treated leg, Fontaine class, and time to target lesion revascularization (TLR). Results No patient had a major adverse event within 4 weeks. One patient required a limb amputation at 30 weeks. At 48 weeks, cohort A and cohort B patients maintained a 37% and 62% increase in ABI compared with baseline, respectively; 70% of cohort A and 78% of cohort B improved by ≥1 Fontaine classification stage, and the TLR rate was 39% for cohort A and 20% for cohort B. Conclusions Percutaneous local delivery of PVS-10200 is a well-tolerated and novel therapeutic approach that may be a suitable treatment for patients after endovascular intervention of the SFA. Larger randomized trials are needed to determine if PVS-10200 can improve ABI and reduce TLR rates.

Objectif Le traitement endovasculaire des pathologies aortiques est une technique recente qui necessite une navigation intra-aortique en trois dimensions avant la mise en place des endoprotheses. Afin de mieux comprendre cette nouvelle vision de l’anatomie aortique nous avons effectue une revue de la litterature pour apprehender les deformations liees a l’âge et aux facteurs de risque cardiovasculaires en situation normale et pathologique. Methode Nous avons collige 36 articles publies decrivant les modifications de l’anatomie de l’aorte sur des series de patients asymptomatiques ou hypertendus ou presentant une dissection ou un anevrisme. Les mesures du diametre, de la longueur et de la tortuosite realisees a partir d’imagerie par resonance magnetique, d’angioscanners, d’angiographies, ou de dissections cadaveriques ont ete collectees. Resultats Bien que les methodes de mesures aient ete tres heterogenes, les resultats etaient homogenes concernant de l’effet de l’âge et des facteurs de risques cardiovasculaires sur l’augmentation du diametre aortique (+ 0,08 a + 0,12 cm par decennie entre 20 et 70 ans) et de la longueur de l’aorte ascendante et de l’arc aortique avec l’âge (+ 4 % a + 12 % par decennie entre 20 et 70 ans). En revanche, l’augmentation de la longueur de l’aorte descendante etait variable selon les etudes. Sept methodes differentes ont ete identifiees pour decrire la courbure aortique. Son angulation diminuait avec l’âge (en moyenne −4 % d’index de tortuosite). Conclusion L’anatomie aortique se deforme avec l’âge et les facteurs de risques cardiovasculaires vers une augmentation du diametre, de la longueur et une diminution de la tortuosite. Nous pensons que les moyens de fixite de l’aorte ne laissent evoluer que certains segments vers l’augmentation de longueur et le deroulement de tortuosites. Un consensus sur les techniques de mesures permettant une description standardisee de l’anatomie aortique, apparait necessaire pour verifier cette hypothese.

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 1990(1) in a rat, then described in mice(2). Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis.

Background Type 2 endoleaks after the endovascular treatment (EVAR) of abdominal aorta aneurysms (AAAs) remain a concern for vascular surgeons, especially when they are associated with an enlargement of the persistent aneurysmal sac. The purpose of this study is to evaluate the effectiveness of secondary reinterventions for type 2 endoleaks associated with enlargement of the aneurysmal sac after EVAR. Methods The incidence of endoleaks, aneurysmal sac diameters, and reinterventions were collected from the clinical and radiologic data of the patients treated by EVAR for AAA with >1 year of follow-up. Patients with a type II endoleak associated with an enlargement of the aneurysmal sac were identified; their operative data and the results of the secondary procedures were recorded. The principal criterion of evaluation was the effectiveness of these reinterventions on the evolution of the diameter of the AAA. The secondary criteria were death rate related to aneurysm and the average costs of these additional procedures. Results In 232 patients treated by EVAR with an average of 2 years of follow-up (23 ± 30 months), 15 type I (6.5%), 94 type II (40.5%), and 8 type III (3.5%) endoleaks were identified. Among the 94 AAAs with a type II endoleak, 21 had a regression of the aneurysmal sac (22.5%), 46 were stable (49.5%), and 27 continued to grow (28%), including 9 because of another type of endoleak. Among the 18 patients presenting with a type II endoleak linked with an enlargement of the aneurysmal sac, 14 were treated with endovascular embolization, 1 was treated by conventional aneurysmectomy, and 3 patients were followed-up only. Among 14 patients treated by embolization, 9 (60%) presented with persistent enlargement of the aneurysmal sac after embolization, of which 5 were finally treated by conventional treatment with 1 postoperative death. The average cost per patient that required a reintervention for a type II endoleaks was €28,096 ± €30,490 ($37,530 ± $40,728). Conclusion Endovascular reinterventions for type II endoleaks associated with an enlargement of the aneurysmal sac after EVAR have a poor effectiveness on the stabilization of the diameter of the AAA. These procedures involve an high cost and high rates of morbidity, which should be taken into account in their use.

