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Introduction: Critical limb ischemia (CLI) represents the most severe form of Peripheral artery disease (PAD). Its prevalence is estimated to be between 0.5% and 2.3% of the population over 40 years old. Despite its importance, epidemiological studies on CLI remain patchy. In Morocco, few studies have been carried out on this subject, and we have no epidemiological data on the morbimortality of chronic critical ischemia of the lower limbs on a national scale. Objective: The objective of our study was to evaluate the results of surgical treatment of critical limb ischemia and to identify the factors associated with the medium-term evolution. Methods: We conducted a retrospective cohort study of all patients admitted to the vascular surgery department of the Hassan II University Hospital for the management of critical ischemia of the lower limbs, who underwent revascularization surgery between 01/01/2013 and 31/12/2019. Patients who underwent a major amputation of the affected limb and those for whom the revascularization procedure was a revision were subsequently excluded. The follow-up period was 2 years and the events of major interest were the occurrence of a major limb amputation and 30-day mortality. Results: The cohort included 232 patients with critical ischemia. The mean age was 62 years with a clear male predominance of 84.5%. The most common comorbidities were diabetes (65.8%), active smoking (42.5%), and hypertension (31.2%). The majority of patients (62%) benefited from endovascular procedures. The primary technical success was 94.1%, the major amputation rate was 19.7%, and the 30-day mortality was 4.3%. In multivariate analysis, factors independently associated with a high postoperative complication rate were preoperative hyperglycemia, concomitant ischemic heart disease, female sex, young age, and intensive care unit stay. Conclusion: Our study highlights several risk factors for the occurrence of postoperative complications of CLI. These results .....

Congenital arteriovenous fistula (AVF) is a rare vascular disease, which may occur anywhere in the body. The forearm is a very rare location. Clinical manifestations are not very specific and can vary from an asymptomatic fistula to a life-threatening congestive heart failure. Although embolization can be an alternative treatment for AVF of the forearm, surgery is still considered as the standard treatment. Herein, we report the case of a 7-year-old boy with a congenital AVF between the radial artery and the superficial cephalic vein in the forearm without any dysmorphic features treated surgically.

Venous aneurysm of external jugular vein is very rare clinical entity. Often asymptomatic, the diagnosis may be suggested by clinical features and is usually confirmed by imaging. Surgical excision is indicated in symptomatic aneurysms and for esthetic reasons, other treatments such as endovascular treatment are being evaluated. We report a case of a 27-year-old woman with a saccular aneurysm of the right external jugular vein diagnosed by computerized tomogram angiography. The patient received successful surgical treatment.

Isolated aneurysms of the common iliac artery are rare, affecting less than 0.01% of the general adult population. Most of these aneurysms are asymptomatic and are discovered as an incidental finding. We describe an elderly patient presented with a urinary retention, which the investigations had led to the diagnosis of a large left common iliac artery aneurysm.

Summary Background Behcet's disease (BD) is a multisystem chronic autoimmune inflammatory disorder that involves multiple organs. Arterial involvement in BD is rare. Aortic involvement is one of the most severe manifestations and is associated with a much higher mortality. In this article, we will present our experience in open surgical repair of abdominal aortic aneurysm combined with immunosuppressive therapy. Methods Between January 2010 and December 2017, 7 patients were treated for abdominal aortic aneurysms (5 infra-renal and 2 supra-renal, in 1 woman and 6 men). All patients were Moroccan, the age range being 25–59 years, mean age 43.2 years. Three Dacron tube grafts, two Dacron aortobiiliac grafts and two patch closures were used. All 7 patients received immunosuppresive therapy after surgery. Results All patients underwent successful open surgical repair without major complications during the 30 days immediately after the procedure. During a mean follow-up of 36 months, there was no recurrent aneurysmal localization, but one patient had lost their sight. Until now, we have been following 6 patients and they continue to receive immunosuppressive therapy. Conclusion Long-term immunosuppressive therapy after aneurysm repair is important to limit pseudoaneurysm recurrence. Through our serie, we describe the results of the combination of surgical treatment and adjunctive immunosuppressive therapy, with a literature review.

