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Sutter W, Alsac JM, Ben Abdallah I, Michel C, Julia P, Empana JP, El Batti S. Treatment of Aortoiliac Occlusive Lesions by Aortic Robotic Surgery: Learning Curve and Midterm Outcome. Ann Vasc Surg 2024; 104:258-267. [PMID: 38593921 DOI: 10.1016/j.avsg.2024.02.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUD The learning curve and midterm results of aortoiliac occlusive disease (AIOD) revascularization by robot-assisted laparoscopic (RAL) surgery may be known. METHODS A prospective single-center study was conducted in the vascular surgery department of Georges Pompidou European Hospital (Paris, France). Patients with AIOD treated by RAL from February 2014 to February 2019 were included. Demographic characteristics, past medical history, Trans-Atlantic Inter-Society Consensus (TASC) lesions classifications, mortality, primary and secondary patency, as well as complication rates were collected. Safety was analyzed by the cumulative sum control chart method with a conversion rate of 10%, operative time by cumulative average-time model, and primary and secondary patency by the Kaplan-Meier method. RESULTS Seventy patients were included, 18 (25.7%) with TASC C lesions and 52 (74.3%) with TASC D lesions. Before discharge, 14 (24.3%) patients had surgical complications. Among them, 10 (14.3%) required at least one reintervention. One (1.4%) patient died during the hospitalization. The learning curve in terms of safety (conversion rate) was 13 cases with an operating time of 220 minutes after 35 patients. During follow-up (median 37 months [21; 49]), 63 patients (91.3%) improved their symptoms, 53 (76.8%) became asymptomatic, and 3 graft limb occlusions occurred. The primary patency at 12, 24, 36, and 48 months was 94%, 92%, 92%, and 92%, respectively, while the secondary patency for the same intervals was 100%, 98.1%, 98.1%, and 98.1%, respectively. CONCLUSIONS Robotic surgery in AIOD revascularization seems safe and effective; allowing to treat patients with few comorbidities and severe lesions, in a dedicated center experienced in RAL, with excellent patency. Prospective clinical trials should be performed to confirm safety.
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Affiliation(s)
- Willy Sutter
- Integrative Epidemiology of Cardiovascular Diseases Team, Paris Cardiovascular Research Center- INSERM UMR-S 970, Paris, France; Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Jean-Marc Alsac
- Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Iannis Ben Abdallah
- Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR-S 1140, Laboratoire de recherches Biochirurgicales de la Fondation Carpentier, Université de Paris-Cité, Paris, France
| | - Cassandre Michel
- Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Julia
- Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Philippe Empana
- Integrative Epidemiology of Cardiovascular Diseases Team, Paris Cardiovascular Research Center- INSERM UMR-S 970, Paris, France
| | - Salma El Batti
- Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR-S 1140, Laboratoire de recherches Biochirurgicales de la Fondation Carpentier, Université de Paris-Cité, Paris, France
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Fortin W, Gautier CH, Escande R, Bel A, Sutter W, El Batti S, Julia P, Achouh P, Alsac JM. Thoracic Endovascular Repair after Total Aortic Arch Replacement with Frozen Elephant Trunk for Type a Aortic Dissection. Ann Vasc Surg 2024; 99:290-297. [PMID: 37858671 DOI: 10.1016/j.avsg.2023.08.026] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The management of residual aortic dissection after initial type A repair with the Frozen elephant trunk technique remains mostly unexplored. This work aimed to evaluate endovascular second-stage surgery for patients with residual aortic dissection. METHODS A retrospective analysis of consecutive patients that underwent Type A aortic repair with Frozen elephant trunk, followed by a second-stage endovascular procedure was done from March 2016 to December 2021. The primary outcome was aortic-related adverse events or mortality, and secondary outcomes were aortic remodeling and perioperative complications. Remodeling was assessed by comparing the difference in ratios for true lumen/total aortic diameters on pre-operative and follow-up scans. RESULTS Thirty-four patients underwent second-stage surgery after Type A repair during the study period (7 thoracic endovascular aortic repair extensions, 1 STABLE/PETTICOAT, and 26 STABILISE). Median follow-up was 23 months (range 2-66 months). There were no perioperative deaths or major complications and 1 reoperation for left subclavian re-embolization. At the last follow-up, there was no aortic-related mortality. There were 5 aortic-related adverse events, including another subclavian re-embolization and a preplanned open conversion. Risk factors were connective tissue disorders (P = 0.01) and aortic aneurysms >55 mm (P = 0.03). Distal remodeling reached statistical significance in all segments (P < 0.01) and was greater for patients treated with the STABILISE technique when compared to extended thoracic endovascular aortic repair (P = 0.01). CONCLUSIONS Second-stage endovascular management of residual aortic dissection after initial Frozen elephant trunk repair showed excellent perioperative and good midterm outcomes and induced significant remodeling of the entire aorta in most cases, particularly with the STABILISE procedure.
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Affiliation(s)
- William Fortin
- Department of Vascular Surgery, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada; Department of Medicine, University of Montreal, Montreal, Canada.
| | - Charles-Henri Gautier
- Department of Cardiac and Vascular Surgery, Assistance Publique - Hôpitaux de Paris, Centre-Université Paris Cité, Hôpital Européen Georges-Pompidou, Paris, France; Department of Medicine, Université de Paris, Paris, France
| | - Remi Escande
- Department of Cardiac and Vascular Surgery, Assistance Publique - Hôpitaux de Paris, Centre-Université Paris Cité, Hôpital Européen Georges-Pompidou, Paris, France; Department of Medicine, Université de Paris, Paris, France
| | - Alain Bel
- Department of Cardiac and Vascular Surgery, Assistance Publique - Hôpitaux de Paris, Centre-Université Paris Cité, Hôpital Européen Georges-Pompidou, Paris, France; Department of Medicine, Université de Paris, Paris, France
| | - Willy Sutter
- Department of Cardiac and Vascular Surgery, Assistance Publique - Hôpitaux de Paris, Centre-Université Paris Cité, Hôpital Européen Georges-Pompidou, Paris, France; Department of Medicine, Université de Paris, Paris, France
| | - Salma El Batti
- Department of Cardiac and Vascular Surgery, Assistance Publique - Hôpitaux de Paris, Centre-Université Paris Cité, Hôpital Européen Georges-Pompidou, Paris, France; Department of Medicine, Université de Paris, Paris, France
| | - Pierre Julia
- Department of Cardiac and Vascular Surgery, Assistance Publique - Hôpitaux de Paris, Centre-Université Paris Cité, Hôpital Européen Georges-Pompidou, Paris, France; Department of Medicine, Université de Paris, Paris, France
| | - Paul Achouh
- Department of Cardiac and Vascular Surgery, Assistance Publique - Hôpitaux de Paris, Centre-Université Paris Cité, Hôpital Européen Georges-Pompidou, Paris, France; Department of Medicine, Université de Paris, Paris, France
| | - Jean-Marc Alsac
- Department of Cardiac and Vascular Surgery, Assistance Publique - Hôpitaux de Paris, Centre-Université Paris Cité, Hôpital Européen Georges-Pompidou, Paris, France; Department of Medicine, Université de Paris, Paris, France
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Wang LZ, Calvet D, Julia P, Domigo V, Mohamedi N, Alsac JM, El Batti S, Messas E, Mirault T, Bruneval P, Goudot G. Is carotid web an arterial wall dysplasia? A histological series. Cardiovasc Pathol 2023; 66:107544. [PMID: 37263518 DOI: 10.1016/j.carpath.2023.107544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Described for 60 years under various names, the carotid web is a suspected cause of cryptogenic stroke, especially in young patients. The web creates an intraluminal protrusion that may contribute to turbulent flow and thrombus embolization into cerebral arteries. Although the carotid web has frequently been related to arterial fibrodysplasia, its natural history and pathological description remain unclear. PATIENTS Among all consecutive patients admitted to the stroke unit of Sainte-Anne Hospital and referred to the vascular surgery department from January 2015 to December 2022, we retrospectively identified 9 patients with a carotid web. The surgical specimens of the 9 patients were submitted to systematic pathological analysis. RESULTS The patients with a histologically confirmed carotid web were young (median age was 42 years), prominently women (7/9), and presenting with low cardiovascular risk. Eight patients had a stroke proven by a magnetic resonance imaging, and 1 had transient monocular amaurosis. The typical pathological lesion supporting the imaging pattern of the carotid web was a focal eccentric intimal hyperplasia forming a protruding lesion characterized by a population of vascular smooth muscle cells intermingled in an abundant, most often loose extracellular matrix. Pathologically proven thrombus was observed in 4 cases. Importantly atherosclerosis was absent. CONCLUSION Histological features in our 9 cases strengthen carotid web characterization as a homogeneous pattern of localized intimal hyperplasia. It is a unique entity consistent with intimal fibroplasia, distinct from medial fibromuscular dysplasia and early atherosclerosis.
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Affiliation(s)
- Louise Z Wang
- Vascular medicine department, Georges Pompidou European hospital, APHP, Paris University Paris France; INSERM U970 PARCC, Université Paris Cité, Paris, France
| | - David Calvet
- Department of Neurology and Stroke Unit, Sainte-Anne hospital, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM 1266, Institut de Psychiatrie et Neurosciences de Paris, FHU Neurovasc -Paris, France
| | - Pierre Julia
- Vascular surgery department, Georges Pompidou European hospital, APHP, Université Paris Cité, Paris, France
| | - Valérie Domigo
- Department of Neurology and Stroke Unit, Sainte-Anne hospital, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM 1266, Institut de Psychiatrie et Neurosciences de Paris, FHU Neurovasc -Paris, France
| | - Nassim Mohamedi
- Vascular medicine department, Georges Pompidou European hospital, APHP, Paris University Paris France
| | - Jean-Marc Alsac
- Vascular surgery department, Georges Pompidou European hospital, APHP, Université Paris Cité, Paris, France
| | - Salma El Batti
- Vascular surgery department, Georges Pompidou European hospital, APHP, Université Paris Cité, Paris, France
| | - Emmanuel Messas
- Vascular medicine department, Georges Pompidou European hospital, APHP, Paris University Paris France; INSERM U970 PARCC, Université Paris Cité, Paris, France
| | - Tristan Mirault
- Vascular medicine department, Georges Pompidou European hospital, APHP, Paris University Paris France; INSERM U970 PARCC, Université Paris Cité, Paris, France
| | - Patrick Bruneval
- Cardiology department, Georges Pompidou European hospital, APHP, Université Paris Cité, Paris France
| | - Guillaume Goudot
- Vascular medicine department, Georges Pompidou European hospital, APHP, Paris University Paris France; INSERM U970 PARCC, Université Paris Cité, Paris, France.