Background Descending thoracic acute aortic syndromes (DTAASs) are life-threatening pathologies in which thoracic endovascular aortic repair (TEVAR) is an attractive therapeutic option. There are few data in the literature on the survival and morbidity rates of TEVAR in such indications. We provide the results of TEVAR from our single-center cohort of DTAASs: ruptured aneurysms (RAs), acute symptomatic dissections (ADs), and traumatic ruptures (TRs). Methods Between 2004 and 2011, data from all patients treated by TEVAR for DTAAS in our university center were collected prospectively. Primary end points were rates of 30-day mortality and morbidity. Secondary end points were mid-term outcomes and reinterventions. Results Forty-eight patients underwent TEVAR for DTAASs: 19 RAs (39.6%), 12 ADs (25.0%), and 17 TRs (35.4%). The cumulative 30-day mortality and morbidity rate was 33%. There were 10 deaths (6 RAs, 1 AD, and 3 TRs), 2 cases of paraplegia (0 postoperative and 2 preoperative cases (2 TRs), and no major reinterventions and 4 minor reinterventions (embolization for endoleak exclusion). Long-term outcomes were known in 33 patients (5 patients were lost to follow-up), with a mean duration follow-up of 27 months. The cumulative mortality and morbidity rate was 9%: no deaths were reported, and 2 major reinterventions (open aneurysm repair) and 1 minor reintervention (endoleak exclusion) were required. Conclusions Our results confirm that TEVAR, as an emergency therapeutic option, is suited to DTAASs. The 21% perioperative mortality rate for such dramatic lesions remains high but is lower than medical or open repair therapeutic options previously reported. No additional deaths occurred during the 2-year follow-up period, and a low incidence of endograft-related reinterventions was observed. Nevertheless, scheduled follow-up visits with computed tomodensitometry scans on a regular basis are mandatory.

Introduction Biological study of the impact of endovascular aortic repair (EVAR) on pathophysiology of aortic abdominal aneurysms (AAA) can only be performed indirectly in humans, by imaging or search for peripheral biomarkers in the circulating blood. Therefore biological mechanism’s modifications into the aneurismal wall related to its endovascular exclusion are still to be elucidated, and small animal models should bring a valuable help in this field. We describe a new experimental model of stentgraft implantation for the exclusion of AAA in rats. Methods Aneurysms were induced as previously described by intra-aortic elastase injection in Wistar rats, or by aortic decellularized xenograft transplantation in Lewis rats. At least 15 days later, the midline laparotomy was reopened, and 3mm covered stentgraft were inserted and deployed in the AAA to obtain its exclusion. The patency of the graft and the AAA exclusion could be assessed by a global arteriogram through the carotid artery. After closure of the laparotomy, the rats were awakened and returned to a normal diet. Results This experimental model of AAA exclusion by a stentgraft allows many in vivo and ex vivo studies of the pathophysiology of AAA after EVAR. Histological modifications of the aortic wall and the intra-luminal thrombus could be assessed. The impact of EVAR on the adventitial immuno-inflammatory activity could be studied by different imaging such as MRI, scintigraphy or PET-scan. In situ biological and enzymatic activities could be evaluated to better understand the local mechanisms leading to AAA shrinkage or expansion after EVAR. Conclusion Exclusion by stentgraft of experimental AAA in rats is the first described model of EVAR in small animals. It is feasible and reproducible for both elastase and xenograft experimental AAA models. This model will definitely help to a better analysis and understanding of the impact of stentgrafting on biological mechanisms in the aneurismal wall, that lead to EVAR success with shrinkage of aneurismal sac or EVAR failure with its continuing expansion.

