[Bilateral sub-acute upper limb ischemia revealing Horton's disease, a rare presentation : A case report and literature review]. / Ischémie subaiguë bilatérale des membres supérieurs révélant une Maladie de Horton, une présentation assez rare : à propos d'un cas et revue de la littérature.

STUDY'S GOAL: Our goal is to enrich the medical literature by sharing our experience in managing a case of sub-acute upper limb ischemia that revealed Horton's disease. This is particularly relevant given the current lack of well-established guidelines. INTRODUCTION: Acute upper limb ischemia is rarely seen in Horton's disease. CASE REPORT: We present a case of a 63-year-old female patient with sub-acute ischemia in both upper limbs, accompanied by jaw claudication and absence of bilateral temporal pulses. The CT Angiography scan revealed bilateral occlusions and stenosis of the axillary and sub-clavier arteries, as well as involvement of the external carotid arteries and its branches. The Arteriography confirmed abnormalities in the medium-sized arteries of the supra-aortic trunks. The histopathology examination of the temporal artery biopsy was negative. The patient received emergency corticosteroid therapy followed by an immunosuppressant. Due to the improved clinical condition of the upper limbs, surgical intervention was not performed.

Infective endocarditis in hemodialysis patients: A 10-year observational single center study.

BACKGROUND: The incidence of infective endocarditis (IE) in chronic hemodialysis (CHD) patients remains high, despite the preventive measures implemented by nephrologists, especially the rigorous respect of hygiene, the use of antibiotic locks for catheters and the use of tunneled catheters instead of non-tunneled. OBJECTIVE: The objective of this study was to determine the clinical, biological, and echocardiographic characteristics, and the prognosis of IE in CHD. PATIENTS AND METHODS: It was a retrospective study, conducted from December 2010 to March 2020, at the Nephrology and Cardiology units of University Hospital in Oujda, Morocco. RESULTS: We compiled a series of 31 CHD patients having developed IE. Eleven cases (35.4%) were collected between 2010 and 2015, and 20 cases (64.6%) between 2016 and 2020. The mean age was 47 ± 19 years, 58% were male, and 25.8% of patients had diabetes. Vascular access for hemodialysis was by arteriovenous fistula, non-tunneled catheter, and tunneled catheter in 22.5%, 32.2%, and 45.2%, of the cases, respectively. About 25.8% of patients had benefited from more than two catheters (tunneled or non-tunneled) during the 3 months preceding the occurrence of IE. The mitral, tricuspid, and aortic valves were the site of IE in 41.9%, 41.9%, and 13% of the cases, respectively. Right heart IE and left heart IE were observed in 42% (13 cases) and 58% (18 cases) of cases, respectively. Blood cultures were negative in 58.1% of the cases at the time of diagnosis of IE. Staphylococcus aureus was identified in 69.2% of the cases. Mortality occurred in 54.8% of the cases. CONCLUSION: IE remains a severe condition in CHD patients with an increasing incidence. Rigorous prevention and screening strategies should be implemented at the hemodialysis centers.

[A periarteritisnodosa presenting as bilateral sub-acute limb ischemia of the legs]. / Ischémie subaiguë bilatérale des membres inférieurs, une présentation rare de périartérite noueuse.

STUDY'S GOAL: As there are no guidelines. This short report shows our experience in management of sub-acute limb ischemia with polyarteritisnodosa. INTRODUCTION: Acute limb ischemia is rarely seen in periarteritisnodosa. CASE REPORT: Here, we present a case with peripheral vascular disease of both lower limbs leading to foot claudication and then a subacute limb ischemia with large necrotic plaques on the lower limb. Angioscan showed occlusion of both superficial femoral arteries. Angiographic imaging showed abnormalities in medium-sized arteries. Pathological study of biopsy from the artery, vein, nerve and skin of the amputated leg confirm the diagnosis of periarteritisnodosa. She benefited from femoral popliteal bypass in both legs, anticoagulant drug and steroids. The non-amelioration of the left leg led to his amputation. The right leg was healed.

[Acute localized dissection of the descending thoracic aorta: A diagnostic trap]. / La dissection aiguë localisée de l'aorte thoracique descendante : un piège diagnostique.

