Short- and long-term evolution of the endoluminal diameter of underdilated stents in transjugular intrahepatic portosystemic shunt.

PURPOSE: The purpose of this study was to evaluate the short- and long-term evolution of endoluminal diameter of covered metallic stents that were underdilated at the time of transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIEL AND METHODS: Sixteen patients (13 men, 3 women) with a mean age of 57.6years±7.9 (SD) were retrospectively included. All patients had had TIPS creation using a 10-mm diameter covered stent (VIATORR®) that was underdilated (i.e., 8mm) at the time of stent placement. Measurements of the mean circulating diameter of the stents were retrospectively performed on angiographic examinations every 6months up to 2years. RESULTS: The endoluminal stent diameter early enlarged from 8.96mm±1.12 (SD) to 10mm±1.45 (SD) after 6months (P=0.04) with no further significant changes over time after 12months (10.28mm±1.9mm), 18months (9.93±1.51mm) and 24months (9.92±0.9mm). CONCLUSION: Our results demonstrate a passive expansion of initially underdilated covered stents during the six months following TIPS creation. This should be taken into account regarding hepatic encephalopathy prevention during TIPS placement.

[Thigh root reconstruction with a pedicled DIEP flap]. / Reconstruction d'une perte de substance de racine de cuisse sur membre lymphœdèmateux par un lambeau DIEP pédiculé

Root thigh extensive loss of substance requires surgical coverage. The presence of chronic lymphedema (LC) makes random with the postoperative healing time longer. We report an original case of reconstruction of extensive loss of substance from the root of the thigh using a pedicled deep inferior epigastric flap perforator (DIEP) flap. A 22-year-old woman with angiosarcoma occurring in hemi-body lymphedema. The defect generated by the oncologic resection was 16×24cm. She was reconstructed by a pedicled DIEP flap. Skin wound healing was obtained within 30 days. Donor site healing was obtained within 15 days. The pedicled DIEP flap seems to be effective for root thigh reconstruction.

[Patient dose: implementation of a clinical practice assessment in medical imaging]. / La dosimétrie patient: exemple d'une démarche d'évaluation des pratiques en imagerie médicale.

PURPOSE: To describe our experience with the implementation of a clinical practice assessment (CPA) with regards to radiation exposure in CT. METHODS: Such a CPA requires that a reference level be available (DRL: diagnostic reference level) along with exposure data (CTDIvol and DLP) allowing for the evaluation of current practices, development of an action plan for improvement and future follow-up after implementation. RESULTS: The action plan for improvements was elaborated based on the review of 641 radiation exposure data points collected over 1 year (CTDIvol and DLP). These data were compared to DRL values of corresponding anatomical regions. The implementation of dose guidelines enabled continuous quality improvement as opposed to punctual radiation dose assessments. CONCLUSION: The requirement of recording patient exposure was an excellent opportunity to perform a CPA activity as described by the Haute Autorité de Santé (HAS) in its clinical audit process.