PurposeNeutrophils have been shown to be involved in all stages of human and experimental abdominal aortic aneurysm (AAA) development. The initial processes of neutrophil rolling and trapping in the intraluminal thrombus (ILT) are mediated mainly by P-selectin expressed by activated platelets. In the present study, we propose to evaluate the beneficial effect of fucoidan, a competitive binding agent of P-selectin, on aneurysmal growth in a rat model of aortic aneurysm with neutrophil enrichment of the ILT induced by repeated episodes of weak bacteremia.MethodsSixty Lewis rats with experimental AAAs, developed from decellularized aortic xenografts, were divided into four groups. Two groups were used as controls: group fucoidan control (FC) was treated with 200 mg of fucoidan (F) delivered by 2 mL, 4-week osmotic pumps placed intraperitoneally before closing the abdomen, and group C received saline instead of fucoidan. Two more groups were injected weekly with Porphyromonas gingivalis (P. gingivalis [Pg]): group F+Pg received 200 mg of intraperitoneal fucoidan and group Pg received saline. AAAs were harvested after 4 weeks and peripheral blood was sampled at that time. Cell-free DNA (cf-DNA) and myeloperoxydase (MPO) antigen concentrations were determined in plasma and in AAA-conditioned media. Histology and P-selectin immunostaining were performed on AAA tissue samples.ResultsComparing rats injected with Pg, those receiving fucoidan presented reduced aneurysmal diameter. Histologic analysis of AAAs showed that fucoidan reduced the ILT thickness in Pg-injected rats, with fewer trapped neutrophils, and with signs of a healing process, as observed in control group C. Immunohistological analysis revealed a substantial decrease in P-selectin immunostaining at the luminal surface of aneurysms in fucoidan-treated rats compared to the other groups, suggesting an interaction between fucoidan and P-selectin. A significant decrease in MPO concentrations in both plasma and conditioned medium was induced by fucoidan treatment in Pg-injected rats, reflecting a pacification of the ILT biological activity. This effect was associated with a reduction in neutrophil activation and apoptosis, reflected by a significant decrease in cf-DNA concentration in both plasma and conditioned medium of fucoidan-treated rats.ConclusionsOur results suggest that fucoidan has a beneficial effect on experimental aneurysmal degeneration by decreasing neutrophil activation in the ILT enhanced by weak pathogen contamination. This effect seems to be related to its interaction with P-selectin, which may decrease the trapping of neutrophils into the ILT. Fucoidan could represent a therapeutic option in AAAs to decrease the neutrophil activation involved in the degenerative process of aneurysmal expansion and rupture.Clinical RelevanceIn the present study, we propose to evaluate the beneficial effect of fucoidan, a competitive binding agent of P-selectin, on aneurysmal growth in a rat model of aortic aneurysm with neutrophil enrichment of the intraluminal thrombus induced by repeated episodes of weak bacteremia. Our results suggest that fucoidan has a beneficial effect on experimental aneurysmal degeneration enhanced by weak pathogen contamination by decreasing the trapping of neutrophils and the release of proteolytic enzymes into the intraluminal thrombus. Fucoidan could, therefore, represent a therapeutic option in abdominal aortic aneurysm to decrease the degenerative process leading to aneurysmal expansion and rupture.

Background Chronic mesenteric ischemia is a rare disease with nonspecific clinical symptoms, such as chronic postprandial abdominal pain and weight loss. Diagnostic modalities and revascularization techniques have evolved during the past 20 years. The significance of stenosis in a single splanchnic vessel remains unclear. Our aims were to assess the outcomes of 2 revascularization techniques and report on the diagnostic modalities of splanchnic vessel stenoses. Methods The demographic data, medical history, technical characteristics, and outcomes of the revascularization procedures were recorded for all of the patients admitted for endovascular revascularization or open surgical revascularization of the splanchnic vessels as treatment for chronic mesenteric ischemia in our tertiary referral center since 2000. Results Fifty-four patients were included in this study: 43 received endovascular revascularization, and 11 had open surgical revascularization. The symptoms were abdominal pain, weight loss, and diarrhea in 98%, 53%, and 25% of the cases, respectively. Computed tomography angiography was the key diagnostic tool for 60% of the patients. A single-vessel stenosis was found in one-third of the patients. Endovascular and open revascularization had similar early and late outcomes, and no 30-day mortality was observed. However, we did observe higher morbidity in the open revascularization group (73% vs 19%, P Conclusions Chronic mesenteric ischemia may be diagnosed in the presence of a splanchnic syndrome and stenosis of a single splanchnic vessel, typically assessed using computed tomography angiography. In selected patients, endovascular revascularization had similar efficacy as, and lower complication rates than open revascularization.

