[Iliac arteriovenous fistula as a complication of lumbar disc surgery]. / Fistule artério-veineuse, complication possible de la chirurgie lombaire.

A 56-year-old man suffering from moderate dyspnea was hospitalised in the unit of surgery. Fifteen days before, he was subjected to a discectomy at L4-L5. The clinical examination demonstrated sinus tachycardia and hepatomegalia. An abdominal CT revealed an arteriovenous fistula between the right common iliac artery and vein that was subsequently confirmed by angiography. The patient underwent an endovascular stent-graft which was positioned at the level of the right common iliac artery related to the fistula. This treatment had an immediate successful effect leading the cardiac rhythm to be back to normal and the fistula to dry up.

[Doppler study of gluteal arteries. A useful tool for excluding gluteal arterial pathology snd an important adjunct to lower limb Doppler studies]. / Le Doppler des artères fessières. Un outil efficace pour exclure une pathologie artérielle fessière et un complément important du Doppler des membres inférieurs.

PURPOSE: 1) To determine the negative predictive value (VPN) of duplex scan in patients complaining of buttock or hip pain and thereby to distinguish vascular claudication from other musculoskeletal or neurological diseases. 2) To show its complementarity in doppler investigation of lower limb arteries. MATERIALS AND METHODS: Prospective study by duplex scan and arteriography of 60 gluteal arteries in 30 consecutive patients referred to check up for lower limb arteriopathy or sexual impotence. Duplex scan was performed by posterior approach. Correlation between doppler ultrasound and arteriography was studied. RESULTS: The study of normal arteries was possible in all cases and only one normal gluteal artery could not be detected in a diabetic overweight patient. On 60 arteries, sensitivity of duplex was 100 percent, specificity 96 percent and VPN 100 percent. Significant obstructive lesions were always associated with pathological velocimetric waveform or were not detected. CONCLUSIONS: Buttock claudication can appear like a typical vascular claudication or mimic neurological or musculoskeletal diseases. It is very useful to rule out a vascular causality responsible for buttock or hip pain by simple, non-invasive and cheap exploration. A normal doppler ultrasound of gluteal arteries can rule out vascular disease responsible for buttock or hip pain thereby avoiding arteriography. The strategy of diagnostic or therapy can be modified by such additional information as shown in two case reports.

Emergency endovascular treatment of an acute traumatic rupture of the thoracic aorta complicated by a distal low-flow syndrome.

We report the case of a patient who suffered major trauma following a motorcycle accident that resulted in multiple fractures, bilateral hemopneumothorax, pulmonary contusions, and an isthmic rupture of the aorta with a pseudoaneurysm compressing the descending aorta. This compression was responsible for distal hypotension and low flow, leading to acute renal insufficiency and massive rhabdomyolysis. Due to the critical clinical status of the patient, which prevented any type of open thoracic surgery, endovascular treatment was performed. An initial stent-graft permitted alleviation of the compression and the re-establishment of normal hemodynamic conditions, but its low position did not allow sufficient coverage of the rupture. A second stent-graft permitted total exclusion of the pseudoaneurysm while preserving the patency of the left subclavian artery.

Transcatheter embolization of pseudoaneurysms complicating pancreatitis.

PURPOSE: To evaluate the therapeutic role of angiography in patients with pseudoaneurysms complicating pancreatitis. METHODS: Thirteen symptomatic pseudoaneurysms were treated in nine patients with pancreatitis. Eight patients had chronic pancreatitis and pseudocyst and one had acute pancreatitis. Clinical presentation included gastrointestinal bleeding in seven patients and epigastric pain without bleeding in two. All patients underwent transcatheter embolization. RESULTS: Transcatheter embolization resulted in symptomatic resolution in all patients. Rebleeding occurred in two patients, 18 and 28 days after embolization respectively, and was successfully treated by repeated embolization. One patient with severe pancreatitis died from sepsis 28 days after embolization. Follow-up was then available for eight patients with no relapse of bleeding after a mean follow-up of 32 months (range 9-48 months). CONCLUSION: Transcatheter embolization is safe and effective in the management of pseudoaneurysms complicating pancreatitis.