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Corniquet M, Khalifé M, Lellouch AG, Bel A, Bellenfant F, Julia P, Alsac JM, El Batti S, Ben Abdallah I. Ruptured infective native thoracic aortic aneurysm treated by endovascular repair as a bridge therapy to open repair. J Med Vasc 2023; 48:36-40. [PMID: 37120270 DOI: 10.1016/j.jdmv.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/14/2023] [Indexed: 05/01/2023]
Abstract
We report the case of a 70-year-old woman who presented with a ruptured infective native thoracic aortic aneurysm (INTAA), associated with spondylodiscitis and posterior mediastinitis. She underwent a staged hybrid repair: urgent thoracic endovascular aortic repair was first performed as a bridge therapy in the context of septic shock. Allograft repair using cardiopulmonary bypass was performed five days later. Given the complexity of INTAA, multidisciplinary teamwork was paramount to determine the most appropriate treatment strategy, including procedure planning with multiple operators as well as perioperative care. Therapeutic alternatives are discussed.
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Affiliation(s)
- M Corniquet
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - M Khalifé
- Department of orthopedic surgery, HEGP, Université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - A G Lellouch
- Department of plastic surgery, HEGP, Université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - A Bel
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - F Bellenfant
- Department of anesthesiology and critical care, HEGP, Université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - P Julia
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France.
| | - J-M Alsac
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - S El Batti
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - I Ben Abdallah
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
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Coscas R, Dubosq M, Charton J, El Batti S, Gaudric J, Koskas F, Chiche L, Couture T, Davaine JM, Castier Y, Cerceau P, EL Hajjam M, Samb P, Beauchet A, Grimaldi L, Javerliat I, Goeau-Brissonniere O, Alsac JM, Onorati I, Martinod E, Desgranges P, Touma J, Cochennec F, Pellenc Q, Julia P, Coggia M. Thrombosis of Medium-Sized and Large Arteries During Covid-19 Infection: Results of the COVIVASC Study. Ann Vasc Surg 2022; 86:35-42. [PMID: 35780947 PMCID: PMC9242891 DOI: 10.1016/j.avsg.2022.04.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/24/2022] [Revised: 03/15/2022] [Accepted: 04/15/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND COVID-19 infection is associated not only with venous thromboses but also with arterial thromboses (COV-ATs) in relation with an endothelial dysfunction, a coagulopathy and rhythm disorders. The incidence, the topography, and the prognosis of COV-ATs remain poorly known. The objective of this study was to report the overall experience of the Greater Paris University Hospitals (Assistance Publique - Hopitaux de Paris, AP-HP) during the first pandemic wave of COVID-19 infection. METHODS After approval by the ethics committee, a study using the AP-HP clinical data warehouse was carried out between March and May 2020. Overall, 124,609 patients had a polymerase chain reaction for COVID-19 in our hospitals, of which 25,345 were positive. From 20,710 exploitable stays, patients tested positive for COVID who presented an episode of acute COV-AT (except coronary and intracranial arteries) were selected on the basis of the French medical classification for clinical procedures codes. The data are presented as absolute values with percentages and/or means with standard deviation. RESULTS Over the studied period, 60 patients (aged 71±14 years, 42 men) presented a COV-AT at the time of their hospitalization, an incidence of 0.2%. The arterial complication occurred 3±7 days after the COVID infection and was inaugural in 30% of the cases (n = 18). The sites of COV-AT were the lower extremities (n = 35%, 58%), the abdominal aorta (n = 10%, 17%), the thoracic aorta (n = 7%, 12%), the upper limbs (n = 7%, 12%), the cerebral arteries (n = 7%, 12%), the digestive arteries (n = 6%, 10%), the renal arteries (n = 2%, 3%), and the ophthalmic artery (n = 1%, 2%). Multiple COV-ATs were observed in 13 patients (22%). At the time of diagnosis, 20 (33%) patients were in intensive care, including six (10%) patients who were intubated. On computed tomography angiography, COVID lesions were classified as moderate and severe in 25 (42%) and 21 (35%) cases, respectively. Revascularization was attempted in 27 patients (45%), by open surgery in 16 cases, using endovascular techniques in 8 cases and with a hybrid approach in three cases. Six patients (22%) required reinterventions. The duration of hospitalization was 12±9 days. Early mortality (in-hospital or at 30 days) was 30% (n = 18). Nine (15%) patients presented severe nonlethal ischemic complications. CONCLUSIONS Arterial involvement is rare during COVID-19 infection. The aorta and the arteries of the limbs are the privileged sites. The morbi-mortality of these patients is high. Future studies will have to determine if the systematization of anticoagulation therapy decreases the incidence and the severity of the condition.
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Affiliation(s)
- Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt, France,UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, 94807 Villejuif, France,Correspondence to: Raphaël Coscas, Department of Vascular Surgery, Ambroise Paré University Hospital, 9 avenue Charles de Gaulle, 92104 Boulogne Cedex, France
| | - Maxime Dubosq
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt, France,UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, 94807 Villejuif, France
| | - Johanna Charton
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt, France,UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, 94807 Villejuif, France
| | - Salma El Batti
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Julien Gaudric
- Department of Vascular and Endovascular Surgery–Tertiary Aortic Center, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris and Sorbonne Médecine Universités, 75013 Paris, France
| | - Fabien Koskas
- Department of Vascular and Endovascular Surgery–Tertiary Aortic Center, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris and Sorbonne Médecine Universités, 75013 Paris, France
| | - Laurent Chiche
- Department of Vascular and Endovascular Surgery–Tertiary Aortic Center, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris and Sorbonne Médecine Universités, 75013 Paris, France
| | - Thibault Couture
- Department of Vascular and Endovascular Surgery–Tertiary Aortic Center, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris and Sorbonne Médecine Universités, 75013 Paris, France
| | - Jean-Michel Davaine
- Department of Vascular and Endovascular Surgery–Tertiary Aortic Center, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris and Sorbonne Médecine Universités, 75013 Paris, France
| | - Yves Castier
- Department of Vascular Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France and Paris-Diderot University, Paris, France
| | - Pierre Cerceau
- Department of Vascular Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France and Paris-Diderot University, Paris, France
| | - Mostafa EL Hajjam
- Department of Radiology, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt, France
| | - Patricia Samb
- Clinical Research Unit, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France,University of Versailles Saint-Quentin en Yvelines, Paris-Saclay University, Paris, France
| | - Alain Beauchet
- Clinical Research Unit, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France,University of Versailles Saint-Quentin en Yvelines, Paris-Saclay University, Paris, France
| | - Lamiae Grimaldi
- Clinical Research Unit, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France,University of Versailles Saint-Quentin en Yvelines, Paris-Saclay University, Paris, France
| | - Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt, France,UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, 94807 Villejuif, France
| | - Olivier Goeau-Brissonniere
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt, France,UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, 94807 Villejuif, France
| | - Jean-Marc Alsac
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Ilaria Onorati
- Department of Thoracic and Vascular Surgery, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, and Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, and Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Pascal Desgranges
- Department of Vascular Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France,Paris-Est Créteil Faculty of Medicine, Créteil, France
| | - Joseph Touma
- Department of Vascular Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France,Paris-Est Créteil Faculty of Medicine, Créteil, France
| | - Frédéric Cochennec
- Department of Vascular Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France,Paris-Est Créteil Faculty of Medicine, Créteil, France
| | - Quentin Pellenc
- Department of Vascular Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France and Paris-Diderot University, Paris, France
| | - Pierre Julia
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt, France,UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, 94807 Villejuif, France
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Corniquet M, Abdallah IB, Alsac JM, Sutter W, Hurel S, Julia P, Timsit MO, Mejean A, Batti SE. Results of the surgical treatment of renal carcinomas complicated by a thrombus of the retro and supra-hepatic inferior vena cava without extracorporeal circulation. Ann Vasc Surg 2022. [DOI: 10.1016/j.avsg.2022.06.047] [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: 11/01/2022]
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Hornebeck F, Du Mont LS, Besançon C, Fortin W, Batti SE, Sutter W, Abdallah IB, Julia P, Alsac JM. Evolution of the management of ruptured abdominal aortic aneurisms before and after the implementation of a “S.O.S Aorta” program dedicated to aortic emergencies. Ann Vasc Surg 2022. [DOI: 10.1016/j.avsg.2022.06.092] [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: 11/01/2022]
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Fitton I, Van Ngoc Ty C, Julia P, Ben Abdallah I, El Batti S. Impact of ancillary shielding barriers on ionizing radiation exposure of vascular surgeons during complex endovascular aortic procedures. Eur J Vasc Endovasc Surg 2022; 64:132-133. [DOI: 10.1016/j.ejvs.2022.04.038] [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] [Received: 01/17/2022] [Revised: 04/09/2022] [Accepted: 04/30/2022] [Indexed: 11/03/2022]
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Boutin L, Caballero M, Guarrigue D, Hammad E, Rennuit I, Delhaye N, Neuschwander A, Meyer A, Bitot V, Mathais Q, Boutonnet M, Julia P, Olaf M, Duranteau J, Hamada S. Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.02.013] [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: 11/17/2022]
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Détriché G, Guédon A, Mohamedi N, Sellami O, Cheng C, Galloula A, Goudot G, Khider L, Mortelette H, Sitruk J, Gendron N, Sapoval M, Julia P, Smadja DM, Mirault T, Messas E. Women Specific Characteristics and 1-Year Outcome Among Patients Hospitalized for Peripheral Artery Disease: A Monocentric Cohort Analysis in a Tertiary Center. Front Cardiovasc Med 2022; 9:824466. [PMID: 35198617 PMCID: PMC8858944 DOI: 10.3389/fcvm.2022.824466] [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: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
Although women have lower age-standardized cardiovascular disease incidence, prevalence, and death-related rates than men, there are also reports indicating that women with cardiovascular disease receive less care, fewer investigations, and have poorer outcomes after a coronary event. The aims of this study were to compare the characteristics of men and women hospitalized for peripheral artery disease (PAD), their cardiovascular and limb outcomes, and their 1-year mortality. The study is a prospective registry collecting data about all consecutive patients hospitalized for PAD within the vascular department of the tertiary center Georges-Pompidou European Hospital (Paris, France). Patients were required to have one of three inclusion criteria: previous revascularization of the lower limb or any lower limb artery occlusion due to an atherosclerotic vascular disease or hemodynamic evidence of PAD. Exclusion criteria were patients with lower extremity arterial occlusion due to another cause. All patients were followed-up for at least 12 months after the initial hospitalization. Among the 235 patients included, there were 61 women (26%), older than men with a median age of 75.6 and 68.3 years, respectively. Main cardiovascular risk factors and comorbidities were similar for men and women except more former or current smokers [145 (83.4%) vs. 33 (54.1%)] and more history of coronary heart disease [42 (24.1%) vs. 7 (11.5%)] in men. Most patients [138 (58.8%)] had critical limb ischemia and 97 (41.3%) had claudication, with no difference for sex. After discharge, 218 patients received an antithrombotic therapy (93.2%), 195 a lipid-lowering drug (83.3%), 185 an angiotensin converting enzyme inhibitor or angiotensin-receptor blocker (78.9%), similarly between sex. At 1-year, overall mortality, major adverse cardiovascular events, major adverse limb events did not differ with 23 (13.2%), 11 (6.3%) and 32 (18.4%) in men, and 8 (13.1%), 3 (4.9%), 15 (24.6%) in women, respectively, despite the difference in age. Overall mortality, cardiovascular outcomes, limb revascularization or amputation did not differ between men and women, 1-year after hospitalization for PAD although the latter were older, less smoker and had less coronary artery disease. Due to the small size of this cohort, larger studies and future research are needed to better understand sex-specific mechanisms in the pathophysiology and natural history of PAD.
