Search

Renal artery aneurysm (AAR) is rare and usually asymptomatic; rupture, thromboembolism are aneurysmal complications that can then lead to renal infarction. AAR is often found fortuitously when exploring other diseases. Renal autotransplantation (RAT) is an alternative treatment for complex AAR, with satisfactory outcomes described in the literature.

Resume Objectif Les lesions traumatiques de l’aorte thoracique descendante en dehors de l’isthme sont rares et moins connues. La rupture aigue post-traumatique (RTA) peut etre multiple ou isolee dans de rares cas. Observation Nous rapportons le cas d’un jeune homme victime d’une chute d’echafaudage ayant occasionne un polytraumatisme avec rupture isolee de l’aorte thoracique descendante. Le diagnostic precoce et un traitement endovasculaire adapte ont permis une evolution favorable du patient. Conclusion La RTA siege dans 90 % des cas en un seul foyer generalement au niveau de l’isthme aortique, mais les ruptures de l’aorte descendante plus rares ne sont pas a meconnaitre et sont a rechercher systematiquement. Le mecanisme physiopathologique et l’attitude pratique devant ce type de lesion sont discutes au vu des donnees de la litterature.

Resume Les faux anevrismes des arteres gluteales sont rares. Ils sont souvent post-traumatiques secondaires a des traumatismes fermes ou penetrants du pelvis. Ces faux anevrismes sont initialement asymptomatiques et se manifestent apres un delai variable allant de quelques semaines jusqu’a des annees apres le traumatisme initial. Leur evolution spontanee peut etre fatale en cas de rupture. Le traitement des faux anevrismes gluteaux etait exclusivement chirurgical, mais l’avenement des techniques endovasculaires a revolutionne leur prise en charge en diminuant la morbidite perioperatoire et en offrant des resultats comparables a ceux de la chirurgie. Nous rapportons le cas d’un patient admis en urgence pour prise en charge d’un faux anevrisme post-traumatique rompu de l’artere gluteale superieure, survenant 20 jours apres un traumatisme fessier penetrant, et traite par embolisation selective avec succes.

Resume Le syndrome de Marfan est une maladie genetique du tissu conjonctif de transmission autosomique dominante, caracterisee par un grand polymorphisme clinique et dont le pronostic depend des complications cardiovasculaires associees, dominees par les atteintes aortiques proximales. Les anevrismes arteriels peripheriques sont rares au cours du syndrome de Marfan et sont exceptionnellement revelateurs de la maladie. Nous rapportons le cas d’un volumineux anevrisme de l’artere axillo-sous-claviere en pre-rupture revelant un nouveau cas de syndrome de Marfan. L’intervention chirurgicale a consiste en une mise a plat de l’anevrisme et retablissement de la continuite arterielle par greffe veineuse ; les suites operatoires etaient simples.

Resume La dissection traumatique du pedicule renal est rarement rapportee apres traumatisme ferme. Les signes cliniques sont pauvres et inconstamment rapportes. Le diagnostic repose sur des donnees d’imagerie par angioscanner et l’arteriographie reste utile lorsqu’un geste de revascularisation est envisage. Nous rapportons ici, le cas d’une dissection traumatique avec thrombose d’un pedicule renal a localisation juxta-aortique imposant une simple surveillance en reanimation. Le diagnostic tardif et la localisation juxta-aortique n’ont pas permis un geste endovasculaire.

False aneurysms of the extracranial vertebral artery (FAVA) are rare because of the path of the artery at the level of the transverse holes. They can be secondary to penetrating cervical trauma, spontaneous in the course of an angiopathy such as Ehlers-Danlos syndrome, or iatrogenic. We report the case of a 31-year-old woman who presented a syndrome of Claude Bernard-Horner related to a spontaneous FAVA. The angioscanner confirmed the diagnosis and the patient underwent successful surgical treatment of the false aneurysm with ligature of the vertebral artery. Outcome was favorable.

Resume La maladie de Behcet est une vascularite systemique d’etiopathogenie inconnue. Les manifestations arterielles a type de pseudo-anevrismes sont rares et peuvent etre le mode de survenue de la maladie. Ces pseudo-anevrismes ont tendance, independamment de leur taille, a evoluer rapidement vers la rupture engageant le pronostic vital. Nous rapportons deux cas de patients ayant presente des pseudo-anevrismes arteriels peripheriques rompus, et dont la prise en charge a consiste en une mise a plat de l’anevrisme, puis retablissement de la continuite arterielle dans un cas et une ligature arterielle dans l’autre ; les suites operatoires etaient simples dans les deux cas.

Angioplasty stenting of popliteal artery lesions is a common procedure in endovascular surgery. Stent fractures in popliteal artery maybe asymptomatic or cause restenosis, false-aneurysm or acute thrombosis. We report one case of acute limb ischemia occurred after a popliteal stent fracture placed four months earlier. The patient underwent an angioplasty stenting, completed with thrombolysis and thrombectomy. This case-report aims to illustrate complications of stent fracture in popliteal artery and possibility's to manage it by endovascular approach.