Objective To document the 30- and 90-day outcomes in patients with severe internal carotid artery stenosis who underwent carotid endarterectomy in the acute phase of crescendo cerebral transient ischemic attacks (CcTIAs). Methods From January 2003 to December 2009, data from patients suffering CcTIAs with an ipsilateral severe internal carotid artery stenosis and consecutively operated in our department were prospectively collected. CcTIA patients operated in the acute phase were those who had experienced ≥two cerebral TIAs and had been consecutively operated within 2 weeks of their first-ever TIA. Clinical assessment was by the vascular neurologist. Duplex ultrasonography was initially used for the diagnosis of severe (>70%) ipsilateral internal carotid artery and further assessed by magnetic resonance angiography and/or computed tomography angiography. Brain damage was assessed by magnetic resonance imaging or at default computed tomography scan. Perioperative medical treatment and operative techniques were standardized. Stroke, death, and major cardiac events were analyzed. Results Sixty-four patients sustained a median of four cerebral TIAs. Median delay to surgery from initial examination was 5 days. The mean degree of internal carotid artery stenosis was 87.9%. Of the 55 patients who had magnetic resonance imaging with diffusion-weighted imaging, 43 (78%) patients had new acute infarction in an area that corresponded to the clinical symptoms. All patients received antiplatelet therapy and statin during the intervening period. All patients underwent conventional carotid endarterectomy (CEA) with patch angioplasty (polytetrafluoroethylene). Fifty-six patients (87.5%) underwent CEA under local anesthesia with two (3.5%) utilizing selective shunting, and eight patients had general anesthesia with systematic shunting. From CEA to discharge, all patients had complete recovery of their unstable clinical syndrome. At discharge and at 1 and 3 months postoperatively, no stroke or death, or major cardiac event occurred in this series with a 100% complete follow-up. Conclusions Short delay between symptom onset and neurological assessment, immediate start of secondary stroke prevention, optimal perioperative medical treatment, and standardized operative techniques enabled performance of CEA in the acute phase of CcTIAs with low combined risk of stroke, death, and major cardiac event.

Background Aortic valve implantation (AVI) is a booming therapeutic option in high-risk patients with calcific aortic stenosis. Retrograde femoral approach drawbacks include vascular complications owing to the size of the introduction system (22- and 24-F).The aim of this study was to retrospectively analyze the incidence and the treatment of vascular complications in the first 2 years of transfemoral AVI experience with the first generation of Edwards SAPIEN transcatheter heart valves. Methods Since December 2007, AVI has been performed in 71 patients, 21 times by the transapical route and 50 times by the transfemoral route through an inguinal approach with the first generation of Edwards SAPIEN transcatheter heart valves (23 and 26 mm). The incidence and the treatment of vascular complications were evaluated as main criteria for transfemoral AVI. Results All the procedures could be successfully performed by a femoral route, except for three cases when the introducing device could not be fixed on the thoracic aorta because of vascular access problems. Vascular access-related complications occurred in nine patients (18%), including three iliac dissections, two aortic dissections, three femoral lesions, and one thoracic aorta rupture. These complications were treated either in a conservative way ( n = 2), or in an endovascular way using a contralateral approach ( n = 3), or surgically through an inguinal approach ( n = 3). A traumatic rupture of the thoracic aorta resulted in the death of a female patient. Conclusion In our experience, transfemoral AVI gives a satisfying technical success rate in the selected patients. The incidence of complications involving the vascular access remains an important limitation of this new technique. Although a conservative or endovascular treatment can be applied in most cases, improving the introduction devices is highly expected because it would reduce the complications rate of vascular access.

Background To report the rare diagnosis and the surgical treatment of a young patient presenting a symptomatic dissection of the abdominal aorta revealing a Takayasu’s arteritis (TA). Methods and Results A 24-year-old woman developed a painful chronic dissection of the infrarenal aorta associated with a claudication of both lower extremities. As the patient was still symptomatic despite an optimal medical treatment, a surgical revascularization was proposed. An aortobifemoral bypass was performed allowing the removal of infrarenal aorta and the histologic diagnosis of TA. Conclusion Isolated abdominal aortic dissection is an unusual event in TA, and this is the first surgically treated case. Only few reports of aortic dissection in TA have been published so far which are commented in this article.

