Percutaneous coil embolization of postcatheterization arterial femoral pseudoaneurysms

AbstractStudy Design: This study was a prospective monocentric study to assess the safety and effectiveness of percutaneous embolization with coils of postcatheterization femoral pseudoaneurysm (PCFP). Patients and Methods: Seventeen PCFPs of 32-mm mean diameter in 16 patients were embolized while anticoagulant or antiplatelet therapy was maintained. Ultrasound scan-guided compression repair failed at least one time in 13 cases and was contraindicated in the four remaining cases. With ultrasound-Doppler scan guidance, the PCFPs were percutaneously punctured with a 16-gauge intravenous catheter. An angiogram was performed through the catheter to ensure its location within the sac. Stainless steel spring coils with synthetic fibers were introduced within the PCFP with fluoroscopic control. Successful thrombosis was checked with ultrasound-Doppler scan and was repeated at days 1, 30, and 180 when possible. Results: All PCFPs of 32-mm mean diameter were successfully treated with two to nine coils. After embolization, gentle additional compression was necessary for complete occlusion, with a mean duration of 6.3 minutes (range, 0 to 15 minutes), except in one case with treatment with abciximab in which it was 45 minutes. All procedures were uneventful and painless. The mean follow-up period was 9.5 months (range, 1 to 21 months). Two recurrences (11.7%) were observed, and one was successfully treated with a second embolization. Conclusion: Percutaneous embolization with coils appears to be a safe and effective method for treatment of PCFP. It may be performed in patients undergoing anticoagulant or antiplatelet therapy and must be attempted when ultrasound scan-guided compression repair has failed or is contraindicated. (J Vasc Surg 2002;36:127-31.

Ponowne zabiegi u chorych leczonych z powodu tętniaka aorty brzusznej stentgraftami wewnątrznaczyniowymi - wskazania, czynniki ryzyka i rokowanie

Background. The aim of this study was evaluation of secondary interventions defined as procedures performed to close endoleak, or to improve limb patency after endovascular AAA repair and to assess their predictive factors and prognosis. Material and methods. Patient’s data and follow-up events of all patients who underwent endovascular repair of AAA between January 1995 and November 2001 in our institution were prospectively collected and stored in our database. Patients were divided into two groups according to the presence or absence of secondary reintervention during follow-up. Age, sex, type of AAA, AAA diameter, comorbidities, type of graft and period of treatment were compared using a univariate analysis. Prognosis was assessed by comparison of life table analysis. Interventional success defined as the lack of AAA conversion or rupture were also compared in both groups. Results. Two hundred and six patients were included in the study. During follow-up, thirty-two patients (16%) required 47 secondary interventions. Respectively 22 and 10 patients were treated with endovascular methods to close various type of endoleaks or were operated on to restore limb blood flow. The only significant predictive factor of secondary reintervention was the type of grafts: early generation 29/101(28.7%) versus the latest generation 3/102 (2.9%). The survival rate was not statistically different in both groups. The interventional success was significantly different 27/32 (84.4%) versus 173/174 (99.4%) Conclusions. Secondary reinterventions which mainly with early generation grafts improved outcome of endovascular AAA repair in 15% of the cases. However no death could be attributed to these reinterventions or to conversions.Wstęp. Celem pracy była ocena powikłań powodujących konieczność wykonania dodatkowych zabiegów likwidujących przeciek lub udrożniających stentgraft u chorych poddanych wewnątrznaczyniowemu leczeniu tętniaków aorty brzusznej (TAB) oraz zbadanie wpływu analizowanych powikłań na odległe wyniki terapii. Materiał i metody. W okresie od stycznia 1995 do listopada 2001 r. na Oddziale Chirurgii Naczyń Hospital Henri Mondor w Creteil metodą wewnątrznaczyniową, stosując stentgrafty aortalne, zoperowano 205 chorych z TAB. W celu przeprowadzenia badania chorych podzielono na dwie grupy: grupę pierwszą stanowili pacjenci wymagający przeprowadzenia ponownych zabiegów, drugą - chorzy niewymagający ponownych zabiegów. Wiek, płeć, rodzaj, wymiary tętniaka, obciążenia, rodzaj stentgraftu i okres obserwacji porównano, stosując odpowiednie analizy statystyczne. Wykonano analizę przeżycia chorych, uwzględniając odległe wyniki leczenia. W obu grupach porównano powodzenie zabiegu zdefiniowane jako brak konwersji do metody otwartej lub pęknięcie TAB. Wyniki. W badaniu uczestniczyło 206 chorych. Podczas obserwacji 32 chorych (16%) wymagało 47 ponownych zabiegów. W celu zlikwidowania przecieku leczono 22 chorych, natomiast 10 chorych poddano terapii z powodu niedrożności stentgraftu z wykorzystaniem technik wewnątrznaczyniowych lub metodą otwartą. Jedynym istotnym statystycznie czynnikiem związanym z liczbą ponownych zabiegów był rodzaj stentgraftu: starsza generacja 29/101 (28,7%), nowsza generacja 3/102 (2,9%). Czas przeżycia w obu grupach nie różnił się w sposób istotny statystycznie. Wyniki w poszczególnych grupach były następujące: 27/32 (84,4%) w pierwszej grupie, 173/174 (99,4%) w drugiej grupie. Wnioski. Ponowne zabiegi spowodowały poprawę wyników w 15% przypadków, obserwowano je głównie w grupie chorych z starszymi typami stentgraftów. Wśród osób poddanych ponownym zabiegom i konwersjom do metody otwartej nie zanotowano przypadków śmiertelnych