Resume Les pseudoanevrymes arteriels et les fistules arterio-veineuses demeurent une complication rare des traumatismes des regions gonales et jambieres. Ils se manifestent generalement a distance du traumatisme initial et peuvent demeurer longtemps asymptomatiques. Leur traitement n’est toujours pas codifie. Nous rapportons le traitement par embolisation par coil en urgence d’un pseudoanevrysme post-traumatique en pre-rupture de l’artere articulaire inferieure du genou et celui d’une fistule arterio-veineuse post-traumatique entre l’artere et la veine tibiale anterieure traitee par embolisation associee a un pseudoanevrysme traite par chirurgie de decompression. Les suites chez les deux patients etaient satisfaisantes.

Although Type B dissection accounts for 25–40% of all aortic dissections, their treatment remains to date quite controversial. In acute complicated cases (visceral malperfusion, refractory pain, etc.), surgical treatment is generally recommended, but is still associated with a high rate of morbimortality. Implantation of endoprosthesis has been proposed as an alternative therapy for patients with high surgical risk. Reports support that endovascular stent-graft treatments of a complicated type B acute dissection produce a short and medium term satisfactory results.

Resume Les anevrismes de l’artere sous-claviere sont rares et demeurent souvent asymptomatiques jusqu’au stade de complications. Nous rapportons le cas d’un anevrisme degeneratif de l’artere sous-claviere gauche intrathoracique decouvert de maniere fortuite et traite avec succes par endoprothese couverte. L’interet de cette observation est de mettre le point sur le role que peuvent apporter les techniques endoluminales dans la gestion des lesions d’acces difficile ou chez les malades a haut risque chirurgical.

The aneurysms of digestive arteries are a rare pathological entity, with a risk of rupture associated to a high mortality rate, often asymptomatic, then they are discovered incidentally during a exam for other diagnostic purposes. We report three cases of digestive aneurysms, one of celiac trunk, one of mesenteric artery on behcet disease, and one of splenic artery, which were treated surgically with success.

Vascular involvement in Behcet's disease is rare, but may be inaugural in many cases. We report a case of Behcet's disease revealed by two pre-rupture aneurysms - a subrenal abdominal aortic aneurysm and a femoral aneurysm. This patient had only one of the International Study Group for Behcet's disease diagnostic criteria: pseudofolliculitis. Behcet's disease must be considered as a possible diagnosis in patients with unexplained inflammatory arteriopathy.

Blunt trauma rarely causes renal pedicle dissection. Clinical signs are minimal and inconsistently reported. The diagnosis is based on computed tomographic angiography; arteriography is still useful when revascularization is considered. We report here a case of traumatic dissection with thrombosis of a juxta-aortic renal pedicle monitored in the intensive care unit. An endovascular procedure could not be proposed because of the juxta-aortic localization.

Marfan syndrome is an autosomal dominant disorder with rheumatoid, ophthalmological, neurological, cutaneous and cardiovascular manifestations. Aneurysmal lesions affecting both the abdominal aorta and the peripheral arteries are not often described in the literature. We report a case associating a bilateral popliteal aneurysm and an aneurysm of the infra-renal abdominal aorta.

Aneurysm of the superior mesenteric artery is a rare finding. The risk of rupture is difficult to predict and manage. We report the case of a young woman who developed an aneurysm of the superior mesenteric artery in a context of bacterial endocarditis. Surgical resection without revascularization was successful.

False aneurysms of the extracranial vertebral artery (FAVA) are rare because of the path of the artery at the level of the transverse holes. They can be secondary to penetrating cervical trauma, spontaneous in the course of an angiopathy such as Ehlers-Danlos syndrome, or iatrogenic. We report the case of a 31-year-old woman who presented a syndrome of Claude Bernard-Horner related to a spontaneous FAVA. The angioscanner confirmed the diagnosis and the patient underwent successful surgical treatment of the false aneurysm with ligature of the vertebral artery. Outcome was favorable.

Resume Nous presentons une etude retrospective de 12 patients operes dans le service de chirurgie vasculaire de l’hopital Militaire d’Instruction Mohammed V de Rabat entre 1996 et 2011. Il s’agissait de sept femmes et de cinq hommes. L’âge moyen etait de 46 ans. Tous les patients avaient ete admis pour un syndrome tumoral. Le diametre de la lesion variait entre 3 et 6 cm. Il n’existait pas de cas bilateral dans cette serie. La symptomatologie evoluait en moyenne depuis 66 mois. La duree de sejour apres l’acte et les complications postoperatoires sont rapportees.

