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Introduction: Covid-19 is associated with thrombo-embolic events. These complications are either veinous or arterial. By this case report, we aim to highlight the physiopathology and the epidemiology of covid-19 related thromboembolic complications. Case report: We report a case of a 65 years old patient who was admitted fo lower limb ischemia complicating a covid-19 infection. Computed tomography of the aorta and lower limbs showed thrombosis of the femoral artery extended to the popliteal artery and leg arteries. Despite a surgical embolectomy the patient rethromboses twice leading to a thigh amputation. Discussion: Several hypotheses have been put forward to explain Covid 19-related thromboembolic events. About 3% of patients develop arterial thrombosis. Raffaello Bellosta and al. reported the incidence of acute limb ischemia has significantly increased during the COVID-19 pandemic in the Italian Lombardy region. Conclusion: The coagulopathy responsible for venous and arterial thrombosis is a well-established complication of COVID-19. Arterial thromboembolic complications can be either stroke, acute coronary syndrome or peripheral acute ischemia. Therefore, patients with covid19 should be monitored more closely for thromboembolic complications.
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Carotid diaphragm is a rare cause of stroke. Because of its rarity, it remains often undiagnosed. We report the case of four patients who presented a stroke due to carotid diaphragm. The diagnosis was made either by ultrasound Doppler, computed tomography-angiography or angiography. Two of the four patients were managed by carotid stenting and the other two by surgery. The follow-up was normal. Carotid diaphragm stroke is associated with a high risk of recurrence if not well managed. Therefore, the knowledge of this rare entity is necessary.
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Brachial artery aneurysmal degeneration is an exceptional complication of distal native fistulas. Chronic mechanical stresses due to high flow, as well as immunosuppressants drugs following renal transplantation, are the mains factors implicated in the pathophysiological mechanism. We report a case of a transplant patient with a true, symptomatic, brachial artery aneurysm, 8 years after transplantation and 5 years after radiocephalic wrist fistula ligation. The patient underwent open surgical repair, with aneurysm resection and end-to-end anastomosis. We present a literature review of the different therapeutic strategies of this unusual entity.
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Aneurisma , Derivación Arteriovenosa Quirúrgica , Trasplante de Riñón , Aneurisma/diagnóstico por imagen , Aneurisma/etiología , Aneurisma/cirugía , Derivación Arteriovenosa Quirúrgica/efectos adversos , Arteria Braquial/diagnóstico por imagen , Arteria Braquial/cirugía , Humanos , Trasplante de Riñón/efectos adversos , Diálisis Renal/efectos adversos , Resultado del TratamientoRESUMEN
The creation and preservation of vascular accesses, in patients with end-stage renal failure, remains a challenge for nephrologists and vascular surgeons. Native fistula is the best vascular access, humeral-basilic fistula is a precious access in patients who have exhausted their venous capital in the forearm and in whom the cephalic vein of the arm is small or damaged. Given its deep location, any puncture of this vein is prohibited before its superficialization, even if it is of good caliber, because it can have dramatic consequences, in particular the loss of the limb or even death. We report the case of a patient undergoing hemodialysis for seven years with a non-superficialized humeral-basilic fistula, admitted for an iatrogenic false aneurysm of the brachial artery following a puncture for dialysis, with compression of the median nerve, treated surgically.
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Aneurisma Falso , Derivación Arteriovenosa Quirúrgica , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Brazo , Derivación Arteriovenosa Quirúrgica/efectos adversos , Arteria Braquial/diagnóstico por imagen , Arteria Braquial/cirugía , Humanos , Diálisis Renal , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Native arteriovenous fistula is the best available vascular access for hemodialysis in end-stage renal failure. It is characterized by higher patency rates and lower rates of morbidity, mortality and complication compared to prosthetic bypass grafts and central venous catheters. Aneurysmal complications remain the main complications of these access with a high risk of rupture and fatal hemorrhage. Their management varies from case to another and several methods are reported in the literature. We describe a case of an atypical localization of a juxta-anastomotic venous aneurysm in the anatomical snuffbox, treated by resection with proximal reimplantation of the cephalic vein at the wrist.