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Affiliation(s)
- Grégoire Détriché
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- *Correspondence: Grégoire Détriché
| | - Alexis Guédon
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Nassim Mohamedi
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Olfa Sellami
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Charles Cheng
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Alexandre Galloula
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Guillaume Goudot
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Paris Research Cardiovascular Center (PARCC), INSERM U970, Paris, France
| | - Lina Khider
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - Hélène Mortelette
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Jonas Sitruk
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Nicolas Gendron
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- Hematology Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Marc Sapoval
- Université de Paris, Paris Research Cardiovascular Center (PARCC), INSERM U970, Paris, France
- Interventional Radiology Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Universit de Paris (APHP-CUP), Paris, France
| | - Pierre Julia
- Université de Paris, Paris Research Cardiovascular Center (PARCC), INSERM U970, Paris, France
- Vascular Surgery Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - David M. Smadja
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- Hematology Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
| | - Tristan Mirault
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Paris Research Cardiovascular Center (PARCC), INSERM U970, Paris, France
| | - Emmanuel Messas
- Vascular Medicine Department, Hôpital Europeen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris (APHP-CUP), Paris, France
- Université de Paris, Paris Research Cardiovascular Center (PARCC), INSERM U970, Paris, France
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11
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Boutin L, Caballero MJ, Guarrigue D, Hammad E, Rennuit I, Delhaye N, Neuschwander A, Meyer A, Bitot V, Mathais Q, Boutonnet M, Julia P, Olaf M, Duranteau J, Hamada SR. Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort. Eur J Vasc Endovasc Surg 2022; 63:401-409. [PMID: 35144894 DOI: 10.1016/j.ejvs.2021.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/28/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Blunt traumatic aortic injury (BTAI) in severe trauma patients is rare but potentially lethal. The aim of this work was to perform a current epidemiological analysis of the clinical and surgical management of these patients in a European country. METHODS This was a multicentre, retrospective study using prospectively collected data from the French National Trauma Registry and the National Uniform Hospital Discharge Database from 10 trauma centres in France. The primary endpoint was the prevalence of BTAI. The secondary endpoints focused chronologically on injury characteristics, management, and patient outcomes. RESULTS 209 patients were included with a mean age of 43 ± 19 years and 168 (80%) were men. The calculated prevalence of BTAI at hospital admission was 1% (162/15 094) (BTAI admissions/all trauma). The time to diagnosis increased with the severity of aortic injury and the clinical severity of the patients (grade 1: 94 [74, 143] minutes to grade 4: 154 [112, 202] minutes, p = .020). This delay seemed to be associated with the intensity of the required resuscitation. Sixty seven patients (32%) received no surgical treatment. Among those treated, 130 (92%) received endovascular treatment, 14 (10%) open surgery (two were combined), and 123 (85%) were treated within the first 24 hours. Overall mortality was 20% and the attributed cause of death was haemorrhagic shock (69%). Mortality was increased according to aortic injury severity, from 6% for grade 1 to 65% for grade 4 (p < .001). Twenty-six (18.3%) patients treated by endovascular aortic repair had complications. CONCLUSION BTAI prevalence at hospital admission was low but occurred in severe high velocity trauma patients and in those with a high clinical suspicion of severe haemorrhage. The association of shock with high grade aortic injury and increasing time to diagnosis suggests a need to optimise early resuscitation to minimise the time to treatment. Endovascular treatment has been established as the reference treatment, accounting for more than 90% of interventional treatment options for BTAI.
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Affiliation(s)
- Louis Boutin
- Department of Anaesthesiology and Critical Care, Hôpital Bicêtre, APHP, Université Paris Saclay, Kremlin Bicêtre, France; Department of Anaesthesiology and Critical Care, Hôpital Saint-Louis, APHP, DMU Parabol, FHU PROMICE, Université de Paris, France; INSERM, UMR 942, MASCOT, Cardiovascular Marker in Stress Condition, Paris, France
| | - Marie-Josée Caballero
- Department of Anaesthesiology and Critical Care, Hôpital Bicêtre, APHP, Université Paris Saclay, Kremlin Bicêtre, France
| | - Delphine Guarrigue
- Department of Anaesthesiology and Critical Care, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Emmanuelle Hammad
- Department of Anaesthesiology and Critical Care, Hôpital Nord, APHM, Marseille, France
| | - Isabelle Rennuit
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, APHP, Université de Paris, Clichy, France
| | - Nathalie Delhaye
- Department of Anaesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, APHP, Université de Paris, Paris, France; Department of Anaesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France
| | - Arthur Neuschwander
- Department of Anaesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France
| | - Alain Meyer
- Department of Anaesthesiology and Critical Care, Centre Hospitalier Universitaire de Hautepierre, Strasbourg, France
| | - Valérie Bitot
- Department of Anaesthesiology and Critical Care, Hôpital Henri Mondor, APHP, Créteil, France
| | - Quentin Mathais
- Department of Anaesthesiology and Critical Care, Military Teaching Hospital Sainte-Anne, Toulon, France
| | - Mathieu Boutonnet
- Department of Anaesthesiology and Critical Care, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Pierre Julia
- Departement of Vascular Surgery, Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France
| | - Mercier Olaf
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Jacques Duranteau
- Department of Anaesthesiology and Critical Care, Hôpital Bicêtre, APHP, Université Paris Saclay, Kremlin Bicêtre, France
| | - Sophie R Hamada
- Department of Anaesthesiology and Critical Care, Hôpital Bicêtre, APHP, Université Paris Saclay, Kremlin Bicêtre, France; Department of Anaesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France; CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France.
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12
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Goudot G, Sitruk J, Jimenez A, Khider L, Julia P, Alsac JM, El Batti S, Bruneval P, Amemyia K, Pedreira O, Calvet D, Tanter M, Mirault T, Pernot M, Messas E. Carotid plaque vulnerability assessed by combined shear wave elastography and ultrafast doppler compared to histology: the UF-plaque study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1995] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
New biomarkers are needed to assess the vulnerability of carotid plaque to guide carotid surgery decision. Ultrafast Ultrasound Imaging (UUI) provides an estimation of plaque stiffness by Shear Wave Elastography (SWE) and the quantification of wall shear stress (WSS) by ultrafast Doppler. We aimed at evaluating the plaque stiffness and WSS applied on the plaque as potential biomarkers of plaque vulnerability.
Methods
Patients were referred for carotid endarterectomy because of symptomatic or asymptomatic carotid stenosis. Their plaques were evaluated by UUI within 48 hours before surgery. For each plaque, WSS and SWE were obtained on a longitudinal view at the stenosis. After endarterectomy, gross analysis and histology were performed on each removed plaque.
Results
46 plaques with SWE data and 29 with WSS data were analysed. Histological analysis revealed 29 vulnerable and 17 stable plaques. Analysis of the Gray Scale Median by B mode, mean and standard deviation of stiffness by SWE were not helpful in identifying vulnerable plaques. Figure 1 presents the SWE acquisition on one plaque (A) and the distribution of plaque's stiffness average over all plaques showing the 4 ranges of stiffness (B). SWE analysis revealed that the percentage of stiffness range of [3–5] m/s was significantly increased in vulnerable plaques (p=0.048) (Figure 2A). WSS alone showed no significant difference between stable and vulnerable plaques regardless of which segment of the plaque was analysed. A multiparametric score using maximal WSS at the peak of the plaque associated with SWE texture analysis parameters was created by a stepwise analysis, leading to a score with a sensitivity of 80% and a specificity of 78%. The ROC curve of this score found an AUC of 0.85 (Figure 2B).