Corporeal veno-occlusive dysfunction: predominantly intracavernous muscular pathology.

PURPOSE: We investigated whether a relationship exists between the flow to maintain an erection obtained at cavernosometry and the alteration of intracavernous structures in impotent patients with corporeal veno-occlusive dysfunction and normal arterial inflow. MATERIALS AND METHODS: Computerized histomorphometric analysis of smooth muscle and elastic fibers, and endothelial cells was compared to the flow necessary to maintain erection after intracavernous vasoactive drug injection in 18 patients with corporeal veno-occlusive dysfunction. RESULTS: A significant correlation between percentage of smooth muscle fibers and flow to maintain erection was observed, while no correlation was noted with elastic fibers and endothelial cells. CONCLUSIONS: Corporeal veno-occlusive dysfunction seems to be due mainly to smooth muscular alterations. According to this observation treatment of impotent patients with this abnormality should not be restricted to the penile veins but should also include the intracavernous structures, predominantly the muscular component.

Endovascular aortic stent-grafts: transcatheter embolization of persistent perigraft leaks.

PURPOSE: To assess efficacy of transcatheter embolization of peri prosthetic leaks from aortic stent-grafts MATERIALS AND METHODS: Eight patients with a long-standing (3-13 months) perigraft leak after stent-graft implantation underwent transcatheter embolization. Leakage was demonstrated at helical computed tomography (CT). Angiography was performed for evaluation of outflow vessels and transcatheter embolization. All patients underwent helical CT follow-up after the procedure and every 3 months. RESULTS: Embolization was successful in seven patients and resulted in aneurysmal sac thrombosis. A second procedure was necessary in one patient to complete occlusion of the aneurysm. No further aneurysmal growth was detected during 4-9 months follow-up. Right leg paresis was observed in one patient immediately after the procedure, but symptoms disappeared completely after 8 days. Another patient had a minor sensory deficit in the region of the right crural nerve. CONCLUSION: Transcatheter embolization of perigraft leaks appears to be an effective technique to achieve aneurysmal thrombosis.

[Imaging of acquired pathologies of the thoracic aorta]. / Imagerie des pathologies acquises de l'aorte thoracique.

For many years, imaging of thoracic aorta has been dominated by angiography. Development of new imaging modalities has modified the diagnostic approach to thoracic aortic pathology. The knowledge of the advantages and limitations of each technique enables a better choice for patient evaluation, in particular under emergency conditions. This study is based on a review of the literature and reports the authors' experience.

[Placing of a Nitiol Memotherm prosthesis: personal experience]. / Mise en place de la prothèse en Nitinol Memotherm: notre experience.

The authors report their experience in the placement of a new Nitinol stent. Thirty eight stents were placed in 28 iliac arteries, 3 superficial femoral arteries, 1 popliteal artery, 2 subclavian arteries, and 2 veins of hemodialysis fistulae. The primary success rate was 100%, but several angioplasty balloons have been ruptured due to the specific configuration of the stent. The mean follow-up period was 6 months. Memotherm placement is an easy procedure, but the specific structure of the device makes the manipulation of the angioplasty balloons delicate, especially in tortuous vessels.

Idiopathic non-familial rectal and colonic varices requiring sigmoidorectal resection and coloanal anastomosis.

A 32-year-old male patient presenting with huge varices involving the sigmoid colon and the entire rectum down to the dentate line is described. There was no familial history of gastrointestinal bleeding. No particular aetiology was identified. Marked anaemia due to recurrent bleeding required resection of the sigmoid colon and rectum. Restoration of the intestinal continuity was performed by a coloanal anastomosis. The patient did well and bleeding has not recurred. To our knowledge, no similar case of such varices requiring extensive rectal surgery to control bleeding has been described in the literature.

Correlation of nocturnal penile tumescence monitoring duplex ultrasonography and infusion cavernosometry for the diagnosis of erectile dysfunction.