Localized dissection of the descending thoracic aorta; class 3 of the classification proposed by the European Society of Cardiology; is a short and limited length dissection involving the descending thoracic aorta. It is a rare and unrecognized variant that poses a clinical and radiological diagnostic challenge. Indeed, it is manifested by an aspecific clinical profile represented by the acute aortic syndrome and characterized by a confused radiological aspect that entangled with the other differential diagnoses. We would like to emphasize the rarity of this uncommon pathology and the difficulty encountered in defining it based on a case treated in our department and a review of the literature.

[Critical ischemia of the lower limb revealing Lupus disease in a young woman]. / Une ischémie critique du membre inférieur chez une jeune femme révélant la maladie du Lupus.

The diversity of juvenile arterial disease aetiologies requires a systematic investigation when limb critical ischemia is diagnosed before the age of 50. We would like to share a rare case of a young woman who was diagnosed with Lupus disease revealed by distal ischemia of the foot.

Infective endocarditis in chronic hemodialysis: A transition from left heart to right heart.

Infective endocarditis (IE) of the left heart is the most frequent type of IE in chronic hemodialysis (CHD) (in 90% of cases) whereas involvement of the right heart is rare. The aim of this study was to determine the clinical, biological, and echocardiographic characteristics, as well as the prognosis of IE in CHD. This is a retrospective study conducted at the Center of Nephrology and Hemodialysis in Oujda, Morocco. Over a period of 56 months, we compiled data on a series of 11 CHD patients with IE. Their mean age was 40.5 ± 14 years, 72% were male and 27.3% had diabetes. All patients had native valve. All patients had bacteremia preceding the episode of IE. The tricuspid valve was the site of IE in 45% of the cases. Cardiac complications were observed in 72% of the patients and mortality was observed in 72% of cases. The period from IE diagnosis to death was 9 ± 6 days. In our study, the tricuspid valve was the most affected valve of IE in CHD.

[Pediatric post-traumatic limb pseudoaneurysm: Case report and literature review]. / Faux anévrysme post-traumatique des membres : à propos d'un cas pédiatrique.

INTRODUCTION: Pediatric post-traumatic pseudoaneurysms are a rare complication of arterial limb injuries. Management modalities in children are poorly defined. We report on a case of post-traumatic pseudoaneurysm of the right anterior tibial artery after minimal penetrating trauma, treated with surgery. CASE REPORT: A 14-year-old boy presented in consultation with a limp and right calf pain 3 months after a penetrating trauma. On physical examination, a painful mass in the middle third of the right leg was found, without inflammatory signs, but with a pulsatile character and a palpable thrill. Ultrasonography revealed a hypoechoic cystic structure, adjacent to the anterior tibial artery with a characteristic ying-yang flow on color Doppler, suggesting a post-traumatic pseudoaneurysm. The diagnosis was confirmed by CT angiography. The treatment was surgical, including flattening of the pseudoaneurysm and interposition of an autologous graft. CONCLUSION: Management of pediatric post-traumatic pseudoaneurysm of the limbs is surgical. Currently however, new alternatives exist: endovascular techniques, ultrasound-guided compression, and embolization by thrombin injection.

[Vascular type of Ehlers-Danlos syndrome: a rare cause of spontaneous pseudo-aneurysms]. / Syndrome d'Ehlers-Danlos de type vasculaire : une cause rare de faux-anévrismes artériels spontanés.

We report a case of a 20-year-old-man who was admitted to our hospital through the emergency room for a swelling of the right thigh, which had appeared spontaneously without fever. The physical exam was highly suggestive of a vascular mass. The arterial CT scan of the right lower limb revealed a pseudo-aneurysm of a branch of the deep right femoral artery. The diagnosis of vascular type of Ehlers Danlos syndrome was established on clinical criteria. The successful management was surgical by the excision of the pseudoaneurysm and the ligation of the feeding branch that supplied the pseudoaneurysm. The postsurgical follow-up was uneventful and the clinical course was smooth with no further complications.

[Multiple tuberculous aortic aneurysms in a child. A case report]. / Multiples anévrismes aortiques d'origine tuberculeuse chez un enfant. A propos d'un cas.