Carbon monoxide (CO) poisoning is a very common reason for emergency ward admission, with symptoms varying from a simple headache and dizziness to severe neurological and cardiac impairment. We report here a rare clinical presentation of CO intoxication manifested by a severe cardiac impairment with intracardiac thrombus formation, acute limb ischemia, renal infarction, and carotid artery thrombosis. There have been initial reports of thromboembolic events in acute CO poisoning with intracardiac thrombosis being sparsely reported. Contrary to venous thromboembolism, arterial thromboembolism in CO poisoning seems to be extremely rare. To the best of our knowledge, this is the first report in recent literature of a combined intracardiac thrombosis and multiple arterial thromboembolism induced by CO poisoning.

Axillary artery injury from humeral neck fracture is an uncommon event. Vascular damage due to these injuries may threaten limb loss. In some cases, the signs of ischemia may not be evident just after the injury and may only appear later on. Therefore, a high index of suspicion is essential. It is important to bear this association in mind, so as to make an early diagnosis and avoid serious complications. We are describing the case of a young patient involved in a motor vehicle crash with an axillary artery trauma due to the surgical neck of humerus fracture. The patient underwent a basilic vein grafting, the postoperative course was good.

True atherosclerotic aneurysms of superficial femoral artery (SFA) are rare and often associated with other peripheral or aortic aneurysms. We are reporting the case of a 78-year-old man who has been admitted with a ruptured superficial femoral artery aneurysm associated with bilateral popliteal artery aneurysm. The patient underwent successful aneurysm resection and bypass grafting.

The other reports a case of fibrodysplasic aneurysm of the extracranial internal carotid artery that was successfully treated by resection and direct end-to-end anastomosis of the internal carotid artery. Keywords: Extracranial internal carotid artery aneurysm, fibromuscular dysplasia, surgical treatment

Knee arthroscopy is a common procedure to treat sports injuries. It is a safe procedure with less injury to soft tissues and very few complications. Pseudoaneurysm of the popliteal artery and/or arteriovenous fistulae is a rare complication of arthroscopic procedure of the knee. We report a case of popliteal artery pseudoaneurysm with arteriovenous fistulae after arthroscopic procedure of the knee in a younger sportsman.

Acute type B aortic dissection can lead to acute limb ischemia which is of poor prognosis. The emergency is the revascularization of the limb. Several revascularization therapies are proposed and are constantly changing. We report a case of an acute limb ischemia revealing an acute type B aortic dissection treated surgically. Key words: Aortic dissection, Limb ischemia, Surgery.

Highlights • Pseudoaneurysms of the deep femoral artery are uncommon and occur as a late complication of various traumas. • We report two cases of profunda femoris artery injury which presented as false aneurysm secondary to penetrating trauma. • As these cases illustrate, the diagnosis of pseudoaneurysm of deep femoral artery following trauma and orthopedic procedures requires awareness and a high index of suspicion., Pseudoaneurysms of the deep femoral artery are uncommon and occur as a late complication of various traumas. Usually associated with femoral fractures, We report two cases of profunda femoris artery injury which presented as false aneurysm secondary to penetrating trauma. Because of its insidious onset, awareness and careful follow-up are the key issues for the early diagnosis.

Resume La maladie de Behcet est une vascularite systemique d’etiologie inconnue. Si l’atteinte veineuse est classique, l’atteinte arterielle est relativement rare mais de pronostic sombre. Souvent anevrysmal, le syndrome aortique du a l’angio-Behcet peut en etre revelateur. La localisation aortique, mais surtout le risque evolutif vers la rupture peuvent engager, dans certains cas, le pronostic vital. Nous rapportons l’observation d’un patient âge de 46 ans dont la maladie de Behcet a ete revelee par un anevrysme de l’aorte abdominale sous-renale en pre-rupture. Le diagnostic de cette maladie a ete retenu devant les criteres cliniques, biologiques et radiologiques. Le patient a beneficie d’une mise a plat de l’anevrysme avec la mise en place d’une prothese en Dacron.