PURPOSE: Nocturnal penile tumescence monitoring was compared to penile duplex ultrasonography and pharmaco-infusion cavernosometry in 50 cases of erectile dysfunction. MATERIALS AND METHODS: Nocturnal penile tumescence was evaluated in all patients as normal or abnormal according to standard general criteria. The results were compared to penile duplex ultrasonography parameters (peak systolic velocity, normal greater than 35 cm. per second, and diastolic velocity, normal less than 5 cm. per second), and to the flow rate needed to maintain erection (normal less than 15 ml. per minute) with pharmaco-infusion cavernosometry. RESULTS: Of the 50 patients 26 had normal nocturnal penile tumescence, including 25 (96%) with normal penile velocity, 18 (69%) with normal penile diastolic velocity and 22 (85%) with normal flow to maintain erection. On the other hand, 24 men had abnormal nocturnal penile tumescence of whom 7 (29%) had abnormal penile blood flow velocity, 17 (71%) had abnormal diastolic flow velocity and 18 (75%) had high flow rate to maintain erection. CONCLUSIONS: Normal nocturnal penile tumescence appears to correlate well with normal systolic blood velocity and cavernosometry but poorly with diastolic blood velocity. On the other hand, a low correlation exists between abnormal nocturnal penile tumescence and abnormal diastolic blood flow or abnormal cavernosometry. Furthermore, no correlation exists between abnormal nocturnal penile tumescence and abnormal systolic blood flow. According to this observation we presume that nocturnal penile tumescence, penile duplex and infusion cavernosometry should be performed to achieve a reasonably accurate diagnosis.

[Erectile dysfunction: the role of Rigiscan in the diagnosis]. / Dysfonctionnement érectile: la place du Rigiscan dans le diagnostic.

OBJECTIVE: Nocturnal penile tumescence (NPT) was performed in all patients and was evaluated as normal or abnormal according to standardized general criteria. The results of NPT were then compared to penile duplex ultrasonography parameters peak systolic velocity (normal > 35 cm/sec) and diastolic velocity (normal < 5 cm/sec), and to the flow rate needed to maintain erection (normal < 15 ml/min) with pharmaco-infusion cavernosometry. RESULTS: Of the 50 patients, 26 showed normal NPT where 25 patients (96%) had normal penile systolic velocity, 18 patients (69%) had normal penile diastolic velocity, and 22 patients (85%) showed normal flow to maintain erection. On the other hand, 24 showed abnormal NPT, where 7 patients (29%) had abnormal penile blood flow velocity and 18 patients (75%) showed high flow rate to maintain erection. CONCLUSION: From this study, we can conclude that normal NPT appears to have a good correlation with normal systolic blood velocity and normal cavernosometry. However, this correlation is low when compared with diastolic blood velocity. On the other hand, a low correlation exists between abnormal NPT and abnormal systolic and diastolic blood flow or abnormal cavernosometry. According to this observation, we can presumed that NPT, penile duplex and infusion cavernosometry considering together should be performed in order to achieve a reasonably accurate diagnosis.

Vertebral artery dissection. Case report.

Vertebral artery dissection is an uncommon but important cause of posterior stroke in young and middle aged adults. We report a case with a long term fluctuating ischemic symptoms due to bilateral spontaneous dissection. Etiology and treatment are discussed.

[Persistent left superior vena cava. Apropos of 2 cases]. / Veine cave supérieure gauche persistante. A propos de deux observations.

Double superior vena cava with persistence of a left superior vena cava is rarely encountered. The prevalence in the general population is 0.3% but may reach 3 to 10% in patients with inborn heart diseases. There are usually no clinical signs and the malformation is usually discovered fortuitiously. We describe the features of two cases observed in our institution and reviewed the literature on the subject.

Treatment of glans hyperemia after penile revascularization by transcatheter embolization.

Glans hyperemia after penile revascularization is a well known complication normally treated by surgery. However, this reintervention is often difficult due to local fibrosis. We report a case of successful embolization after supra-selective catheterization of the deep dorsal vein through the surgical anastomosis.

