Imagerie des fistules arterio-veineuses durales a drainage veineux peri -medullaire

Les fistules durales rachidiennes a drainage veineux perimedullaire constituent une pathologie d'individualisation recente. C'est les plus frequentes des malformations vasculaires vertebromedullaires; elles se presentent sous la forme d'une myelopathie spastique progressive chez un sujet de plus de 40 ans. A partir d'une etude retrospective des donnees cliniques et explorations radiologiques d'une serie de 11 cas en IRM et arteriographie medullaire; nous avons recense l'ensemble des signes radiologiques qui orientent le diagnostic. L'IRM a montre un hypersignal T2 centromedullaire de facon constante ainsi que des vaisseaux perimedullaires pathologiques. L'angiographie medullaire reste l'examen cle pour le diagnostic. Elle a permit de montrer dans dix cas le shunt arterio-veineux ainsi que ses afferences arteriels et son retour veineux; permettant de planifier le traitement. Huit patients ont ete pris en charge chirurgicalement avec exclusion de la fistule suivie d'une amelioration clinique. L'imagerie joue aussi un role important dans le suivi post-therapeutique. L'IRM permet de mettre en evidence la disparition progressive des anomalies initiales; signe de l'efficacite du traitement. Les fistules arterio-veineuses a drainage veineux perimedullaire sont une pathologie qui reste encore meconnue. La connaissance de tous ces elements d'imagerie est fondamentale pour un diagnostic et une prise en charge precoces; seuls garants d'une bonne evolution apres traitement

Peripheral Vascular Injuries and their Management in Accra

Background: The true incidence of vascular injuries in Ghana is not known on account of low reporting. Objective: We performed a study aimed at reviewing the pattern of injuries to peripheral vessels; and also the pattern of referral; presentation and management of these injuries at the Korle-Bu Teaching Hospital; Accra. Method: The study covered the period of January 1989 to March 2005 and involved a review of all peripheral vessel injuries referred for vascular surgical opinion. Results: Fifty two (52) patients with aged between 13- 50 years were reviewed. Penetrating trauma (82.7) and blunt trauma (11.5) were the commonest modes of injury. Arterial injuries (63.5) and combined arterial and venous injuries (23.1) were the commonest forms of injury. Brachial artery injuries were the commonest injuries seen. Associated nerve injuries occurred in 25 of patients most of whom also had brachial artery injuries. Late presentations of false aneurysms and arteriovenous fistulae were seen in 40.4patients. There were delays in referring patients (range 1 hour to 4 years). Vascular investigations like angiograms and duplex scanning were obtained in only 25.0 of patients. Vascular reconstruction was successful in 84.6patients and 7.7of patients required major limb amputation and an equal number of patients died from other injuries. Conclusion: There is undue delay in referring patientswith vascular injuries for intervention due to the inability of the initial attending medical personnel to recognize these injuries. Most of these injuries can be adequately treated without the use of sophisticated investigations; which are usually expensive