Vascular leiomyosarcomas are extremely rare, and involve veins 5 times more often than arteries. In the lower extremity, the great saphenous vein is the most frequent site of origin. We report the case of a healthy 45-year-old patient who presented with a painless mass located proximally in the right thigh in line with the great saphenous vein. At surgery, the treatment consisted of wide local excision. Histopathological studies confirmed mass as leiomyosarcoma. In light of this report, we draw attention to this rare disease, though with a poor prognosis.

Aneurysms of the profunda femoris artery (PFA) are exceptionally rare but dreadful because of their high rate of rupture. In this report, we describe the case of a 70-year-old man presented to the emergency department with a ruptured PFA aneurysm. The patient underwent successful aneurysmorrhaphy and distal reconstruction with a vein graft.

Le syndrome de Klippel-Trenaunay (SKT) est une malformation vasculaire combinee complexe congenitale. Le SKT peut associer plusieurs anomalies vasculaires a « flux lent » : malformations capillaires, veineuses et/ou lymphatiques [1].Nous rapportons le cas d’une fillette âgee de 10 ans, qui presente depuis sa naissance une macule erythemateuse s’etendant progressivement lors de la croissance avec apparition progressive de paquets variqueux sur la face externe de la cuisse droite [...]

stv.2013.0783 Auteur(s) : Hamid Jiber Hamid_jiber@yahoo.fr, Othman Zizi, Youssef Zrihni, Abdellatif Bouarhroum CHU Hassan II, service de chirurgie vasculaire, Fes, Maroc Tires a part : H. Jiber L’incidence de la maladie renale chronique de stade 5 exigeant un traitement par hemodialyse immediate continue a augmenter. Il existe egalement un nombre croissant de patients qui ont des difficultes d’acces arterio-veineux en raison du diabete et d’echecs de fistule [1]. La plupart des [...]

stv.2013.0781 Auteur(s) : Hamid Jiber Hamid_jiber@yahoo.fr, Youssef Zrihni, Rachid Zaghloul, Abdellatif Bouarhroum CHU Hassan II, service de chirurgie vasculaire, Fes, Maroc Tires a part : H. Jiber Toutes localisations confondues, la frequence des anomalies vasculaires des extremites des membres est d’environ 10 % [1]. Ces anomalies representent entre 5 et 10 % des masses des parties molles interessant la main, loin derriere les kystes synoviaux, les synovites villonodulaires, [...]

L’incidence de l’insuffisance renale chronique terminale ne cesse d’augmenter dans la population pediatrique [1]. Les problemes des acces vasculaires chez ce type de patients fragiles viennent compliquer la situation avec un nombre croissant d’enfants qui ont des echecs de leurs acces vasculaires pour l’hemodialyse secondairement a plusieurs causes. D’apres les recommandations KDOQI [2], le choix optimal de l’acces chez ces patients sans veine cephalique utilisable demeure [...]

La fistule artério-veineuse native est l'accès vasculaire de choix pour l'hémodialyse chronique en raison de sa longévité, son taux faible de complication et de mortalité par rapport aux pontages artério-veineux et aux cathéters. Cependant, il arrive assez souvent que l'on assiste à des complications qui sont dominées par la sténose et la thrombose. C'est une étude rétrospective des complications ayants survenues pour 31 fistules artério-veineuses pour hémodialyse chronique des 200 fistules réalisées chez 200 patients au sein du service de chirurgie vasculaire du CHU Hassan II de Fès sur une période de trois ans, étendue de Janvier 2007 à Décembre 2009. Ces complications ont été présentés par les thromboses dans 14 cas soit 45,15% de l'ensemble des complications, les sténoses dans 4 cas (12,90%,) les anévrismes dans 4 cas (12,90%), les complications ischémiques dans 3 cas (9,67%), l'infection dans 3 cas (9,67%), l'hémorragie dans 2 cas (6,45%) et l’ hyperdébit dans un seul cas soit 3,22%. On a pu conserver 22 fistules soit 70,96% par traitement chirurgical ou endovasculaire, on a confectionné une nouvelle fistule dans 8 cas soit 25,80%, et on a adressé une patiente (3,22%) pour pose d'un cathéter veineux tunnelisé permanent. Les complications des fistules artério-veineuses pour l'hémodialyse chronique sont la principale cause de morbidité chez les patients hémodialysés, il est donc important de s'impliquer lors de leur création, et de donner un maximum d'attention quand ils sont manipulés. Ceci suggère la mise en place d'un programme de surveillance de ces fistules en raison de l'impact des complications sur la morbi-mortalité du patient hémodialysé et sur le plan financier.

