The carotid diaphragm, an often overlooked cause of stroke by cardiologists.

Carotid diaphragm is a rare cause of stroke. Because of its rarity, it remains often undiagnosed. We report the case of four patients who presented a stroke due to carotid diaphragm. The diagnosis was made either by ultrasound Doppler, computed tomography-angiography or angiography. Two of the four patients were managed by carotid stenting and the other two by surgery. The follow-up was normal. Carotid diaphragm stroke is associated with a high risk of recurrence if not well managed. Therefore, the knowledge of this rare entity is necessary.

An acute lower limb ischemia revealing a covid-19 infection: A case report.

Introduction: Covid-19 is associated with thrombo-embolic events. These complications are either veinous or arterial. By this case report, we aim to highlight the physiopathology and the epidemiology of covid-19 related thromboembolic complications. Case report: We report a case of a 65 years old patient who was admitted fo lower limb ischemia complicating a covid-19 infection. Computed tomography of the aorta and lower limbs showed thrombosis of the femoral artery extended to the popliteal artery and leg arteries. Despite a surgical embolectomy the patient rethromboses twice leading to a thigh amputation. Discussion: Several hypotheses have been put forward to explain Covid 19-related thromboembolic events. About 3% of patients develop arterial thrombosis. Raffaello Bellosta and al. reported the incidence of acute limb ischemia has significantly increased during the COVID-19 pandemic in the Italian Lombardy region. Conclusion: The coagulopathy responsible for venous and arterial thrombosis is a well-established complication of COVID-19. Arterial thromboembolic complications can be either stroke, acute coronary syndrome or peripheral acute ischemia. Therefore, patients with covid19 should be monitored more closely for thromboembolic complications.

[Brachial artery aneurysm in kidney transplant patient after distal fistula closure]. / Anévrisme de l'artère brachiale chez un patient transplanté rénal après fermeture de fistule distale.

Brachial artery aneurysmal degeneration is an exceptional complication of distal native fistulas. Chronic mechanical stresses due to high flow, as well as immunosuppressants drugs following renal transplantation, are the mains factors implicated in the pathophysiological mechanism. We report a case of a transplant patient with a true, symptomatic, brachial artery aneurysm, 8 years after transplantation and 5 years after radiocephalic wrist fistula ligation. The patient underwent open surgical repair, with aneurysm resection and end-to-end anastomosis. We present a literature review of the different therapeutic strategies of this unusual entity.

[Compressive false aneurysm of the brachial artery in a hemodialysis patient: Always superficialize the basilic vein of the arm!] / Faux anévrisme compressif de l'artère brachiale chez un hémodialysé : toujours superficialiser la veine basilique du bras !

The creation and preservation of vascular accesses, in patients with end-stage renal failure, remains a challenge for nephrologists and vascular surgeons. Native fistula is the best vascular access, humeral-basilic fistula is a precious access in patients who have exhausted their venous capital in the forearm and in whom the cephalic vein of the arm is small or damaged. Given its deep location, any puncture of this vein is prohibited before its superficialization, even if it is of good caliber, because it can have dramatic consequences, in particular the loss of the limb or even death. We report the case of a patient undergoing hemodialysis for seven years with a non-superficialized humeral-basilic fistula, admitted for an iatrogenic false aneurysm of the brachial artery following a puncture for dialysis, with compression of the median nerve, treated surgically.

[Juxta-anastomotic venous aneurysm of a fistula in the anatomical snuffbox: An atypical location]. / Anévrisme veineux juxta-anastomotique d'une fistule au niveau de la tabatière anatomique : une localisation atypique.

Native arteriovenous fistula is the best available vascular access for hemodialysis in end-stage renal failure. It is characterized by higher patency rates and lower rates of morbidity, mortality and complication compared to prosthetic bypass grafts and central venous catheters. Aneurysmal complications remain the main complications of these access with a high risk of rupture and fatal hemorrhage. Their management varies from case to another and several methods are reported in the literature. We describe a case of an atypical localization of a juxta-anastomotic venous aneurysm in the anatomical snuffbox, treated by resection with proximal reimplantation of the cephalic vein at the wrist.

Survival of the first arteriovenous fistula in 96 patients on chronic hemodialysis.

BACKGROUND: Native arteriovenous fistula (AVF) represents the best vascular approach for chronic hemodialysis. The aim of this study was to determine the survival of the first AVF and to identify the factors responsible for poor AVF survival. MATERIALS AND METHODS: A retrospective study was conducted on 96 chronic hemodialysis patients benefiting from the creation and cannulation of their first AVF at our center, with a minimum follow-up period of 1 year. We collected demographic, clinical, and biological data, as well as analyzed the following AVF characteristics: anatomic site, cannulation time, survival, and complications. To identify the predictive factors of poor AVF survival, we defined and compared two groups of patients on the basis of whether they lost their first AVF during the evolution. RESULTS: Patients' mean age was 42.1 ± 13 years, with predominantly female patients. Mean AVF cannulation time was 17.5 ± 24 days. AVF loss was mainly related to thrombosis in 29% of the cases and stenosis in 9.4%. AVF survival was 87%, 77%, 71%, 67%, and 64% after 1, 3, 5, 8, and 10 years of hemodialysis, respectively. In our study, the main factors associated with AVF loss were lengthy jugular venous catheters placement (p = 0.004), short AVF cannulation time after its creation (p = 0.03), and hypotension episodes during dialysis (p = 0.03). CONCLUSION: Long-term survival and quality of life in hemodialysis depend on an appropriate dialysis carried out-thanks to a correct vascular approach! According to the previously published data, survival of the first AVF can vary between 10% and 36% at 10 years. In our study, survival of the first native AVF was satisfying because it reached 64% at 10 years. Early AVF creation and prevention and management of its complications remain the safest and most comfortable solution to ensure AVF survival and thus a satisfying survival and quality of life in chronic hemodialysis patients.

Successful endovascular management of postoperative arterio portal fistula.

Arterioportal fistulas are rare and mostly a result of late complication of gastric and biliary surgery. Surgical excision has been the therapy of reference. Endovascular treatment is emerging as a real alternative to surgery. The present study reports a case of postsurgical arterioportal fistula involving the gastroduodenal artery, the cause of portal hypertension, which was successfully treated by transarterial embolization using embospheres. Portal hypertension improved dramatically.