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Aneurisma , Derivación Arteriovenosa Quirúrgica , Fístula , Aneurisma/diagnóstico por imagen , Aneurisma/etiología , Aneurisma/cirugía , Derivación Arteriovenosa Quirúrgica/efectos adversos , Humanos , Diálisis Renal , Resultado del Tratamiento , Grado de Desobstrucción Vascular , MuñecaRESUMEN
Catheterization of the internal jugular vein is widely performed by both nephrologists and surgeons. It has become a routine procedure, but can be associated with serious complications. Carotid-jugular arterio-venous fistula (CJAVF) is a rare but potentially fatal complication. Very few cases have been reported in the literature. This study involved a patient with iatrogenic CJAVF following hemodialysis catheter placement performed three weeks earlier. The diagnosis was clinically suspected based on the discovery of laterocervical thrill and confirmed by echo-Doppler and angiography. The patient underwent successful open surgery. Operator experience and trainees support, in addition to the use of ultrasound guidance, can significantly reduce the occurrence of complications during jugular venous catheterization.
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Fístula Arteriovenosa/etiología , Traumatismos de las Arterias Carótidas/etiología , Cateterismo Venoso Central/efectos adversos , Venas Yugulares/lesiones , Angiografía , Fístula Arteriovenosa/diagnóstico por imagen , Traumatismos de las Arterias Carótidas/diagnóstico por imagen , Cateterismo Venoso Central/métodos , Ecocardiografía Doppler , Humanos , Venas Yugulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Diálisis Renal/métodosRESUMEN
Exostoses or osteochondromas are benign osseous tumors that develop on the bone surface and can be sporadic or hereditary. Their evolution is generally benign, but they may be complicated in some patients by conflicts with the surrounding nervous or vascular structures, in particular arteries. We report a case of false aneurysm of the popliteal artery secondary to an isolated exostosis of the left femur in a 20-year-old woman. A delay in the diagnosis allowed the development of the false aneurysm, which was at the origin of a major venous compression. The surgical treatment consisted in aneurysmectomy and reconstruction by end-to-end anastomosis associated with the resection of the osseous tumor, and the deep venous thrombosis was treated medically.
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Aneurisma Falso/etiología , Neoplasias Óseas/complicaciones , Fémur , Osteocondroma/complicaciones , Arteria Poplítea , Trombosis de la Vena/etiología , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Angiografía por Tomografía Computarizada , Femenino , Fémur/diagnóstico por imagen , Humanos , Osteocondroma/diagnóstico por imagen , Osteocondroma/cirugía , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/cirugía , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológico , Adulto JovenRESUMEN
Infectious aneurysm is a severe entity of the aneurysmal pathology, due essentially to a bacterial agent. The most frequently implicated organisms are salmonella and staphylococci. We report the case of an infectious aneurysm of the two primitive iliac arteries with Salmonella typhimurium in a 70-year-old man.
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Aneurisma Infectado/diagnóstico , Arteria Ilíaca/microbiología , Infecciones por Salmonella/diagnóstico , Salmonella typhimurium/aislamiento & purificación , Anciano , Aneurisma Infectado/microbiología , Aneurisma Infectado/patología , Resultado Fatal , Humanos , Arteria Ilíaca/patología , Masculino , Marruecos , Infarto del Miocardio/microbiología , Infarto del Miocardio/patología , Infecciones por Salmonella/microbiología , Infecciones por Salmonella/patologíaRESUMEN
BACKGROUND: Native arteriovenous fistula (AVF) represents the best vascular approach for chronic hemodialysis. The aim of this study was to determine the survival of the first AVF and to identify the factors responsible for poor AVF survival. MATERIALS AND METHODS: A retrospective study was conducted on 96 chronic hemodialysis patients benefiting from the creation and cannulation of their first AVF at our center, with a minimum follow-up period of 1 year. We collected demographic, clinical, and biological data, as well as analyzed the following AVF characteristics: anatomic site, cannulation time, survival, and complications. To identify the predictive factors of poor AVF survival, we defined and compared two groups of patients on the basis of whether they lost their first AVF during the evolution. RESULTS: Patients' mean age was 42.1 ± 13 years, with predominantly female patients. Mean AVF cannulation time was 17.5 ± 24 days. AVF loss was mainly related to thrombosis in 29% of the cases and stenosis in 9.4%. AVF survival was 87%, 77%, 71%, 67%, and 64% after 1, 3, 5, 8, and 10 years of hemodialysis, respectively. In our study, the main factors associated with AVF loss were lengthy jugular venous catheters placement (p = 0.004), short AVF cannulation time after its creation (p = 0.03), and hypotension episodes during dialysis (p = 0.03). CONCLUSION: Long-term survival and quality of life in hemodialysis depend on an appropriate dialysis carried out-thanks to a correct vascular approach! According to the previously published data, survival of the first AVF can vary between 10% and 36% at 10 years. In our study, survival of the first native AVF was satisfying because it reached 64% at 10 years. Early AVF creation and prevention and management of its complications remain the safest and most comfortable solution to ensure AVF survival and thus a satisfying survival and quality of life in chronic hemodialysis patients.