Abstract Primary vascular tumours are very rare. Most cases are leiomyosarcomas usually arising from large veins such as the inferior vena cava. Involvement of major veins in the limbs is uncommon and of small veins or tributaries extremely uncommon. We report a case of leiomyosarcoma originating from a tributary of the femoral vein in a 55-year-old woman.

La rupture d’un anevrysme de l’aorte abdominale ou de l’artere iliaque (AAIR) est grevee d’un taux de mortalite spontane de plus de 80% (1). La «mise a plat greffe chirurgicale» de l’anevrysme est le traitement de reference des AAIR mais le taux de mortalite de cette intervention rapporte par une meta-analyse sur 171 etudes compilees depuis 1955 est de 48% (2).

Background We report a hybrid treatment for a ruptured penetrating aortic ulcer (PAU) of the aortic arch in emergency conditions. Methods A 74-year-old man with severe comorbidity was diagnosed with a symptomatic rupture of a PAU of the aortic arch. As he was considered unfit for conventional open repair and it was an emergency condition, an acute endovascular repair with cervical debranching of the supra-aortic trunks could be proposed. The left common carotid artery and left subclavian artery were first debranched and revascularized through cervical access, and the endovascular stent graft was then deployed via femoral access in the aortic arch. At ≥2 years the patient is safe with no sign of progression of the disease. Conclusion Acute debranching and stent grafting is feasible in emergency conditions to treat ruptured PAU of the aortic arch, with satisfying short- and mid-term outcomes, and can be proposed to patients considered unfit for conventional open repair.

Objectif Etudier la position en trois dimensions des ostia des troncs supra-aortiques (TSA) sur l’arc aortique chez les patients presentant une dissection aigue de type B, pour evaluer la faisabilite anatomique de la mise en place d’endoprotheses echancrees. Methodes Les reconstructions tomodensitometriques tridimensionnelles de 21 patients consecutifs presentant une dissection aigue de type B ont ete analysees. La disposition des TSA etait modale (groupe 1, n = 16) ou presentait un tronc commun (TC, groupe 2, n = 5). La position de chaque artere a ete caracterisee par l’angle entre le plan sagittal de l’arc aortique et le plan passant par le centre de la section frontale de l’aorte et le centre de chaque ostium αtronc arteriel brachiocephalique (TABC), αTC, αCCG (artere carotide commune gauche), αSCG (artere subclaviere gauche). Les mesures suivantes ont ete effectuees : diametres des TSA (OTABC ou OTC, OACCG, OASCG), de l’arc aortique (OCr), distances entre les TSA dans le plan sagittal (μSCG-CCG ; μCCG-TABC ou μSCG-TC) et dans le plan frontal (λSCG-CCG ; λCCG-TABC ou λSCG-TC). Deux positionnements d’endoprothese ont ete etudies : au pied de l’artere SCG ou CCG. Resultats Les angles medians etaient : groupe 1 αTABC = −4,5°, αCCG = +10,7°, αSCG = +11,2°, groupe 2 αTC = +10°, αSCG = +12,5°. Les diametres medians etaient : groupe 1 OCr = 31,7 mm, OTABC = 20,3 mm, OCCG = 13,9 mm, OSCG = 12,7 mm ; groupe 2 OCr = 31 mm ; OTC = 28,3 mm, OSCG = 13,7 mm. Les distances medianes etaient dans le plan sagittal : groupe 1 μSCG-CCG = 24,5 mm, μCCG-TABC = 22,5 mm ; groupe 2 μSCG- TC = 34 mm et dans le plan frontal : groupe 1 λSCG-CCG = 14,9 mm et λCCG-TABC = 18,8 mm ; groupe 2 λSCG-TC = 24,4 mm. Conclusion Le traitement des dissections aortique de type B par endoprothese est anatomiquement faisable. Dans les deux configurations envisagees, une echancrure de 25 mm de profondeur et de 18 mm de largeur permettrait de traiter la majorite des patients.

Chimney endovascular aneurysm repair is still a controversial treatment of complex aortic aneurysms. Stent-graft patency and type-I endoleaks are the main challenges that temper this bailout technique. Endovascular aneurysm sealing (EVAS) consists of anchoring and sealing the device within the aneurysm sac. The first results are promising, even for adverse anatomy. We describe a case of EVAS for a pararenal aortic aneurysm associated with a chimney stent graft for the right renal artery. Wrapping the chimney stent graft inside endobags filled with polymer is expected to prevent gutters and stent compressions.

