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Pellenc Q, Boitet A, Roussel A, Milleron O, Mordant P, Senemaud J, Cerceau P, Jondeau G, Castier Y. Non-Dissecting Distal Aortic and Peripheral Arterial Aneurysms in Patients With Marfan Syndrome. Front Cardiovasc Med 2022; 9:827357. [PMID: 35360038 PMCID: PMC8962944 DOI: 10.3389/fcvm.2022.827357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background In Marfan syndrome (MFS), an aortic or peripheral arterial dilatation is usually the consequence of aortic dissection. Non-dissecting distal aortic and peripheral aneurysms (DAPA) are barely described. We sought to determine the incidence and prognostic impact of non-dissecting DAPA, requiring a surgical repair in a large population of patients with MFS. Methods The patients referred to the French MFS reference center were included in a prospective database, and the patients treated for a non-dissecting DAPA between 2013 and 2020 were retrospectively reviewed. The first-line therapy was open surgery. The patients unfit for open repair or experiencing life-threatening complications underwent endovascular repair. Results Among 1,575 patients with MFS, 19 (1.2%) were operated for 25 non-dissecting DAPA. The mean age was 42.4 ± 11.5 years. Non-dissecting DAPA involved the subclavian or axillary artery (n = 12), the descending or thoracoabdominal aorta (n = 6), the abdominal aorta andiliac arteries (n = 6), and the popliteal artery (n = 1). Open and endovascular repairs were performed in 22 and three cases, respectively. After a median follow-up of 54.2 months, no local recurrence was noticed and no secondary procedure was performed. Eight patients presented a new aortic event, including two aortic dissections and seven new aortic surgeries. Compared to the overall MFS population, the non-dissecting DAPA group presented a significantly higher risk of an aortic event (100 vs. 28%, p < 0.0001), a higher risk of aortic dissection (53 vs. 8%, p < 0.0001), and a higher rate of pejorative genetic mutations (68 vs. 40%, p = 0.011). Conclusion Among the patients with MFS, the diagnosis of non-dissecting DAPA is infrequent but is associated with a significant adverse outcome, thus, advocating for a specific follow-up.
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Affiliation(s)
- Quentin Pellenc
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
- Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
- INSERM U 1148, LVTS, Bichat Hospital, Paris, France
- Université de Paris, Paris, France
- *Correspondence: Quentin Pellenc
| | - Auréline Boitet
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
| | - Arnaud Roussel
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
- Université de Paris, Paris, France
| | - Olivier Milleron
- Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
- INSERM U 1148, LVTS, Bichat Hospital, Paris, France
- Department of Cardiology, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
| | - Pierre Mordant
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
- Université de Paris, Paris, France
| | - Jean Senemaud
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
- INSERM U 1148, LVTS, Bichat Hospital, Paris, France
- Université de Paris, Paris, France
| | - Pierre Cerceau
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
| | - Guillaume Jondeau
- Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
- INSERM U 1148, LVTS, Bichat Hospital, Paris, France
- Université de Paris, Paris, France
- Department of Cardiology, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
| | - Yves Castier
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique–Hopitaux de Paris (AP-HP), Paris, France
- INSERM U 1148, LVTS, Bichat Hospital, Paris, France
- Université de Paris, Paris, France
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Girault A, Pellenc Q, Roussel A, Senemaud J, Cerceau P, Maggiori L, Huguet A, Corcos O, Ben Abdallah I, Castier Y. Midterm results after covered stenting of the superior mesenteric artery. J Vasc Surg 2021; 74:902-909.e3. [PMID: 33684478 DOI: 10.1016/j.jvs.2021.02.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Despite the continuing controversy of covered stents (CS) vs bare metal stents, the use of CS in mesenteric occlusive disease (MOD) has been recommended by expert centers. The aim of this study was to report midterm results with CS of the superior mesenteric artery. METHODS Between January 2014 and October 2019, patients with MOD with a severe atheromatous stenosis or occlusion of the superior mesenteric artery treated by mesenteric CS were included. Clinical presentation included both acute mesenteric ischemia (AMI), chronic mesenteric ischemia, and asymptomatic patients planned for major surgery. Demographics, procedure details, and follow-up data were prospectively collected and retrospectively reviewed. Study end points included primary patency, primary assisted patency, and secondary patency. RESULTS During the study period, 86 