Conclusions
Multiparameter scoring including plaque stiffness and flow analysis using ultrafast ultrasound imaging allows an effective identification of histologically vulnerable carotid plaques.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fédération Française de cardiologieSociété Française de Cardiologie Figure 1Figure 2
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Affiliation(s)
- G Goudot
- European Hospital Georges Pompidou, Vascular Medicine, Paris, France
| | - J Sitruk
- European Hospital Georges Pompidou, Vascular Medicine, Paris, France
| | - A Jimenez
- Inserm, Physics for Medicine, U1273 INSERM, Paris, France
| | - L Khider
- European Hospital Georges Pompidou, Vascular Medicine, Paris, France
| | - P Julia
- Hopital Europeen Georges Pompidou - University Paris Descartes, Vascular Surgery Department, Paris, France
| | - J M Alsac
- Hopital Europeen Georges Pompidou - University Paris Descartes, Vascular Surgery Department, Paris, France
| | - S El Batti
- Hopital Europeen Georges Pompidou - University Paris Descartes, Vascular Surgery Department, Paris, France
| | - P Bruneval
- Hopital Europeen Georges Pompidou - University Paris Descartes, Pathology Department, Paris, France
| | - K Amemyia
- Hopital Europeen Georges Pompidou - University Paris Descartes, Pathology Department, Paris, France
| | - O Pedreira
- Inserm, Physics for Medicine, U1273 INSERM, Paris, France
| | - D Calvet
- Inserm, Physics for Medicine, U1273 INSERM, Paris, France
| | - M Tanter
- Inserm, Physics for Medicine, U1273 INSERM, Paris, France
| | - T Mirault
- European Hospital Georges Pompidou, Vascular Medicine, Paris, France
| | - M Pernot
- Inserm, Physics for Medicine, U1273 INSERM, Paris, France
| | - E Messas
- European Hospital Georges Pompidou, Vascular Medicine, Paris, France
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13
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Goudot G, Sitruk J, Jimenez A, Julia P, Khider L, Alsac JM, El Batti S, Bruneval P, Amemyia K, Pedreira O, Mortelette H, Calvet D, Tanter M, Mirault T, Pernot M, Messas E. Carotid Plaque Vulnerability Assessed by Combined Shear Wave Elastography and Ultrafast Doppler Compared to Histology. Transl Stroke Res 2021; 13:100-111. [PMID: 34181190 DOI: 10.1007/s12975-021-00920-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/05/2020] [Revised: 04/25/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Ultrafast ultrasound imaging (UUI) provides an estimation of carotid plaque stiffness by shear wave elastography (SWE) and the quantification of wall shear stress (WSS) by ultrafast Doppler. We aimed to evaluate the combined criteria of plaque stiffness and WSS applied on the plaque as potential biomarkers of plaque vulnerability assessed by histology. We included patients for whom carotid endarterectomy had been decided by a multidisciplinary team. UUI was performed within 48 h before surgery, and acquisitions were obtained on a carotid longitudinal view. After endarterectomy, gross examination and histological analysis were performed on each removed plaque. Forty-six plaques with SWE data and 29 with WSS data were analyzed. Histological analysis revealed 29 vulnerable and 17 stable plaques. Gray-scale median analysis by B-mode, mean, and standard deviation of stiffness by SWE did not differ between vulnerable and stable plaques. SWE analysis revealed that the percentage of stiffness range of 3-5 m/s was significantly increased in vulnerable plaques (p = 0.048). WSS alone showed no difference between stable and vulnerable plaques regardless of the segment of the plaque which was analyzed. A multiparametric score using maximal WSS at the peak of the plaque associated with SWE texture analysis parameters was calculated by stepwise regression, leading to a score with a sensitivity of 80% and a specificity of 78%. Area under the receiver operating characteristics curve was 0.85. A multiparameter scoring system including plaque stiffness and flow analysis using UUI allows to effectively identify histologically vulnerable carotid plaques. ClinicalTrials.gov Identifier: NCT03234257.
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Affiliation(s)
- Guillaume Goudot
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France. .,INSERM U970 PARCC, Paris University, Paris, France.
| | - Jonas Sitruk
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France.,Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Anatole Jimenez
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Pierre Julia
- Vascular Surgery Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France
| | - Lina Khider
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France.,Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Jean-Marc Alsac
- Vascular Surgery Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France
| | - Salma El Batti
- Vascular Surgery Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France
| | - Patrick Bruneval
- Pathology Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France
| | - Kisaki Amemyia
- Pathology Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France
| | - Olivier Pedreira
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Hélène Mortelette
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France
| | - David Calvet
- Department of Neurology and Stroke Unit, Sainte-Anne Hospital, GHU Paris Psychiatrie Et Neurosciences, INSERM 1266, Institut de Psychiatrie Et Neurosciences de Paris, DHU Neurovasc, Paris University, Paris, France
| | - Mickaël Tanter
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Tristan Mirault
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France.,INSERM U970 PARCC, Paris University, Paris, France
| | - Mathieu Pernot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Emmanuel Messas
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France.,INSERM U970 PARCC, Paris University, Paris, France
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14
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Poree J, Goudot G, Pedreira O, Laborie E, Khider L, Mirault T, Messas E, Julia P, Alsac JM, Tanter M, Pernot M. Dealiasing High-Frame-Rate Color Doppler Using Dual-Wavelength Processing. IEEE Trans Ultrason Ferroelectr Freq Control 2021; 68:2117-2128. [PMID: 33534706 DOI: 10.1109/tuffc.2021.3056932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Doppler ultrasound is the premier modality to analyze blood flow dynamics in clinical practice. With conventional systems, Doppler can either provide a time-resolved quantification of the flow dynamics in sample volumes (spectral Doppler) or an average Doppler velocity/power [color flow imaging (CFI)] in a wide field of view (FOV) but with a limited frame rate. The recent development of ultrafast parallel systems made it possible to evaluate simultaneously color, power, and spectral Doppler in a wide FOV and at high-frame rates but at the expense of signal-to-noise ratio (SNR). However, like conventional Doppler, ultrafast Doppler is subject to aliasing for large velocities and/or large depths. In a recent study, staggered multi-pulse repetition frequency (PRF) sequences were investigated to dealias color-Doppler images. In this work, we exploit the broadband nature of pulse-echo ultrasound and propose a dual-wavelength approach for CFI dealiasing with a constant PRF. We tested the dual-wavelength bandpass processing, in silico, in laminar flow phantom and validated it in vivo in human carotid arteries ( n = 25 ). The in silico results showed that the Nyquist velocity could be extended up to four times the theoretical limit. In vivo, dealiased CFI were highly consistent with unfolded Spectral Doppler ( r2=0.83 , y=1.1x+0.1 , N=25 ) and provided consistent vector flow images. Our results demonstrate that dual-wavelength processing is an efficient method for high-velocity CFI.
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15
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Goudot G, Poree J, Pedreira O, Khider L, Julia P, Alsac JM, Laborie E, Mirault T, Tanter M, Messas E, Pernot M. Wall Shear Stress Measurement by Ultrafast Vector Flow Imaging for Atherosclerotic Carotid Stenosis. Ultraschall Med 2021; 42:297-305. [PMID: 31856281 DOI: 10.1055/a-1060-0529] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Carotid plaque vulnerability assessment could guide the decision to perform endarterectomy. Ultrafast ultrasound imaging (UF) can evaluate local flow velocities over an entire 2D image, allowing measurement of the wall shear stress (WSS). We aimed at evaluating the feasibility of WSS measurement in a prospective series of patients with carotid stenosis. METHODS UF acquisitions, performed with a linear probe, had an effective frame rate of 5000 Hz. The flow velocity was imaged over the entire plaque area. WSS was computed with the vector field speed using the formula: with the blood velocity and μ, the blood viscosity. The WSS measurement method was validated using a calibrated phantom. In vivo, WSS was analyzed in 5 areas of the carotid wall: common carotid artery, plaque ascent, plaque peak, plaque descent, internal carotid artery. RESULTS Good correlation was found between in vitro measurement and the theoretical WSS values (R2 = 0.95; p < 0.001). 33 patients were prospectively evaluated, with a median carotid stenosis degree of 80 % [75-85]. The maximum WSS value over the cardiac cycle follows the shape of the plaque with an increase during the ascent, reaching its maximum value of 3.25 Pa [2.26-4.38] at the peak of the plaque, and a decrease after passing of the peak (0.93 Pa [0.80-1.19]) lower than the WSS values in the non-stenotic areas (1.47 Pa [1.12-1.77] for the common carotid artery). CONCLUSION UF allowed local and direct evaluation of the plaque's WSS, thus better characterizing local hemodynamics to identify areas of vulnerability. KEY POINTS · Ultrafast vector Doppler allows calculation of the wall shear stress (WSS) by measuring velocity vectors over the entire 2D image.. · The setup to measure the WSS has been validated in vitro on a linear flow phantom by comparing measurements to in silico calculations.. · Applying this method to carotid plaque allows us to better describe the hemodynamic constraints that apply along the entire length of the plaque..