Marfan’s syndrome is an autosomal dominant disorder of connective tissue characterized by a large number of possible mutations and by heterogeneity of clinical presentation primarily in skeletal, ocular and cardiovascular organ systems. Cardiovascular complications of the disease are responsible for high mortality. The case of a 42-year-old patient with a progressive advanced abdominal aorta dilatation visualized on computed tomography images is presented. Pathogenesis, diagnosis and management of patients with Marfan’s syndrome are also discussed.

Gluteal artery aneurysms are rare and mostly secondary to blunt or penetrating trauma. As an absolute rarity, we report an exceptional presentation of bilateral mycotic aneurysm of the superior gluteal artery in a 16-year-old boy associated with bacterial endocarditis. The left pseudoaneurysm was ruptured and treated using open surgery; 1 week later, the right location was successfully treated by embolization.

Introduction La fistule arterio-veineuse (FAV) native est l’acces vasculaire de choix pour l’hemodialyse chronique en raison de sa longevite, son taux faible de complication et de mortalite par rapport aux pontages arterio-veineux et aux catheters. Cependant, il arrive assez souvent que l’on assiste a des complications. La dilatation anevrismale constitue une complication grave avec parfois perte de la FAV, rupture, voire une hemorragie fatale. Notre objectif etait de determiner les aspects cliniques, les caracteristiques et la prise en charge des dilatations anevrismales sur FAV d’hemodialyse. Patients et Methodes C’est une etude retrospective des complications anevrismales survenues pour 17 FAV pour hemodialyse chronique realisees au sein du service de chirurgie vasculaire du CHU Hassan II de Fes sur une periode de 7 ans, etendue de janvier 2007 a decembre 2013. On a defini comme anevrisme une dilatation ≥ 3 fois le diametre de la veine native. Les faux anevrismes ont ete inclus dans notre etude. Les caracteristiques des anevrismes (diametre, localisation, thrombose, stenose associee, infection et eventuelle rupture), les symptomes et le type de traitement ont ete etudies. Resultats L’âge moyen de nos patients etait de 45 ans. Dix FAV etaient brachio-cephaliques (58,80 %), cinq etaient radio-cephaliques (29,40 %) et 2 etaient brachio-basiliques (11,8 %). Onze etaient des faux anevrismes (64,70 %) et 6 des anevrismes vrais (35,3 %). Le delai moyen entre la creation de la FAV et la complication etait de 6 mois. On a pu conserver 9 FAV soit 52,94 % par divers gestes chirurgicaux et on a confectionne une nouvelle FAV apres ligature de la FAV dans 8 cas soit 47,06 %. Conclusion La dilatation anevrismale sur FAV pour hemodialyse represente une complication grave qui peut conduire a la perte de l’abord. Ceci suggere une manipulation prudente et une surveillance etroite de ces FAV par le personnel soignant. Le traitement chirurgical permet en general de preserver la FAV.

Auteur(s) : Nabil Sedki, Badre Rhissassi, Youssef Zrihni, Hamid Jiber, Abdellatif Bouarhroum Service de chirurgie vasculaire, CHU Hassan II, Fes, Maroc Observation Il s'agissait d'un patient âge de 24 ans, sans antecedent notable, qui etait admis aux urgences dans un etat de choc hypovolemique suite a une plaie cervicale gauche occasionnee par arme blanche. Apres remplissage vasculaire, persistait un elargissement de la tension arterielle differentielle. L'examen trouvait [...]