[Internal carotid aneurysm of dysphasic origin]. / Un anévrisme de l'artère carotide interne d'origine dysplasique.

Extracranial carotid aneurysms are rare, but are of significant clinical interest due to the high risk of cerebral embolism. Despite considerable progress in endovascular techniques, surgical treatment of these aneurysms remains the golden standard. We report the case of a 50-year-old man who presented an aneurysm of the left internal carotid artery measuring 46 × 26 mm. Resection of the aneurysm with interposition of a prosthetic graft was performed. The postoperative course was uneventful. Pathology reported that the aneurysmal sac probably had a dysplastic origin.

[False traumatic aneurysm of the ulnar artery in a teenager]. / Faux anévrysme traumatique de l'artère ulnaire chez un adolescent.

Most aneurysms of hand arteries are traumatic. It is a generally rare unrecognized pathology. Complications are serious (embolism and thromboses of interdigital arteries). Two main causes can be recalled: acute trauma, with development of a false aneurysm; repeated microtrauma (hand hammer syndrome), with occurrence of an arterial dysplasic aneurysm. The diagnosis is based on the presence of a pulsatile mass, with finger dysesthesia, unilateral Raynaud's phenomenon. It is confirmed by duplex Doppler. Arteriography is necessary but can be replaced by an angio-MR. We report a case of false traumatic aneurysm of the ulnar artery in a teenager. This case illustrates this rare condition and opens discussion on therapeutic options.

External jugular vein aneurysm: a rare cause of neck swelling. A report of three patients.

Venous aneurysms are a relatively rare pathology, far less common than arterial aneurysms. Unrelated to either age or gender, they can affect any vein, including cervical, thoracic, visceral, and lower limb veins. Aneurysmal dilatations in cervical veins are rare due to low pressure in the vena cava system; they can involve any vein but most frequently are observed on the internal and external jugular veins. This report of three patients highlights some of the specific diagnostic and therapeutic features of this pathology.

[Multiple paragangliomas: about two cases]. / Paragangliomes multiples: à propos de deux cas.

The multiple paragangliomas are rare tumours, with slow evolution, posing diagnostic and therapeutic problems. The carotid and jugulo-tympanic localization are the most frequent, and the aortic localization is very infrequent. The association of two, three and four localization is possible in the multiple forms. These multiple localizations are more frequent in familial forms. Surgical removal is the first intention treatment of these tumours. In the multiple forms, the therapeutic strategy must be adapted to each case: usually, the intervention begins by the carotid localization. We report two cases of chemodectoma with multiple localizations. The first case is a 44 years-old woman, who presented a double localization: carotid (bilateral) and aortic (arch). The second case is a patient with a double aortic localization, carotid and aortic, associated to a tympano-jugular localization. Surgical treatment was performed for all these localization, except for the tympano-jugular localization, treated by embolization. The post-operative periods were uneventful. The first case had adjunctive radiotherapy.

[Cerebral revascularisation in Takayasu's arteritis]. / Revascularisation cérébrale dans la maladie de Takayasu.

SUBJECT: Supraaortic angioplasty is often not feasible in patients with Takayasu's arteritis because of involvement of long segment of arteries. Consequently, the role of surgical treatment in the management of cerebral ischemia is important in this disease. The objective of this work is to specify the indications and surgical techniques in lesions of arteries to the head in this disease and to report our experience. METHODS: Seven patients with cervical arterial lesions due to Takayasu's arteritis were treated by bypass surgery in the department of vascular surgery, Ibn-Sina hospital on one period of 11 years. RESULTS: It is about 6 women and one man of middle age at the time of the diagnosis of 33,8 years. The revealing signs were essentially of neurological and ocular order. Six of our patients were in inflammatory thrust at the time of the diagnosis, and required a medical treatment first to basis of corticosteroids. Bypasses from the ascending aorta to the carotid artery were performed in six cases. In one case, the bypass was performed between the brachiocephalic artery and common carotid artery. A death in relation with a cerebral hemorrhage occurred 2 days after the revascularisation. A clean improvement of the functional signs was noted among 3 patients, whereas the improvement was partial at two other. A secondary thrombosis of the bypass surgery occurred in 3 cases. CONCLUSION: The natural history of Takayasu's arteritis and its evolution is badly known. The operative indications must not rest solely on the only anatomical balance, but based on a bundle of arguments in which, the assessment of the cerebral blood flow would be useful. Cerebral hyperperfusion syndrom constitutes a major risk that can be reduced by staged revascularisations.

Facial cutaneous cholesterol embolism revealing a tight carotid stenosis: a case report.

We report a case of systemic cholesterol embolisms (CE) with rare localization to the level of the face from a tight carotid stenosis. The case history is that of a 75 year old patient who presented with cholesterol embolisms in the territory of the external carotid artery. The patient underwent successful carotid endarterectomy with no postoperative neurological event.

[Chronic dissection of the aorta after coronary bypass surgery]. / Dissection aortique chronique après pontages coronaires. Une stratégie chirurgicale difficile.

Dissection of the aorta is a potential complication of all forms of cardiac surgery. It occurs after a variable interval. When observed in the long term, surgery may be complex with greater technical difficulties resulting in increased postoperative morbidity and mortality compared with other types of dissection. These difficulties are all the more marked when the initial surgery is coronary bypass grafting and when the grafts, especially internal mammary artery grafts, remain patent. A surgical strategy has to be elaborated to prevent certain per- and postoperative complications. The authors report the case of a patient who developed a chronic dissection of the aorta 9 months after coronary bypass surgery with patent internal mammary artery grafts. In this situation, a strategy associating anterograde cerebral perfusion before the sternotomy and endovascular control of the internal mammary grafts was proposed.