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Affiliation(s)
- Guillaume Goudot
- Georges-Pompidou European Hospital, vascular medicine department, APHP, Paris, France
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Jonathan Poree
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Olivier Pedreira
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Lina Khider
- Georges-Pompidou European Hospital, vascular medicine department, APHP, Paris, France
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Pierre Julia
- Georges-Pompidou European Hospital, vascular surgery department, APHP, Paris, France
| | - Jean-Marc Alsac
- Georges-Pompidou European Hospital, vascular surgery department, APHP, Paris, France
| | - Emeline Laborie
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Tristan Mirault
- Georges-Pompidou European Hospital, vascular medicine department, APHP, Paris, France
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Mickael Tanter
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Emmanuel Messas
- Georges-Pompidou European Hospital, vascular medicine department, APHP, Paris, France
- INSERM U970, PARCC, Paris University, Paris, France
| | - Mathieu Pernot
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
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Goudot G, Sitruk J, Jimenez A, Khider L, Tanter M, Pedreira O, Bruneval P, Julia P, El Batti S, Alsac J, Calvet D, Mirault T, Pernot M, Messas E. Carotid plaque vulnerability assessed by Shear Wave elastography and ultrafast Doppler compared to histology: The UF-plaque study. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.085] [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: 10/21/2022]
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Ben Abdallah I, Alsac JM, Sénémaud J, Corcos O, Julia P, El Batti S, Castier Y. A paradigm shift from bypass to retrograde open mesenteric stenting in acute thrombotic mesenteric ischemia. J Vasc Surg 2020; 72:2217-2218. [PMID: 33222831 DOI: 10.1016/j.jvs.2020.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/26/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Iannis Ben Abdallah
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Center, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jean-Marc Alsac
- Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jean Sénémaud
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Center, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Olivier Corcos
- SURVI, Service de gastroentérologie, MICI et assistance nutritive, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Sorbonne-Paris Cité, Paris, France; Hôpital Bichat, Laboratory for Vascular Translationnal Science, Inserm U1148, Paris, France
| | - Pierre Julia
- Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Salma El Batti
- Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Yves Castier
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Center, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
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Goudot G, Khider L, Del Giudice C, Mirault T, Galloula A, Bruneval P, Julia P, Sapoval M, Houdouin A, Tanter M, Suarez D, Rémond M, Messas E, Pernot M. Non-invasive recanalization of deep venous thrombosis by high frequency ultrasound in a swine model with follow-up. J Thromb Haemost 2020; 18:2889-2898. [PMID: 32741128 DOI: 10.1111/jth.15034] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/30/2022]
Abstract
AIMS Pulsed cavitational ultrasound therapy (thombotripsy) allows the accurate fractionation of a distant thrombus. We aimed to evaluate the efficacy and safety of non-invasive thrombotripsy using a robotic assisted and high frequency ultrasound approach to recanalize proximal deep venous thrombosis (DVT) in a swine model. METHODS Occlusive thrombosis was obtained with a dual jugular and femoral endoveinous approach. The therapeutic device was composed of a 2.25 MHz focused transducer centered by a linear ultrasound probe, and a robotic arm. The feasibility, security, and efficacy (venous channel patency) assessment after thrombotripsy was performed on 13 pigs with acute occluded DVT. To assess the mid-term efficacy of this technique, 8 pigs were followed up for 14 days after thrombotripsy and compared with 8 control pigs. The primary efficacy endpoint was the venous patency. Safety was assessed by the search for local vessel wall injury and pulmonary embolism. RESULTS We succeeded in treating all pigs except two with no accessible femoral vein. After median treatment duration of 23 minutes of cavitation, all treated DVT were fully recanalized acutely. At 14 days, in the treated group, six of the eight pigs had a persistent patent vein and two pigs had a venous reocclusion. In the control group all pigs had a persistent venous occlusion. At sacrifice, no local vein nor arterial wall damage were observed as well as no evidence of pulmonary embolism in all pigs. CONCLUSION High frequency thrombotripsy seems to be effective and safe for non-invasive venous recanalization of DVT.
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Affiliation(s)
- Guillaume Goudot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
- Georges Pompidou European Hospital, APHP, Paris, France
| | - Lina Khider
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
- Georges Pompidou European Hospital, APHP, Paris, France
| | - Costantino Del Giudice
- Georges Pompidou European Hospital, APHP, Paris, France
- INSERM U970 PARCC, Paris University, Paris, France
| | - Tristan Mirault
- Georges Pompidou European Hospital, APHP, Paris, France
- INSERM U970 PARCC, Paris University, Paris, France
| | | | - Patrick Bruneval
- Georges Pompidou European Hospital, APHP, Paris, France
- INSERM U970 PARCC, Paris University, Paris, France
| | - Pierre Julia
- Georges Pompidou European Hospital, APHP, Paris, France
| | - Marc Sapoval
- Georges Pompidou European Hospital, APHP, Paris, France
| | - Alexandre Houdouin
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Mickaël Tanter
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Daniel Suarez
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | | | - Emmanuel Messas
- Georges Pompidou European Hospital, APHP, Paris, France
- INSERM U970 PARCC, Paris University, Paris, France
| | - Mathieu Pernot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
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Ben Abdallah I, El Batti S, Chakfe N, Cardon A, Desgranges P, Martinez R, Albertini JN, Millon A, Julia P, Alsac JM. One-year results of the REP multicentric study of the proximal scalloped Relay thoracic stentgrafts for the treatment of the lesions of the aortic arch. Ann Vasc Surg 2020. [DOI: 10.1016/j.avsg.2020.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Dubert M, Abihssira S, Diamantis S, Guenin R, Messaoudi R, Roux AL, Rouis K, Lillo A, Surgers L, Douard R, Julia P, Lebeaux D. Mycobacterium bovis infection of an aortobifemoral bypass graft with Streptococcus intermedius superinfection after intravesical bacillus Calmette-Guérin immunotherapy for bladder cancer. Infection 2020; 49:345-348. [PMID: 32749595 DOI: 10.1007/s15010-020-01495-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/11/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Bacillus Calmette-Guerin (BCG) is a life-attenuated form of Mycobacterium bovis widely used as immunotherapy for localized bladder cancer. Adverse reactions to intravesical BCG instillations are rare. CASE We describe a 70-year-old man with a history of an aortobifemoral bypass graft, placement of a synthetic mesh for treatment of a ventral hernia and, most recently, superficial bladder cancer treated with BCG therapy. Ten months after his final intravesical BCG instillation, he complained of fever and asthenia. After 12 months of investigation, he was diagnosed with Mycobacterium bovis infection of his aortobifemoral bypass graft and abdominal mesh, with Streptococcus intermedius superinfection. The bypass graft was excised and replaced with an in situ arterial allograft, the abdominal mesh was removed, and treatment started with amoxicillin, isoniazid, rifampicin and ethambutol. Several additional vascular interventions were needed for allograft degradation, but 12 months after the final procedure, outcome was good. DISCUSSION AND CONCLUSIONS Among 35 cases of mycotic aneurysm reported after BCG therapy in the last 10 years, only one involved a vascular prosthesis. Surgical repair of such aneurysms using prosthetic grafts is commonly performed, associated with anti-mycobacterial treatment. Prognosis is poor with mortality of 14% (4/35) and a 26% rate of aneurysm recurrence under treatment (9/35).
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Affiliation(s)
- Marie Dubert
- Université de Paris, 75006, Paris, France. .,Service de Microbiologie, Unité Mobile D'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - Sharon Abihssira
- Service de Chirurgie Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Sylvain Diamantis
- Service de Maladies Infectieuses, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Remi Guenin
- Service de médecine nucléaire, Centre de Médecine Nucléaire, 77 Santepole, Melun, France
| | - Rabah Messaoudi
- Service d'urologie, Clinique Saint Jean de L'Hermitage, Dammarie-Les-Lys, Melun, France
| | - Anne-Laure Roux
- Service de Microbiologie, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, Paris, France
| | | | - Agnès Lillo
- Centre de Pharmacovigilance, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Laure Surgers
- Service de Maladies Infectieuses, Hôpital Saint Antoine, AP-HP Sorbonne Université, Paris, France.,Sorbonne université, CIMI équipe 13, INSERM U1135, 75005, Paris, France
| | - Richard Douard
- Service de Chirurgie générale, Digestive Et Oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Pierre Julia
- Service de Chirurgie Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - David Lebeaux
- Université de Paris, 75006, Paris, France. .,Service de Microbiologie, Unité Mobile D'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
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Ben Abdallah I, Sénémaud J, Alsac JM, Corcos O, Julia P, Castier Y, El Batti S. Using the OUTBACK Catheter to Overcome Aortic Reentry Issues in Retrograde Open Mesenteric Stenting. Ann Vasc Surg 2020; 68:559-562. [PMID: 32561244 DOI: 10.1016/j.avsg.2020.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/23/2020] [Accepted: 06/01/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The purpose of this study was to describe the use of the OUTBACK catheter to overcome aortic reentry issues in acute mesenteric ischemia (AMI) treated by retrograde open mesenteric stenting (ROMS). TECHNIQUE The technique is demonstrated in two female patients presenting with late AMI related to flush occlusion of the superior mesenteric artery (SMA). In such cases of thrombotic AMI with clear preoperative evidence of intestinal necrosis, ROMS is the first-line revascularization technique in our intestinal stroke center. Following an open approach of the SMA through laparotomy, the SMA was punctured in a retrograde fashion. Retrograde mesenteric subintimal recanalization was initiated. In case of aortic reentry issue, the OUTBACK Elite (Cordis, Hialeah, Fl) catheter was advanced through the occlusion over a 0.014 guidewire. The aortic reentry was created by puncture of the aortic wall with the OUTBACK needle, positioned in the desired position. After low-profile balloon angioplasty of the reentry site and 0.035 guidewire exchange, ROMS was performed using balloon-expandable covered stent. CONCLUSIONS The OUTBACK catheter appears to be a safe and effective tool to overcome aortic reentry issues in ROMS. This technical tip might therefore increase the technical success rate of challenging ROMS and decrease the need for bailout bypass in the septic context of AMI.
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Affiliation(s)
- Iannis Ben Abdallah
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Center, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France; Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
| | - Jean Sénémaud
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Center, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France; Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jean-Marc Alsac
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Center, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France; Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Olivier Corcos
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Center, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France; Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Pierre Julia
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Center, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France; Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Yves Castier
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Center, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France; Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Salma El Batti
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Center, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France; Department of Vascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
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Goudot G, Khider L, Pedreira O, Poree J, Julia P, Alsac JM, Amemiya K, Bruneval P, Messas E, Pernot M, Mirault T. Innovative Multiparametric Characterization of Carotid Plaque Vulnerability by Ultrasound. Front Physiol 2020; 11:157. [PMID: 32194437 PMCID: PMC7064056 DOI: 10.3389/fphys.2020.00157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/12/2020] [Indexed: 01/22/2023] Open
Abstract
Objective The degree of stenosis of a carotid plaque is a well-established risk factor for ischemic stroke. Nevertheless, the risk of ipsilateral stroke in asymptomatic carotid stenosis remains low and new imaging markers are needed to better target which patients would benefit most from endarterectomy or intensive medical therapy. Ultrafast ultrasound imaging offers parameters helping at characterizing the carotid plaque by shear wave elastography and Ultrafast Doppler (UFD). We aimed at using these techniques to characterize 3 different ultrasound biomarkers: plaque stiffness heterogeneity, wall shear stress (WSS) and intraplaque micro-flows and to correlate these biomarkers with findings on computed tomography angiography (CTA) and the pathological examination. Methods We present the case of a multimodal evaluation of a carotid plaque using ultrasound. Elastography has been coupled to the WSS assessment and the detection of intraplaque micro-flows by UFD. The data have been compared to CTA and to the pathology examination of the tissue after carotid endarterectomy. Results Elastography allowed at identifying stiff areas corresponding to calcifications, as well as a soft area corresponding to an intraplaque hemorrhage. The flow evaluation with UFD showed an increase of the WSS along the plaque and identified the presence of a plaque rupture, confirmed by the pathologist. Conclusion Ultrafast ultrasound imaging is an innovative, easily accessible technique that provides imaging modalities on top of the conventional B-mode. Ultrafast ultrasound biomarkers such as plaque stiffness heterogeneity, WSS and intraplaque micro-flows could help to define the vulnerability of the carotid plaque in order to stratify patients that could benefit most from endarterectomy or intensive medical therapy.