patients (mean age, 70 ± 9 years; 57% males) were included. Clinical presentation was AMI (n = 42 [49%]), chronic mesenteric ischemia (n = 31 [36%]), and asymptomatic (n = 13 [15%]). The technical success rate was 97%. A total of 96 stents were implanted, including 86 proximal CS (Advanta V12, n = 73; Lifestream, n = 13). The mean length and mean diameter of the CS were 31.5 ± 6.3 mm and 6.9 ± 0.5 mm, respectively. Additional distal bare metal stents were used in 10 patients (12%) to overcome a kinking (n = 9) or a dissection (n = 1) downstream of the CS. All postoperative deaths occurred in patients with AMI (n = 11, 13%). During a median follow-up of 15.6 months (95% confidence interval [CI], 15.6 ± 3.6 months), 12 patients (14%) underwent reinterventions for either stent misplacement (n = 3), stent recoil (n = 3), stent thrombosis (n = 2), de novo stenosis at the distal edge of the CS (n = 2), or gastric ischemia (n = 1). At 1 year, overall the primary patency, primary assisted patency, and secondary patency rates were 83% (95% CI, 83% ± 9%), 99% (95% CI, 99% ± 3%), and 99% (95% CI, 99% ± 3%), respectively. At 2 years, the overall primary patency, primary assisted patency, and secondary patency rates were 76% (95% CI, 76% ± 13%), 95% (95% CI, 95% ± 8%) and 95% (95% CI, 95% ± 8%), respectively. CONCLUSIONS Mesenteric CS provide very satisfactory midterm results in patients with MOD, with an excellent primary assisted patency rate at 2 years, at the price of a significant reintervention rate.
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Affiliation(s)
- Antoine Girault
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France.
| | - Quentin Pellenc
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Arnaud Roussel
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Jean Senemaud
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Pierre Cerceau
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Léon Maggiori
- Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Service de chirurgie viscérale, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Audrey Huguet
- Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Service de gastro-entérologie et assistance nutritive, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Olivier Corcos
- Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Service de gastro-entérologie et assistance nutritive, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Iannis Ben Abdallah
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Yves Castier
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
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Pellenc Q, Roussel A, Senemaud J, Cerceau P, Iquille J, Boitet A, Leclere JB, Milleron O, Jondeau G, Castier Y. Staged hybrid repair of type II thoracoabdominal aneurysms. J Vasc Surg 2020; 74:20-27. [PMID: 33340705 DOI: 10.1016/j.jvs.2020.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Open repair of type II thoracoabdominal aortic aneurysms (TAAAs) remains a challenging procedure. Staged procedures could decrease the incidence and severity of complications after complex aortic repair. In the present report, we have described a strategy using thoracic endovascular aortic repair (TEVAR) for proximal repair, followed by distal open repair. METHODS From 2014 to 2018, 14 patients had undergone TEVAR, followed by distal open repair, for type II TAAAs. All patients should have a suitable proximal landing zone according to the current guidelines. In cases of chronic dissection, false lumen embolization was performed to achieve total exclusion. RESULTS The mean patient age was 48 ± 15 years. Of the 14 patients, 5 had had Marfan syndrome (36%) and 6 had undergone previous aortic arch repair (43%). Ten patients had had a chronic dissection. The maximal aortic diameter was 73 ± 12 mm. The TEVAR technical success rate was 100%. The aortic length coverage was 211 ± 63 mm. The number of covered segmental arteries was 6 (range, 4-13). Two endoleaks were observed, one type Ib and one type II. The delay between TEVAR and open repair was 12 ± 8 weeks. Cerebrospinal fluid drainage was used in 13 patients. Six patients had undergone segmental artery reattachment during surgery. No spinal cord ischemic event was observed. One patient had died 5 weeks after open repair of multiple organ failure. During the 32 months of follow-up, no aortic-related deaths had occurred. No new aortic procedure was needed. The type Ib endoleak had resolved during open repair, and the type II TAAA had resolved spontaneously. The mean maximal thoracic aortic diameter had significantly decreased to 49 ± 8 mm (P < .0001). Aneurysmal shrinkage of ≥5 mm was observed in 13 patients (93%). CONCLUSIONS Staged hybrid repair of type II TAAAs appears to be efficient, with low morbidity and mortality rates. This technique could improve postoperative outcomes after open repair, and TEVAR might have a role in ischemic preconditioning to protect against spinal cord ischemia.