The aims of treating patients with popliteal aneurysm (PA) are to prevent limb-threatening ischemia from aneurysm thrombosis, distal embolization, and rupture, while concurrently restoring adequate blood flow to the lower extremity. This involves often an interposition graft or a bypass. We report four cases of PAs treated with resection of the aneurysm sac and direct end-to-end anastomosis. This technique, which does not require any graft interposition, presents many advantages, and, therefore, should be considered by vascular surgeons.

PURPOSE To report successful endovascular repair of thoracic aortic aneurysms in 2 patients with human immunodeficiency virus (HIV). CASE REPORTS Thoracic and abdominal aortic aneurysms (AAA) were found in a 60-year-old woman 1 year after she was diagnosed with HIV. Because of pain and risk of rupture, the AAA was repaired with conventional open techniques in February 1997, while the thoracic aneurysm was excluded in a staged procedure using a homemade endograft delivered through a 10-mm conduit sewn to the aortic tube graft. Two months later, new aneurysms were found in the superficial femoral arteries bilaterally; both were excised and replaced with vein grafts. After 7 years, the patient is well and no longer takes antiretroviral medication. Surveillance imaging shows continued patency of the stent-graft without evidence of leak or migration. In a more contemporary case, a 46-year-old man was found to have 5 focal aneurysms in the aorta; the most proximal descending thoracic aneurysm increased 2 cm in 2 weeks. The two thoracic aneurysms were successfully excluded using 2 Excluder stent-grafts. At 7 months, he was doing well, and the aneurysm had shrunk 11 mm. CONCLUSIONS Endovascular and open treatment of HIV-related aneurysms is possible, with excellent long-term results. Patients with long-life expectancy should be treated according to the same guidelines as patients without HIV.

Les thromboses arterielles des membres superieurs sont rares. Il n'existe que peu de series medicales qui sont de faible effectif mais decrivent des etiologies tres diverses, plus variees que pour les membres inferieurs. Objectif de l'etude : L'objectif de ce travail retrospectif etait de decrire les caracteristiques des patients hospitalises en milieu medical pour une thrombose arterielle de membre superieur, les etiologies retrouvees, les examens complementaires effectues, le traitement instaure ainsi que le pronostic. Patients et methode : Il s'agit d'une etude observationnelle, retrospective et bi-centrique menee dans le service de medecine vasculaire de l'HEGP (AP-HP) et dans le service de medecine interne du CHU de Rouen, entre le 01/01/2000 et le 30/05/2013. Les donnees ont ete extraites en utilisant le codage CIM-10 "Thromboses arterielles des membres superieurs". Resultats : 181 patients ont ete inclus. L'âge moyen est de 55+17 ans (53% d'homme). Les FDRCV les plus frequents sont l'âge du patient, le tabagisme, l'HTA, l'hypercholesterolemie, l'obesite, le diabete et l'heredite cardiovasculaire. L'etiologie la plus frequente est le syndrome du marteau hypothenar (13,8%), suivie des embolies ou thromboses-sur plaque d'atherome (13,3%) et des cardiopathies emboliques (13,3%). Les autres etiologies sont plus rares : connectivites (10,5%), causes iatrogenes (7,7%), maladie de Buerger (7,7%), cancers (5,0%), thrombophilies (4,4%), DTCB (3,9%), embolies paradoxales (2,2%) et vascularites des gros vaisseaux (2,2%). Dans 16,0% des cas, l'etiologie reste indeterminee. Les arteres les plus frequemment occluses sont les arteres ulnaire et de la main. Dans 13,5% des cas, la thrombose se complique de gangrene et necessite une amputation, digitale principalement. Le deces survient chez 7 patients (3,9%) pendant le sejour. Conclusion : Comparativement aux membres inferieurs, la population est plus jeune et avec un sex-ratio plus equilibre. Il existe une grande diversite etiologique, qui justifie une enquete large. Malgre cela, 16% des cas restent inexpliques. La morbidite est importante, avec 13,5% d'amputation. La mortalite est de 3,9%.