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Affiliation(s)
- Guillaume Goudot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France.,Vascular Department, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Lina Khider
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France.,Vascular Department, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Olivier Pedreira
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Jonathan Poree
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Pierre Julia
- Vascular Department, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Jean-Marc Alsac
- Vascular Department, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | | | | | - Emmanuel Messas
- Vascular Department, Hôpital Européen Georges Pompidou, APHP, Paris, France.,INSERM U970 PARCC, Paris University, Paris, France
| | - Mathieu Pernot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Tristan Mirault
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France.,Vascular Department, Hôpital Européen Georges Pompidou, APHP, Paris, France.,INSERM U970 PARCC, Paris University, Paris, France
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Faure EM, El Batti S, Sutter W, Bel A, Julia P, Achouh P, Alsac JM. Stent-assisted balloon dilatation of chronic aortic dissection. J Thorac Cardiovasc Surg 2020; 162:1467-1473. [DOI: 10.1016/j.jtcvs.2020.01.081] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022]
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Imaizumi Y, Obeid H, Julia P, Calvet D, Boutouyrie P. P16 Assessment of Plaque Vulnerability Using a Novel Technique: Multi-spectral Photoacoustic Imaging (CVENT-PAI). Artery Res 2020. [DOI: 10.2991/artres.k.191224.050] [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: 11/01/2022] Open
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Bruno RM, Imaizumi Y, Obeid H, Jaeger M, Julia P, Bruneval P, Calvet D. P.46 Assessment of Intraplaque Hemorrhage by Photoacoustics Imaging (PAI): First in-vivo Human Validation Study. Artery Res 2020. [DOI: 10.2991/artres.k.201209.058] [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: 11/01/2022] Open
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Abdallah IB, El Batti S, Julia P, Alsac JM. Experimental Evaluation of Endovascular Fenestration Scissors in an Ovine Model of Aortic Dissection. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.818] [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: 11/26/2022]
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Ben Abdallah I, El Batti S, Julia P, Alsac JM. Thoracic Stent-Grafts with Proximal Scallop in Aortic Arch Repair. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.740] [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: 11/24/2022]
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28
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Goudot G, Khider L, Pedreira O, Poree JM, Julia P, Alsac JM, Mirault T, Pernot M, Messas E. 3041Wall shear stress measurement by ultrafast vector flow imaging for atherosclerotic carotid stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Carotid plaque vulnerability assessment is an important factor in guiding the decision to treat significant carotid stenosis. Ultrafast Ultrasound Imaging (UF) offers the possibility of evaluating local flow velocities over an entire 2D image, allowing access to velocity measurements in contact with the arterial wall and to measure the wall shear stress (WSS).
Purpose
To evaluate the feasibility of WSS measurement in a prospective series of patients with carotid stenosis.
Methods
A 7.5 MHz linear probe of an Aixplorer scanner was used. UF acquisitions had 3 tilted plane waves transmits (−10; 0; 10°) and an effective frame rate of 5000Hz. We evaluated the flow velocity in 5 areas of the carotid wall: common carotid artery (1), plaque ascent (2), plaque peak (3), plaque descent (4), internal carotid artery (5) (Figure). WSS was computed with the vector field speed using the following formula, WSS=μ·δn·v with v the blood velocity, n the normal vector to the vessel wall and μ, the blood viscosity, calculated from the hematocrit value for each patient. WSS measurement method was first validated using a laminar flow phantom and known viscosity. And then, 33 patients were then prospectively evaluated, with a median carotid stenosis degree of 80% [75–85].
Results
Significant correlation was found between in vitro measurement and the theoretical WSS values (R2=0.95; p<0.001).In patients,the maximum WSS value over the cardiac cycle follows the shape of the plaque with an increase during the ascend, reaching its maximum value of 3.57 Pa [2.47–4.45] at the peak of the plaque, and a fall after passing the peak (0.99 Pa [0.8–1.32]) lower than the WSS values in the non-stenotic areas (1.55 Pa [1.13–1.90] for the common carotid artery) (Table).
Table 1 Wall's area Wall shear stress (Pa) Min Max Delta 1. Common carotid artery 0.14 [0.05–0.27] 1.55 [1.13–1.90] 0.73 [0.55–0.96] 2. Plaque's ascent 0.39 [0.24–0.59] 2.63 [1.89–3.28] 1.20 [0.89–1.79] 3. Plaque's peak 0.60 [0.32–0.89] 3.57 [2.47–4.45] 1.78 [1.44–2.46] 4. Plaque's descent 0.16 [0.13–0.22] 0.99 [0.80–1.32] 0.52 [0.34–0.73] 5. Internal carotid artery 0.17 [0.13–0.35] 1.37 [1.04–1.75] 0.72 [0.50–0.87] Results are median [25th–75th percentile].
Figure 1
Conclusion
UF provide reliable WSS values. High WSS was present at the peak of the plaque, whereas lowest WSS values were found at the post-stenotic zone. WSS evaluation may help to better characterize the carotid plaque vulnerability.
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Affiliation(s)
- G Goudot
- European Hospital Georges Pompidou, Vascular medicine, Paris, France
| | - L Khider
- European Hospital Georges Pompidou, Vascular medicine, Paris, France
| | - O Pedreira
- Institut Langevin, INSERM U979, ESPCI Paris, PSL University, Paris, France
| | - J M Poree
- Institut Langevin, INSERM U979, ESPCI Paris, PSL University, Paris, France
| | - P Julia
- European Hospital Georges Pompidou, APHP, Paris Descartes University - USPC, INSERM U970 PARCC, Paris, France
| | - J M Alsac
- European Hospital Georges Pompidou, APHP, Paris Descartes University - USPC, INSERM U970 PARCC, Paris, France
| | - T Mirault
- European Hospital Georges Pompidou, Vascular medicine, Paris, France
| | - M Pernot
- Institut Langevin, INSERM U979, ESPCI Paris, PSL University, Paris, France
| | - E Messas
- European Hospital Georges Pompidou, Vascular medicine, Paris, France
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Faure E, El Batti S, Abou Rjeili M, Julia P, Alsac JM. The STABILISE technique to treat chronic aortic dissections. Ann Vasc Surg 2019. [DOI: 10.1016/j.avsg.2019.08.019] [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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El Batti S, Sutter W, Ben Abdallah I, Abou Rjeili M, Boitet A, Fillet P, Julia P, Alsac JM. Results at 4 years of the treatment of aorto-iliac occlusive lesions by robotic surgery. Ann Vasc Surg 2019. [DOI: 10.1016/j.avsg.2019.08.031] [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: 11/28/2022]
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Ben Abdallah I, Alsac JM, Sutter W, Julia P, El Batti S. Regarding "Management of failed endovascular aortic aneurysm repair with explantation or fenestrated-branched endovascular aortic aneurysm repair". J Vasc Surg 2019; 69:2009-2010. [PMID: 31159995 DOI: 10.1016/j.jvs.2019.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Iannis Ben Abdallah
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France; Unité de Recherche en Développement, Imagerie et Anatomie, Paris, France
| | - Jean-Marc Alsac
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France; Inserm U970 and Fondation Carpentier, Paris Cardiovascular Research Center, Paris, France
| | - Willy Sutter
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France; Inserm U970 and Fondation Carpentier, Paris Cardiovascular Research Center, Paris, France
| | - Pierre Julia
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France; Inserm U970 and Fondation Carpentier, Paris Cardiovascular Research Center, Paris, France
| | - Salma El Batti
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France; Unité de Recherche en Développement, Imagerie et Anatomie, Paris, France
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Goudot G, Pedreira O, Khider L, Mirault T, Alsac J, Julia P, Pernot M, Messas E. Clinical evaluation of wall shear stress by ultrafast vector flow imaging in carotid atherosclerotic stenosis. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.054] [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: 10/26/2022]
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Faure EM, El Batti S, Sutter W, Bel A, Julia P, Achouh P, Alsac JM. Stent-assisted balloon-induced intimal disruption and relamination of distal remaining aortic dissection after acute DeBakey type I repair. J Thorac Cardiovasc Surg 2019; 157:2159-2165. [DOI: 10.1016/j.jtcvs.2018.10.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 11/16/2022]
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Faure E, El Batti S, Rjeili MA, Achouh P, Julia P, Alsac JM. Medium-term Results of the STABILISE Technique in type B Acute Aortic Dissections in Patients Having a Marfan Disease. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.08.024] [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: 11/26/2022]
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Ben Abdallah I, El Batti S, Rjeili MA, Julia P, Alsac JM. Mid-term Results of Scalloped Thoracic Stentgrafts to Treat Aortic Lesions Involving the Arch. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.08.027] [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: 11/25/2022]
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El Batti S, Ben Abdallah I, Julia P, Alsac JM, Vouhé P. Crossed pulmonary arteries as additional cause of dysphagia in association with right aortic arch and Kommerell diverticulum. Surg Radiol Anat 2018; 40:1165-1168. [PMID: 30128895 DOI: 10.1007/s00276-018-2085-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/21/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
We describe an uncommon association of crossed pulmonary arteries and a right aortic arch with a Kommerell diverticulum and a left ligamentum arteriosum, resulting in disabling dysphagia in a 33-year-old woman. First, endovascular exclusion of the Kommerell diverticulum was performed using a thoracic stent graft, associated with left subclavian-carotid transposition. Second, open aneurysmorrhaphy and division of the left ligamentum arteriosum allowed a proper release of the oesophageal compression. Dysphagia completely disappeared in the postoperative course. Control computed tomography angiography at 6-month follow-up showed a satisfactory hybrid repair. A complete understanding of the combined effects of these two anatomical variations on oesophageal compression led to a suitable surgical management.