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Affiliation(s)
- Quentin Pellenc
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France.
| | - Arnaud Roussel
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Jean Senemaud
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Pierre Cerceau
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jules Iquille
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Auréline Boitet
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jean-Baptiste Leclere
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Olivier Milleron
- Cardiology Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France
| | - Guillaume Jondeau
- Cardiology Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France
| | - Yves Castier
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France
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Affiliation(s)
- Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Boulogne-Billancourt, France; UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France; UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France.
| | - Jean Senemaud
- UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France; Department of Vascular Surgery, Bichat Claude Bernard Hospital, Paris, France
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Etienne H, Journé C, Rouchaud A, Senemaud J, Louedec L, Pellenc Q, Coscas R, Gouya L, Dupont S, Michel JB. Persistence of Intraluminal Thrombus Makes Saccular Aneurysm More Biologically Active than Fusiform in an Experimental Rat Model. J Vasc Res 2020; 57:164-176. [PMID: 32222706 DOI: 10.1159/000506159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/26/2020] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Saccular aneurysms are thought to have a worse prognosis than fusiform aneurysms in humans, due to hemodynamic reasons. However, data comparing hemodynamic and biology in saccular and fusiform aneurysms are lacking. The main objective was to evaluate the impact of aneurysm morphology on intra-luminal thrombus (ILT) formation and activity. METHODS Forty Lewis rats were ran-domly divided into 2 groups of 20: "saccular" (Group A) and "fusiform" (Group B) aneurysms. Decellularized thoracic aortas from guinea pigs were xenografted to create saccular or fusiform aneurysms. Final imaging evaluation of the aneurysms was carried out during the third week, by quantitative Doppler ultrasound and magnetic resonance imaging. Assays of myeloperoxidase (MPO), platelet factor 4 (PF4), advanced oxidation protein products (AOPPs) iron and matrix metallopeptidase-9 (MMP-9) were performed as biological criteria. RESULTS Quantitatively, saccular aneurysms are characterized by a more thicker ILT, lower inflow velocities and more important relative backflow velocities as compared to fusiform aneurysms. Compared to fusiform, saccular aneurysms released significantly more MPO (p = 0.004), PF4 (p = 0.02), AOPPs (p < 0.002), iron (p < 0.0001) and MMP-9 (p < 0.04). CONCLUSION Experimental saccular and fusiform aneurysms show differential specific hemodynamics, which seem to impact the histology and the biology of the ILT in each type of aneurysm.
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Affiliation(s)
- Harry Etienne
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France,
| | - Clément Journé
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France.,UMS 34, Fédération de Recherche en Imagerie Multimodalités, Paris, France
| | - Aymeric Rouchaud
- Université Limoges, CNRS, XLIM, UMR 7252, Limoges, France.,Department of interventional neuroradiology, CHU Dupuytren, Limoges, France
| | - Jean Senemaud
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France.,Department of Vascular, Thoracic Surgery and Lung Transplantation, Hôpital Xavier Bichat, Paris, France
| | - Liliane Louedec
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France
| | - Quentin Pellenc
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France.,Department of Vascular, Thoracic Surgery and Lung Transplantation, Hôpital Xavier Bichat, Paris, France
| | - Raphaël Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France
| | - Laurent Gouya
- Paris Diderot University, INSERM U1149, Hème, fer et pathologies inflammatoires, Assistance Publique des Hôpitaux de Paris, Hôpital Louis Mourier, Paris, France
| | - Sébastien Dupont
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France
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Bizos A, Chaufour X, Segal J, Senemaud J, Desgranges P, Canoui-Poitrine F, Cochennec F. Comparison of Fenestrated Stentgrafts and Open Repair for Juxtarenal Aortic Aneurysms Using A Propensity Score Matching. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bizos A, Chaufour X, Desgranges P, Segal J, Becquemin JP, Senemaud J, Canoui-Poitrine F, Cochennec F. Comparative study with propensity score between FEVAR and open surgery for juxtarenal aortic aneurisms. Ann Vasc Surg 2019. [DOI: 10.1016/j.avsg.2019.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Senemaud J, Ben Abdallah I, Touma J, Becquemin JP, Desgranges P, Cochennec F. Mid-term results of the fenestrated stentgrafts modified by the surgeon to treat pararenal and thoracoabdominal aortic aneurysms. Ann Vasc Surg 2019. [DOI: 10.1016/j.avsg.2019.