[Radiologic diagnosis of renal cortical necrosis. Apropos of a case and review of the literature]. / Diagnostic radiologique de la nécrose corticale rénale. A propos d'un cas et revue de la littérature.

One case of renal cortical necrosis is reported. The results of ultrasound and angiographic imaging and the relevant literature are reviewed. The examinations, particularly selective angiography, are of great interest in the diagnostic and in the etiology of this disease.

[Iatrogenic femoral pseudo-aneurysm and arteriovenous fistula. Non-surgical treatment]. / Pseudo-anévrysme et fistule artério-veineuse fémoraux iatrogènes. Traitement non chirurgical.

Pseudoaneurysm and arteriovenous fistulae are classical but unusual complications of femoral catheterism. The use of large diameter catheters, heparinotherapy and fibrinolysis constitute risk factors. These local complications are becoming more frequent resulting from an increase in interventional techniques. Therefore, a non invasive management of these lesions becomes necessary. A simple manual percutaneous compression of the puncture site was successful as treatment of 3 arteriovenous fistulae and 4 of 7 pseudoaneurysms. That is the reason why the authors consider that this technique constitutes a good alternative of the surgical treatment.

[Computed tomography aspects of cerebral toxoplasmosis in AIDS]. / Aspects tomodensitométriques de la toxoplasmose cérébrale dans le SIDA.

We followed by CT 19 AIDS patients with cerebral toxoplasmosis. Diagnosis of cerebral toxoplasmosis was assessed on radiological and clinical basis, including the therapeutic response. CT allowed to confirm brain lesions (40 lesions in 19 patients) and to follow the evolution with treatment. Analysis of the CT features of these brain lesions permits to define some characteristic findings, though not pathognomonic. These lesions share common characteristics with other granulomatous diseases or with brain abscesses. The most frequently observed features are: target lesions (74%) with contrast enhancement (95%), frequently multiple (53%), associated with a hypodense area of oedema (100%), and responsible for a mass effect (79%). Under treatment, we observed improvement in 89%, resulting either in complete disappearance of the lesions (16%), disappearance of one or more contrast enhancing (46%) or hypodense (6%) areas, or volumetric regression of the hypodensities (50%). We conclude that CT is a good first-step examination for the detection and follow-up of cerebral toxoplasmosis in AIDS patients. MRI, a method with a higher sensitivity but still less accessible, may be considered at the present time as a second-step examination for those patients with solitary lesions on CT, or for symptomatic patients with normal CT.

[Iatrogenic femoral pseudo-aneurysm. Analysis of the causes, diagnosis and treatment. Study of 12,248 arterial catheterizations]. / Pseudo-anévrysmes fémoraux iatrogènes. Analyse des causes, diagnostic et traitement. Etude portant sur 12,248 cathétérismes artériels.

Pseudoaneurysm is a classical but unusual complication of femoral catheterism. 22 cases are reviewed: 19 occurred after coronarography, 2 after peripheral percutaneous angioplasty and only one after a renal diagnostic arteriography. In all cases, the diagnosis of the pseudoaneurysm was established by I.V. D.S.A. 2 different medical teams are distinguished: the first using small catheters (4 and 5 F), the second using larger catheters (7 and 8 F) which are more aggressive. Two factors allow to avoid this complication: the diameter of the catheter and a correct compression dressing. The treatment of this complication, usually surgical, consisted in a simple manual percutaneous compression in 3 patients.

[A case of multiple brain calcifications associated with hypoparathyroidism]. / Un cas de calcifications cérébrales multiples associées à une hypoparathyroïdie.

We report a case of extensive cerebral calcifications associated with hypoparathyroidism in a 82-year-old woman who has been thyroidectomized and received an antiepileptic treatment for 26 years after an episode of coma followed by confusion. We discuss the frequent confusion in terminology used for describing such cases, emphasizing the necessary distinction between Fahr's disease (extensive cerebral calcifications without abnormal phosphocalcium metabolism) and cerebral calcinosis associated with hypoparathyroidism.