Resume Les malformations arterioveineuse constituent une entite specifique parmi les angiodysplasies vasculaires. Outre leur extreme rarete, elles se caracterisent par le risque de complications locales et generales parfois graves, ainsi que par une grande difficulte de prise en charge therapeutique. Nous rapportons un cas de malformation arterioveineuse du membre superieur ayant connu un tournant evolutif dramatique apres traitement chirurgical et nous discutons, a la lumiere de cette observation, les particularites diagnostiques et therapeutiques de ce type de lesion.

Middle aortic syndrome (MAS) results from a diffuse narrowing of the distal thoracic or abdominal aorta commonly involving both the visceral and renal arteries. Congenital, acquired, inflammatory, and infectious etiologies have been described. Symptoms typically occur within the first three decades of life and include hypertension, lower extremity claudication, and mesenteric ischemia. The condition is considered a life-threatening emergency as a result of the complications associated with severe hypertension. Diagnosis is made with magnetic resonance and computed tomography angiography. Surgical bypass grafting is the optimal method of treatment and must be tailored depending on the distribution of disease. We report one case of MAS treated with thoracic aorta to abdominal aorta bypass and reimplantation of the right renal artery.

Marfan syndrome is an autosomal dominant disorder with rheumatoid, ophthalmological, neurological, cutaneous and cardiovascular manifestations. Aneurysmal lesions affecting both the abdominal aorta and the peripheral arteries are not often described in the literature. We report a case associating a bilateral popliteal aneurysm and an aneurysm of the infra-renal abdominal aorta.

The aneurysms of digestive arteries are a rare pathological entity, with a risk of rupture associated to a high mortality rate, often asymptomatic, then they are discovered incidentally during a exam for other diagnostic purposes. We report three cases of digestive aneurysms, one of celiac trunk, one of mesenteric artery on behçet disease, and one of splenic artery, which were treated surgically with success.

We report a retrospective analysis of 12 patients who underwent vascular surgery for cervical paraganglioma at the Mohammed V Military Hospital at Rabat from 1996 to 2011. There were seven women and five men, mean age 46 years. All patients presented a tumor syndrome. At surgery, the diameter of the lesion measured 3 to 6 cm. There were no bilateral cases in this series. Symptoms had been noted on average for 66 months. Hospital stay after surgery and postoperative complications are reported.

Middle aortic syndrome (MAS) results from a diffuse narrowing of the distal thoracic or abdominal aorta commonly involving both the visceral and renal arteries. Congenital, acquired, inflammatory, and infectious etiologies have been described. Symptoms typically occur within the first three decades of life and include hypertension, lower extremity claudication, and mesenteric ischemia. The condition is considered a life-threatening emergency as a result of the complications associated with severe hypertension. Diagnosis is made with magnetic resonance and computed tomography angiography. Surgical bypass grafting is the optimal method of treatment and must be tailored depending on the distribution of disease. We report one case of MAS treated with thoracic aorta to abdominal aorta bypass and reimplantation of the right renal artery.

Behçet's disease is an uncommon systemic process generally developing during the third or fourth decade of life. Recurrent inflammatory lesions are characteristic. Cardiovascular involvement, which may be arterial or venous, is rare but with particularly severe prognosis. Four cases of abdominal aortic aneurysm are reported. One patient underwent emergency surgery for acute rupture. All patients were male, age range 29-45 years, mean age 36.5 years. Three patients were followed for Behçet's disease. Surgical revascularization was performed in all four patients, mainly with prosthetic grafts, one with patch aortoplasty. The postoperative period was complicated by paraplegia and thrombosis of the prosthetic graft in the patient who underwent emergency surgery. On the basis of these cases and cases reported in the literature, it can be concluded that morbidity and mortality are high because of the etiology underlying vascular involvement in Behçet's disease.

Objectifs pedagogiques Connaitre les signes en imagerie de la pathologie aigue de l’aorte thoracique et abdominale sous-renale en tomodensitometrie et en imagerie par resonance magnetique. Envisager les indications des differentes techniques d’imagerie selon leur pertinence. Messages a retenir Dans le cadre de l’urgence, la strategie diagnostique depend de l’etat du patient. L’angioscanner est l’examen a faire en urgence ; il permet de mettre en evidence rapidement la lesion et son retentissement et oriente ainsi la conduite a tenir. L’angio-IRM s’est imposee comme une technique de reference pour le diagnostic et le bilan des anevrysmes de l’aorte, les dissections aigues et la surveillance de l’aorte operee. L’angiographie voit le champ de son indication se reduire grâce aux deux techniques precedentes beaucoup moins invasives.

Bladder leiomyosarcoma is a rare neoplasm. Early diagnosis, cystectomy, radiation therapy and chemotherapy seem to improve prognosis. The authors report one case of a leiomyosarcoma of the bladder in a seventy year old woman. There has been no evidence of recurrence after partial cystectomy, with more than a two-year follow up. Clinical, histological, therapeutic and prognostic aspects of this unusual tumor are discussed.