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Affiliation(s)
- Salma El Batti
- Unité de Recherche en Développement, Imagerie et Anatomie, EA4465, Université Paris Descartes, Faculté de Médecine, 45 rue des Saint-Pères, 75006, Paris, France. .,Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - Iannis Ben Abdallah
- Unité de Recherche en Développement, Imagerie et Anatomie, EA4465, Université Paris Descartes, Faculté de Médecine, 45 rue des Saint-Pères, 75006, Paris, France.,Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Pierre Julia
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Jean-Marc Alsac
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Pascal Vouhé
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
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Faure EM, El Batti S, Abou Rjeili M, Julia P, Alsac JM. Mid-term Outcomes of Stent Assisted Balloon Induced Intimal Disruption and Relamination in Aortic Dissection Repair (STABILISE) in Acute Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2018; 56:209-215. [DOI: 10.1016/j.ejvs.2018.04.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/13/2018] [Indexed: 10/14/2022]
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Verscheure D, Gaudric J, Jayet J, Tresson P, Jarraya M, Julia P, Coggia M, Chiche L, Koskas F. Postmortem Retrieval of Arterial Allografts: Preliminary Results. Ann Vasc Surg 2018; 52:201-206. [PMID: 29678647 DOI: 10.1016/j.avsg.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 02/04/2018] [Accepted: 04/03/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cryopreserved arterial allografts are vascular substitutes used for arterial reconstructions in a septic field. Their use remains however limited by the shortage of donors. One of the possibilities to address this lack of grafts is to multiply the sources of retrieval. The objective of this preliminary study was the evaluation of the early clinical results and the microbiological safety of arterial grafts retrieved after death. METHODS In addition to the standard conditions of arterial sampling, the criteria of inclusion for postmortem retrieval comprised the refrigeration of the body of the donor within 4 hr following the death, a 24-hr time limit from the death, and the availability of an adapted place for retrieval (surgical unit or death chamber respecting the required aseptic conditions). We only retrieved the femoral axes (FAs) and the aortoiliac bifurcation. The conditions of retrieval, transportation, preparation, and conservation were identical to those of cryopreserved arterial allografts harvested during standard multiple organs retrieval. We evaluated the bacteriological risk of contamination and the patency of the grafts in the short and medium term. RESULTS In 2015 and 2016, 6 donors were included. Eleven FAs and 2 aortic bifurcations were harvested. The bacteriological samples done on arrival in bank and after thawing were negative in the 6 donors, but one of the 6 donors presented a bacterial contamination of other removed tissues, and the arterial grafts obtained from this donor were destroyed as a precaution (3 grafts). The quality of the grafts evaluated by the surgeon during harvesting was good in all the cases. The indications of allografts were arterial reconstruction in a septic field (n = 8) and aorto-hepatic bypass during hepatic transplantation (n = 1). One graft was unhopefully thawed without being used. At the end of the follow-up, 8 out of 9 grafts were patent. Two ruptures occurred in a context of locally persistent sepsis (crural abscess due to Salmonella typhi and persistent groin wound disunion with a polymicrobial flora). One allograft thrombosis was observed (aorto-hepatic bypass for transplantation). These complications were unrelated to the mode of graft harvesting. No aneurysmal evolution was observed. CONCLUSIONS The preliminary results of this protocol are encouraging because the immediate quality of the grafts was good with a risk of microbiological contamination identical with that of the usual harvesting mode. This mode of harvesting looks promising to reduce the shortage in arterial allografts and could be extended to harvest thoracic aortic allografts. However, results at a larger scale are necessary to confirm these data.
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Affiliation(s)
- Dorian Verscheure
- Service de chirurgie vasculaire, CHU Pitié-Salpêtrière, Paris, France
| | - Julien Gaudric
- Service de chirurgie vasculaire, CHU Pitié-Salpêtrière, Paris, France.
| | - Jérémie Jayet
- Service de chirurgie vasculaire, CHU Pitié-Salpêtrière, Paris, France
| | - Philippe Tresson
- Service de chirurgie vasculaire, CHU Pitié-Salpêtrière, Paris, France
| | - Mohamed Jarraya
- Banque des Tissus Humains, APHP, Hôpital Saint-Louis, Paris, France
| | - Pierre Julia
- Service de Chirurgie Cardiaque et Vasculaire-Hôpital Européen Georges Pompidou, Paris, France
| | - Marc Coggia
- Service de chirurgie vasculaire, CHU Ambroise Paré Boulogne-Billancourt, et Université de Versailles Saint Quentin en Yvelines, Boulogne-Billancourt, France
| | - Laurent Chiche
- Service de chirurgie vasculaire, CHU Pitié-Salpêtrière, Paris, France
| | - Fabien Koskas
- Service de chirurgie vasculaire, CHU Pitié-Salpêtrière, Paris, France
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Kheloufi M, Vion AC, Hammoutene A, Poisson J, Lasselin J, Devue C, Pic I, Dupont N, Busse J, Stark K, Lafaurie-Janvore J, Barakat AI, Loyer X, Souyri M, Viollet B, Julia P, Tedgui A, Codogno P, Boulanger CM, Rautou PE. Endothelial autophagic flux hampers atherosclerotic lesion development. Autophagy 2018; 14:173-175. [PMID: 29157095 DOI: 10.1080/15548627.2017.1395114] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Blood flowing in arteries generates shear forces at the surface of the vascular endothelium that control its anti-atherogenic properties. However, due to the architecture of the vascular tree, these shear forces are heterogeneous and atherosclerotic plaques develop preferentially in areas where shear is low or disturbed. Here we review our recent study showing that elevated shear forces stimulate endothelial autophagic flux and that inactivating the endothelial macroautophagy/autophagy pathway promotes a proinflammatory, prosenescent and proapoptotic cell phenotype despite the presence of atheroprotective shear forces. Specific deficiency in endothelial autophagy in a murine model of atherosclerosis stimulates the development of atherosclerotic lesions exclusively in areas of the vasculature that are normally resistant to atherosclerosis. Our findings demonstrate that adequate endothelial autophagic flux limits atherosclerotic plaque formation by preventing endothelial apoptosis, senescence and inflammation.
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Affiliation(s)
- Marouane Kheloufi
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France.,c Université Paris Diderot , Sorbonne Paris Cité , France
| | - Anne-Clemence Vion
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France
| | - Adel Hammoutene
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France
| | - Johanne Poisson
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France
| | - Juliette Lasselin
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France
| | - Cecile Devue
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France
| | - Isabelle Pic
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France
| | - Nicolas Dupont
- b Université Paris Descartes , Sorbonne Paris Cité , Paris , France.,d INSERM U1151 , Institut Necker-Enfants Malades-INEM , Paris , France.,e CNRS UMR8253 , Paris , France
| | - Johanna Busse
- f Medizinische Klinik I, Klinikum der Universität München , Munich , Germany
| | - Konstantin Stark
- f Medizinische Klinik I, Klinikum der Universität München , Munich , Germany
| | - Julie Lafaurie-Janvore
- g LadHyX - CNRS - Ecole Polytechnique UMR 7646 ; Mechanics & Living Systems ; Cardiovascular Cellular Engineering ; Palaiseau , France
| | - Abdul I Barakat
- g LadHyX - CNRS - Ecole Polytechnique UMR 7646 ; Mechanics & Living Systems ; Cardiovascular Cellular Engineering ; Palaiseau , France
| | - Xavier Loyer
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France
| | - Michele Souyri
- h INSERM UMR_S 1131/IUH/Université Paris Diderot , Paris
| | - Benoit Viollet
- b Université Paris Descartes , Sorbonne Paris Cité , Paris , France.,i INSERM U1016, Institut Cochin , Paris , France.,j CNRS UMR8104 , Paris , France
| | - Pierre Julia
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France.,k Service De Chirurgie Cardiaque Et Vasculaire - Hôpital Européen Georges Pompidou, AP-HP , Paris , France
| | - Alain Tedgui
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France
| | - Patrice Codogno
- b Université Paris Descartes , Sorbonne Paris Cité , Paris , France.,d INSERM U1151 , Institut Necker-Enfants Malades-INEM , Paris , France.,e CNRS UMR8253 , Paris , France
| | - Chantal M Boulanger
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France
| | - Pierre-Emmanuel Rautou
- a INSERM , U970, Paris Cardiovascular Research Center - PARCC.,b Université Paris Descartes , Sorbonne Paris Cité , Paris , France.,l DHU Unity , Pôle des Maladies de L'appareil Digestif , Service d'Hépatologie , Centre de Référence des Maladies Vasculaires Du Foie , Hôpital Beaujon, AP-HP , Clichy , France
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Piccoli F, Alsac JM, El Batti S, Sandri M, Zuccolotto P, Julia P. A French comparative monocentric study of reimboursed stent-grafts for abdominal aortic aneurysms. Ital J Vasc Endovasc Surg 2017. [DOI: 10.23736/s1824-4777.17.01303-1] [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: 11/08/2022]
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Alsac JM, El Batti S, Rjeili MA, Julia P. One-year results of the Nellix stentgraft for juxta- and infra-renal AAA. Ann Vasc Surg 2017. [DOI: 10.1016/j.avsg.2017.06.060] [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: 11/24/2022]
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Ben Abdallah I, El Batti S, Abou-Rjeili M, Fabiani JN, Julia P, Alsac JM. Open Conversion After Endovascular Abdominal Aneurysm Repair: An 8 year Single Centre Experience. Eur J Vasc Endovasc Surg 2017; 53:831-836. [DOI: 10.1016/j.ejvs.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/02/2017] [Indexed: 12/27/2022]
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Kheloufi M, Vion AC, Hammoutene A, Poisson J, Lasselin J, Devue C, Pic I, Dupont N, Busse J, Stark K, Loyer X, Souyri M, Viollet B, Julia P, Tedgui A, Codogno P, Boulanger CM, Rautou PE. Abstract 590: Autophagy is Required for Endothelial Atheroprotective Signaling Under Physiological Flow. Arterioscler Thromb Vasc Biol 2017. [DOI: 10.1161/atvb.37.suppl_1.590] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Preferential development of atherosclerotic lesions in areas of low shear stress is associated with increased endothelial inflammation, apoptosis and senescence. On the contrary, high shear stress areas are protected from plaque development, but the mechanisms remain elusive. Autophagy is a protective mechanism allowing recycling of defective organelles and proteins to maintain cellular homeostasis. Our aim was to understand the role of autophagy in athero-protective effects of high shear stress.