INTRODUCTION: Tuberculous aortic aneurysms are rarely seen. Their major complication is unforeseeable and lethal aneurysmal rupture. We report an exceptional case of multiple tuberculous aortic aneurysms in a child. CASE REPORT: A 13-year-old girl was admitted to our hospital with abdominal pain. She reported a history of fever, night sweats and weight loss. Physical examination showed a pulsatile mass over the umbilicus. Thoracoabdominal angio-NMR revealed multiple pseudoaneurysms of the thoracic and abdominal aorta. The patient underwent elective laparotomy, resection of the abdominal aortic and in situ prosthetic repair with an aortic graft. The postoperative recovery was uneventful. The histopathologic examination of the aortic wall and para-aortic lymph nodes showed evident features of tuberculosis. Antituberculous chemotherapy was initiated. CONCLUSION: Tuberculous aortic aneurysms are rarely seen. Their major complication is rupture. Surgery must not be delayed just like antitubercular therapy.

[Giant aneurysm of the splenic artery. Case report and review of the literature]. / Anévrisme géant de l'artère splénique. A propos d'un cas et revue de la littérature.

INTRODUCTION: Giant splenic artery aneurysm is exceptional. We report a case and review the literature to ascertain the characteristic epidemiological, clinical and therapeutic features of this condition. CASE REPORT: A 62-year-old man was admitted for epigastric pain. Physical examination found an epigastric pulsatile mass. A contrast computed scan of the abdomen revealed a 10-cm thrombosed aneurysm of the splenic artery. An abdominal aortography, including selective celiac angiography, confirmed the presence of a 10-cm aneurysm originating from the medial third of the splenic artery. The patient underwent open surgical repair. The proximal and the distal splenic artery were ligated from within the aneurysm. The postoperative period was uneventful. CONCLUSION: Giant aneurysm of the splenic artery is a rare clinical entity. These aneurysms differ from usual splenic artery aneurysms in several ways involving the predominant gender, localization on the splenic artery, clinical presentation, and treatment.

[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.

[Bilateral carotid aneurysm revealing Takayasu disease]. / Anévrisme carotidien bilatéral révélant une maladie de Takayasu.

Extracranial carotid aneurysms caused by Takayasu's arteritis is extremely rare. Their evolutionary risk is dominated by rupture and cerebral ischemia. We report a case of a 23 years old woman presenting bilateral common carotid aneurysm secondary to Takayasu's arteritis. Surgical treatment with the patient under steroid coverage was performed to prevent the risque of rupture. The aneurysm was resected, reconstruction was performed with prothetic aortocarotid bypass. She was discharged without major complications. The graft have remanied patent during the four years follow-up periods. A biologic inflammatory syndrome and a parietal thickening of the aneurysm in a young woman must provoke diagnosis. The surgery must be appropriate every time that the diagnosis is carried considering the evolutionary risk of these aneurysms.

[Two cases of malignant tumors of the inferior vena cava]. / Deux cas de tumeurs malignes de la veine cave inférieure.

The malignant tumors of the inferior vena cava are rare. Their prognosis is bad. We report two cases of a 17-year-old and 46-year-old woman presenting the one an intimal sarcoma of the inferior vena cava and the other a metastatic of adenocarcinoma whose primary tumor was not identified. The aortic wall was invaded in both patients. The ureter repulsed in first case, was invaded in second case. The treatment consisted on resection of the tumor including the aortic wall with vein closure in both patients, with right nephrectomy in second patient. In the two cases, a prosthetic reconstruction of the arterial integrity was attempted with aortobiiliac bypass. The two patients died after relapse tumorous to the 6th month in first patient and by multisystem organ failure 5th day post-operative in second. Through these two personal cases, we try to point out the difficult problem of diagnosis that put these tumors and their bad prognosis despite an improvement of treatment.

[Abdominal aortic aneurysm and Behçet's disease: four cases]. / Anévrisme de l'aorte abdominale au cours de la maladie de Behçet. A propos de 4 cas.

Behçet's disease is an uncommon systemic process generally developing during the third or fourth decade of life. Recurrent inflammatory lesions are characteristic. Cardiovascular involvement, which may be arterial or venous, is rare but with particularly severe prognosis. Four cases of abdominal aortic aneurysm are reported. One patient underwent emergency surgery for acute rupture. All patients were male, age range 29-45 years, mean age 36.5 years. Three patients were followed for Behçet's disease. Surgical revascularization was performed in all four patients, mainly with prosthetic grafts, one with patch aortoplasty. The postoperative period was complicated by paraplegia and thrombosis of the prosthetic graft in the patient who underwent emergency surgery. On the basis of these cases and cases reported in the literature, it can be concluded that morbidity and mortality are high because of the etiology underlying vascular involvement in Behçet's disease.