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Touma J, Senemaud J, Jaziri A, Cochennec F, Desgranges P. Percutaneous Trans-venous Femoropopliteal Bypass in Long Occlusions of the Superficial Femoral Artery. Cardiovasc Intervent Radiol 2019; 42:1800-1805. [PMID: 31435757 DOI: 10.1007/s00270-019-02310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/05/2019] [Accepted: 08/10/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE This technical note describes a total percutaneous technique to perform ultrasound and fluoroscopy-assisted femoropopliteal bypass in long superficial femoral artery (SFA) lesions, using standard equipment, through a juxta-anatomical superficial femoral vein (SFV) tunnel. MATERIALS AND METHODS Three percutaneous accesses were obtained under ultrasound guidance. The first was retrograde, with crossover maneuver, at the contralateral groin. The second was a proximal SFV-to-SFA stump puncture. The third was a distal popliteal artery-to-popliteal vein puncture. Through the described snaring and capture maneuvers, one single 0.018″ guide wire entered the femoral vein through the SFA stump and re-entered the popliteal artery distally. The fistulous tracts were then dilated and covered stents deployed and post-dilated. RESULTS Three patients aged 68 ± 3 years and presenting Rutherford 4 chronic limb ischemia were treated with this technique. The mean SFA lesion length was 22.6 ± 3 cm. The mean procedure duration was 88 ± 18 min. No intraoperative complication occurred. The postoperative course was uneventful. In particular, no deep vein thrombosis occurred. Rutherford stage decreased from 4 to 1 in all patients, with a mean follow-up duration of 6.6 ± 2 months. CONCLUSION The main advantage of the technique is avoiding calcification issues by abandoning the trans-arterial recanalization approach for long calcified lesions. The second interest is its feasibility by simple endovascular means without any particular or dedicated device. However, longer follow-up is needed to assess safety and durability.
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Affiliation(s)
- Joseph Touma
- Vascular Surgery Department, Paris Est Créteil Faculty of Medicine, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France.
| | - Jean Senemaud
- Vascular Surgery Department, Paris Est Créteil Faculty of Medicine, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Asma Jaziri
- Angiology Unit, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Frédéric Cochennec
- Vascular Surgery Department, Paris Est Créteil Faculty of Medicine, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Pascal Desgranges
- Vascular Surgery Department, Paris Est Créteil Faculty of Medicine, Henri Mondor University Hospital, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France
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Sannier A, Stroumza N, Caligiuri G, Le Borgne-Moynier M, Andreata F, Senemaud J, Louedec L, Even G, Gaston AT, Deschildre C, Couvelard A, Ou P, Cheynier R, Nataf P, Dorent R, Nicoletti A. Thymic function is a major determinant of onset of antibody-mediated rejection in heart transplantation. Am J Transplant 2018; 18:964-971. [PMID: 29160947 DOI: 10.1111/ajt.14595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/20/2017] [Accepted: 11/05/2017] [Indexed: 01/25/2023]
Abstract
Thymic function decreases progressively with age but may be boosted in certain circumstances. We questioned whether heart transplantation was such a situation and whether thymic function was related to the onset of rejection. Twenty-eight antithymocyte globulin-treated heart transplant recipients were included. Patients diagnosed for an antibody-mediated rejection on endomyocardial biopsy had a higher proportion of circulating recent thymic emigrant CD4+ T cells and T cell receptor excision circle levels than other transplanted subjects. Thymus volume and density, assessed by computed tomography in a subset of patients, was also higher in patients experiencing antibody-mediated rejection. We demonstrate that thymic function is a major determinant of onset of antibody-mediated rejection and question whether thymectomy could be a prophylactic strategy to prevent alloimmune humoral responses.
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Affiliation(s)
- A Sannier
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Pathology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | | | - G Even
- INSERM U1148, Paris, France
| | | | | | - A Couvelard
- Denis Diderot University, Paris, France.,Department of Pathology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - P Ou
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Cheynier
- INSERM U1016, Cochin Institute, Paris, France
| | - P Nataf
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Cardiac Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Dorent
- INSERM U1148, Paris, France.,Department of Cardiac Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A Nicoletti
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France
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Senemaud J, Benabdallah I, Boissieu PD, Majewski M, Kobeiter H, Becquemin JP, Desgranges P, Cochennec F. Comparative study of peroperative events and early results of manufactured and homemade fenestrated stentgrafts. Ann Vasc Surg 2017. [DOI: 10.1016/j.avsg.2017.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hertault A, Senemaud J, Matray L, Daniel G, Rouer M, Maurel B. VascuRad: Qualitative study of the training in radiation protection of the young French vascular surgeons. Ann Vasc Surg 2017. [DOI: 10.1016/j.avsg.2017.06.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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