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Derivación Arteriovenosa Quirúrgica , Enfermedades Renales/terapia , Diálisis Renal , Adulto , Derivación Arteriovenosa Quirúrgica/efectos adversos , Distribución de Chi-Cuadrado , Enfermedad Crónica , Constricción Patológica , Femenino , Oclusión de Injerto Vascular/etiología , Humanos , Masculino , Persona de Mediana Edad , Marruecos , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Trombosis/etiología , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Arterioportal fistulas are rare and mostly a result of late complication of gastric and biliary surgery. Surgical excision has been the therapy of reference. Endovascular treatment is emerging as a real alternative to surgery. The present study reports a case of postsurgical arterioportal fistula involving the gastroduodenal artery, the cause of portal hypertension, which was successfully treated by transarterial embolization using embospheres. Portal hypertension improved dramatically.
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Resinas Acrílicas/uso terapéutico , Fístula Arteriovenosa/terapia , Colecistectomía Laparoscópica/efectos adversos , Duodeno/irrigación sanguínea , Embolización Terapéutica , Procedimientos Endovasculares , Gelatina/uso terapéutico , Hipertensión Portal/terapia , Vena Porta/lesiones , Estómago/irrigación sanguínea , Arterias/lesiones , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/etiología , Humanos , Hipertensión Portal/diagnóstico por imagen , Hipertensión Portal/etiología , Masculino , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Radiografía , Resultado del TratamientoRESUMEN
Tuberculous false aneurysm of the aorta is rare and has an unpredictable complication of aneurysm rupture. We report a case of a 32-year old woman who was referred to the Department of Vascular Surgery, Avicenne Hospital for severe abdominal pain. Chest x-ray revealed miliary tuberculosis. Contrast enhanced computed tomography (CT) scan showed a false aortic aneurysm involving the juxtarenal aorta. Antituberculous treatment was started because of high presumption of tuberculosis. Five days later, the patient presented with symptoms of aneurysm rupture. She underwent an emergency a surgical resection of the aneurysm with repair of the aortic wall defect by a Dacron Silver patch. The histopathologic examination of the aortic wall showed features of tuberculosis.
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Tuberculosis is an endemic disease in Morocco. Main blood vessels are rarely affected; the few mentioned cases are aneurysmal. We report a 17-year-old patient presenting with renovascular arterial hypertension, revealed thanks to the discovery of an occlusion of the right renal artery in Duplex scan. During the intervention, the observation of pararenal and mesenteric tuberculous polyadenopathy let us suggest the same kind of lesion at the level of the occluded renal artery. Once antituberculosis treatment had been carried out, the right renal artery was revascularized with a right iliorenal bypass using reversed internal saphenous vein. The postoperative course was uneventful, with an 18-month follow-up. Arterial pressure was normal without antihypertensive treatment, and the bypass was patent. As far as we know, this is the first case of renovascular arterial hypertension resulting from tuberculosis treated with an iliorenal bypass.