Approach and Results:
We used the parallel plate chamber system in vitro to generate different shear stress conditions on endothelial cell deficient or not in autophagy (shRNA Atg5 vs. control) and examined autophagic flux in cells transfected with RFP-GFP-LC3 plasmid. Endothelial autophagy was silenced in
Atg5
flox/flox
; VE-cadherin-cre
mice. We first demonstrated in human and murine arteries and in cultured endothelial cells that atheroprotective shear stress activates endothelial autophagic flux. On the opposite, endothelial cells exposed to atheroprone low shear stress displayed inefficient autophagy, associated with activation of mTOR, inhibition of AMPKα pathways and blockade of the autophagic flux. Interestingly, plaque burden augmented specifically in areas usually atheroresistant in
ApoE
-/-
hypercholesterolemic mice deficiency in endothelial autophagy. Both in cultured endothelial cells and in transgenic mice, deficiency in endothelial autophagy was associated with a defect in endothelial alignment with flow direction, a hallmark of endothelial cell health. Deficiency in endothelial autophagy increased endothelial senescence and TNFα-induced inflammation under high shear stress conditions. These effects were associated with impaired KLF2 activation. In transgenic mice, endothelial senescence and apoptosis was augmented in high shear stress areas of the descending thoracic aorta when compared to control littermate mice.
Conclusions:
Altogether, these results show that adequate endothelial autophagic flux under high shear stress limits atherosclerotic plaque formation by preventing inflammation, senescence and apoptosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Johanna Busse
- Medizinische Klinik I, Klinikum der Universität München, München, Germany
| | - Konstantin Stark
- Medizinische Klinik I, Klinikum der Universität München, München, Germany
| | | | | | | | - Pierre Julia
- Service de Chirurgie Cardiaque et Vasculaire - Hôpital Européen Georges Pompidou, AP-HP, Paris, France
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Tresson P, Touma J, Gaudric J, Pellenc Q, Le Roux M, Pierret C, Kobeiter H, Julia P, Goeau-Brissonniere O, Desgranges P, Koskas F, Castier Y. Management of Vascular Trauma during the Paris Terrorist Attack of November 13, 2015. Ann Vasc Surg 2017; 40:44-49. [PMID: 28161564 DOI: 10.1016/j.avsg.2016.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/11/2016] [Accepted: 09/19/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND On November 13, 2015, Paris and Saint-Denis were the targets of terrorist attacks. The Public Hospitals of Paris Organization and the Percy Armed Forces Instruction Hospitals were mobilized to face the mass casualty situation. The objective of this study is to analyze the management of the victims presenting with a nonthoracic vascular trauma (NTVT). METHODS All the data relating to the victims of NTVT who required a specific vascular open or endovascular treatment were analyzed retrospectively. A 6-month follow-up was obtained for all the patients. RESULTS Among the 351 wounded, 20 (5.7%) patients had an NTVT and were dispatched in 8 hospitals (11 men of average age 32). NTVTs were gunshots in 17 cases (85%) or due to a handmade bomb in 3 cases (15%). Twelve patients (60%) received cardiopulmonary resuscitation during prehospital care. NTVT affected the limbs (14 cases, 70%) and the abdomen or the small pelvis (6 cases, 30%). All the patients were operated in emergency. Arterial lesions were treated with greater saphenous vein bypasses, by ligation, and/or embolization. Eleven venous lesions were treated by direct repair or ligation. Associated lesions requiring a specific treatment were present in 19 patients (95%) and were primarily osseous, nervous, and abdomino-pelvic. Severe postoperative complications were observed in 9 patients (45%). Fourteen patients (70%) required blood transfusion (6.4 U of packed red blood cells on average, range 0-48). There were no deaths or amputation and all vascular reconstructions were patent at 6 months. CONCLUSIONS The effectiveness of the prehospital emergency services and a multisite and multidisciplinary management made it possible to obtain satisfactory results for NTVT casualties. All the departments of vascular surgery must be prepared to receive many wounded victims in the event of terrorist attacks.
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Affiliation(s)
- Philippe Tresson
- Service de Chirurgie Vasculaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France
| | - Joseph Touma
- Service de Chirurgie Vasculaire, Hôpital Henri-Mondor, AP-HP, UPEC, Créteil, France
| | - Julien Gaudric
- Service de Chirurgie Vasculaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France
| | - Quentin Pellenc
- Service de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, AP-HP, Faculté de Médecine Denis Diderot, Université Paris 7, Paris, France
| | - Marielle Le Roux
- Service de Chirurgie Thoracique et Vasculaire, Hôpital Tenon, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France
| | - Charles Pierret
- Service de Chirurgie Vasculaire, Hôpital d'Instruction des Armées de Percy, Clamart, France
| | - Hicham Kobeiter
- Service de Radiologie, Hôpital Henri-Mondor, AP-HP, UPEC, Créteil, France
| | - Pierre Julia
- Service de Chirurgie Vasculaire, Hôpital Européen Georges-Pompidou, AP-HP, Faculté de Médecine Paris Descartes, Université Paris 5, Paris, France
| | - Olivier Goeau-Brissonniere
- Service de Chirurgie Vasculaire, Hôpital Ambroise-Paré, AP-HP, Boulogne-Billancourt, Université de Versailles Saint Quentin en Yvelines, Versailles, France
| | - Pascal Desgranges
- Service de Chirurgie Vasculaire, Hôpital Henri-Mondor, AP-HP, UPEC, Créteil, France
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France
| | - Yves Castier
- Service de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, AP-HP, Faculté de Médecine Denis Diderot, Université Paris 7, Paris, France.
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El Batti S, Alsac JM, Julia P. One Year Results of the Robot-assisted Treatment of Aorto-iliac Occlusive Lesions: Which Place Compared to Endovascular Treatment? Ann Vasc Surg 2017. [DOI: 10.1016/j.avsg.2016.07.010] [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: 10/20/2022]
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Ben Abdallah I, El Batti S, da Costa JB, Julia P, Alsac JM. Phlegmasia Cerulea Dolens as an Unusual Presentation of Ruptured Abdominal Aortic Aneurysm into the Inferior Vena Cava. Ann Vasc Surg 2016; 40:298.e1-298.e4. [PMID: 27939371 DOI: 10.1016/j.avsg.2016.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Iannis Ben Abdallah
- Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
| | - Salma El Batti
- Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Faculté de Médecine, Université Paris-Descartes, Paris, France
| | - José Batista da Costa
- Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Pierre Julia
- Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Faculté de Médecine, Université Paris-Descartes, Paris, France
| | - Jean-Marc Alsac
- Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Faculté de Médecine, Université Paris-Descartes, Paris, France
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Aguir S, El Batti S, Achouh P, Julia P, Bel A, Fabiani JN, Alsac JM. Technical Aspects of Open Repair for Degenerative Aneurysmal Evolution Despite Early Thoracic Endovascular Repair of Type B Aortic Dissection. Ann Vasc Surg 2016; 40:297.e13-297.e17. [PMID: 27903475 DOI: 10.1016/j.avsg.2016.08.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Sonia Aguir
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Salma El Batti
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Paul Achouh
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre Julia
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Alain Bel
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Noël Fabiani
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Marc Alsac
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Ben Abdallah I, El Batti S, Sapoval M, Abou Rjeili M, Fabiani JN, Julia P, Alsac JM. Proximal Scallop in Thoracic Endovascular Aortic Aneurysm Repair to Overcome Neck Issues in the Arch. Eur J Vasc Endovasc Surg 2016; 51:343-9. [DOI: 10.1016/j.ejvs.2015.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/13/2015] [Indexed: 10/22/2022]
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Desgranges P, Kobeiter H, Katsahian S, Bouffi M, Gouny P, Favre JP, Alsac J, Sobocinski J, Julia P, Alimi Y, Steinmetz E, Haulon S, Alric P, Canaud L, Castier Y, Jean-Baptiste E, Hassen-Khodja R, Lermusiaux P, Feugier P, Destrieux-Garnier L, Charles-Nelson A, Marzelle J, Majewski M, Bourmaud A, Becquemin JP. ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus): A French Randomized Controlled Trial of Endovascular Versus Open Surgical Repair of Ruptured Aorto-iliac Aneurysms. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.07.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Desgranges P, Kobeiter H, Katsahian S, Bouffi M, Gouny P, Favre JP, Alsac J, Sobocinski J, Julia P, Alimi Y, Steinmetz E, Haulon S, Alric P, Canaud L, Castier Y, Jean-Baptiste E, Hassen-Khodja R, Lermusiaux P, Feugier P, Destrieux-Garnier L, Charles-Nelson A, Marzelle J, Majewski M, Bourmaud A, Becquemin JP. Editor's Choice – ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus): A French Randomized Controlled Trial of Endovascular Versus Open Surgical Repair of Ruptured Aorto-iliac Aneurysms. Eur J Vasc Endovasc Surg 2015; 50:303-10. [DOI: 10.1016/j.ejvs.2015.03.028] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/12/2015] [Indexed: 12/15/2022]
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