reconstruction of the renal and/or visceral arteries. The approach was retroperitoneal in 51.8% of the cases (n1⁄429) and transperitoneal in 48.2% of the cases (n1⁄427). Clamping was supra-renal in 71.4% of the cases (n1⁄440) and supra-visceral in 28.6% of the cases (n1⁄416). The median duration of renal clamping was 29.5 min [1550]. Postoperative impaired renal function was observed in 37.5% of the patients (n1⁄421). Only one patient (1.8%) necessitated temporary dialysis. Respiratory complications (pneumopathy, acute respiratory insufficiency, reintubation) were observed in 14.3% of the patients (n1⁄48). No patient had postoperative paraplegia or occlusion of the renal or visceral arteries. Six patients (10.7%) had a re-implantation of the lower mesenteric artery. Overall survival rate was 85.2% at two years and 75.2% at five years. Duration of clamping higher than 30 min was significantly associated with an increased mortality at 2.5 and 7 years. Conclusion: The morbi-mortality of conventional surgery for JR-AAA is similar to that of infrarenal AAA provided that the duration of supra-renal clamping remains < 30 min, with very satisfactory long-term results. The conventional surgery of JR-AAA does not require a reconstruction of the renal or visceral arteries contrary to fenestrated stentgrafts.

was observed in 54.5% of the cases (n1⁄412) when they were perfused by the false channel, and in 7.9% of the cases (n1⁄43) when they were perfused by the true channel. Conclusion: The extensive deployment of a bare stent in this model of type B acute dissection allowed a re-expansion of the true channel in all the cases but involved a significant fall of the systolic pressure in the digestive and renal arteries in 54.5% of the cases when they originated from the false channel.

Background In selected type B acute aortic dissection with aortic growth and patent false lumen, an intervention may be required to prevent aortic rupture. Apart from stent grafting of the thoracic aorta, aimed at occluding the primary intimal tear, some have advocated closure of reentry tears by stent grafting of the aortic true lumen after hybrid revascularization of the excluded viscera or by branched aortic endografts. Methods We describe a simple technique for occluding a major reentry tear in the visceral abdominal aorta, using on-the-shelf covered stent grafts, arising from the aortic true lumen, crossing the dissection septum tear and aortic false lumen, and being distally anchored in the visceral branch vessel, acting as a rivet on the dissection septum tear, achieving aortic false lumen thrombosis. Results In selected cases, we achieved aortic false lumen thrombosis by spot stenting of the tear. Conclusions This spot stenting technique may be a useful way of achieving complete false lumen thrombosis or lowering the false lumen pressure of degenerating dissecting aneurysms.

Objectifs Rapporter le diagnostic rare et le traitement chirurgical d’un jeune patient present une dissection symptomatique de l’aorte abdominale revelant une arterite de Takayasu (TA). Methodes et resultats Une femme de 24 ans a developpe une dissection chronique douloureuse de l’aorte sous-renale avec une claudication des deux membres inferieurs. Comme la patiente restait symptomatique en depit d’un traitement medical optimal, on a propose une revascularisation chirurgicale. Un pontage aortobifemoral a ete fait avec resection de l’aorte sous-renale et le diagnostic histologique de TA. Conclusion La dissection aortique abdominale isolee est un evenement rare au cours d’une TA, et c’est le premier cas traite chirurgicalement. Peu de cas de dissection aortique avec TA ont ete publies, qui sont commentes dans cet article.

Nous rapportons le traitement hybride en urgence pour un ulcere penetrant (UP) rompu de l'arche aortique. Un homme de 74 ans avec de graves comorbidites s'est presente avec une rupture symptomatique d'un UP de l'arche aortique. Comme il etait considere inoperable en chirurgie conventionnelle a ciel ouvert et qu'il s'agissait d'une urgence, on a pu lui proposer une reparation endovasculaire aigue associe a un debranchement cervical des troncs supra-aortiques. L'artere carotide commune gauche et l'artere sous-claviaire gauche ont d'abord ete debranchees et revascularisees par voie cervical, puis l'endoprothese a ete deployee par voie femorale dans l'arche aortique. Apres plus de deux ans de recul, le patient est vivant sans signe de progression de la maladie. Le debranchement et la pose d'une endoprothese est faisable en urgence pour traiter un UP rompu de l'arche aortique, avec un resultat satisfaisant a court et moyen terme, et peut etre propose aux patients considere inoperable de facon conventionnelle.