RGTA® or ReGeneraTing Agents mimic heparan sulfate in regenerative medicine: from concept to curing patients

The importance of extracellular matrix (ECM) integrity in maintaining normal tissue function is highlighted by numerous pathologies and situations of acute and chronic injury associated with dysregulation or destruction of ECM components. Heparan sulfate (HS) is a key component of the ECM, where it fulfils important functions associated with tissue homeostasis. Its degradation following tissue injury disrupts this delicate equilibrium and may impair the wound healing process. ReGeneraTing Agents (RGTA®s) are polysaccharides specifically designed to replace degraded HS in injured tissues. The unique properties of RGTA® (resistance to degradation, binding and protection of ECM structural and signaling proteins, like HS) permit the reconstruction of the ECM, restoring both structural and biochemical functions to this essential substrate, and facilitating the processes of tissue repair and regeneration. Here, we review 25 years of research surrounding this HS mimic, supporting the mode of action, pre-clinical studies and therapeutic efficacy of RGTA® in the clinic, and discuss the potential of RGTA® in new branches of regenerative medicine

Long Term Stabilization of Expanding Aortic Aneurysms by a Short Course of Cyclosporine A through Transforming Growth Factor-Beta Induction

Abdominal aortic aneurysms (AAAs) expand as a consequence of extracellular matrix destruction, and vascular smooth muscle cell (VSMC) depletion. Transforming growth factor (TGF)-beta 1 overexpression stabilizes expanding AAAs in rat. Cyclosporine A (CsA) promotes tissue accumulation and induces TGF -beta1 and, could thereby exert beneficial effects on AAA remodelling and expansion. In this study, we assessed whether a short administration of CsA could durably stabilize AAAs through TGF-beta induction. We showed that CsA induced TGF-beta1 and decreased MMP-9 expression dose-dependently in fragments of human AAAs in vitro, and in animal models of AAA in vivo. CsA prevented AAA formation at 14 days in the rat elastase (diameter increase: CsA: 131.9±44.2%; vehicle: 225.9±57.0%, P = 0.003) and calcium chloride mouse models (diameters: CsA: 0.72±0.14 mm; vehicle: 1.10±0.11 mm, P = .008), preserved elastic fiber network and VSMC content, and decreased inflammation. A seven day administration of CsA stabilized formed AAAs in rats seven weeks after drug withdrawal (diameter increase: CsA: 14.2±15.1%; vehicle: 45.2±13.7%, P = .017), down-regulated wall inflammation, and increased αSMA-positive cell content. Co-administration of a blocking anti-TGF-beta antibody abrogated CsA impact on inflammation, αSMA-positive cell accumulation and diameter control in expanding AAAs. Our study demonstrates that pharmacological induction of TGF-beta1 by a short course of CsA administration represents a new approach to induce aneurysm stabilization by shifting the degradation/repair balance towards healing

Viral to metazoan marine plankton nucleotide sequences from the Tara Oceans expedition

A unique collection of oceanic samples was gathered by the Tara Oceans expeditions (2009-2013), targeting plankton organisms ranging from viruses to metazoans, and providing rich environmental context measurements. Thanks to recent advances in the field of genomics, extensive sequencing has been performed for a deep genomic analysis of this huge collection of samples. A strategy based on different approaches, such as metabarcoding, metagenomics, single-cell genomics and metatranscriptomics, has been chosen for analysis of size-fractionated plankton communities. Here, we provide detailed procedures applied for genomic data generation, from nucleic acids extraction to sequence production, and we describe registries of genomics datasets available at the European Nucleotide Archive (ENA, www.ebi.ac.uk/ena). The association of these metadata to the experimental procedures applied for their generation will help the scientific community to access these data and facilitate their analysis. This paper complements other efforts to provide a full description of experiments and open science resources generated from the Tara Oceans project, further extending their value for the study of the world's planktonic ecosystems

Operating a full tungsten actively cooled tokamak: overview of WEST first phase of operation

WEST is an MA class superconducting, actively cooled, full tungsten (W) tokamak, designed to operate in long pulses up to 1000 s. In support of ITER operation and DEMO conceptual activities, key missions of WEST are: (i) qualification of high heat flux plasma-facing components in integrating both technological and physics aspects in relevant heat and particle exhaust conditions, particularly for the tungsten monoblocks foreseen in ITER divertor; (ii) integrated steady-state operation at high confinement, with a focus on power exhaust issues. During the phase 1 of operation (2017–2020), a set of actively cooled ITER-grade plasma facing unit prototypes was integrated into the inertially cooled W coated startup lower divertor. Up to 8.8 MW of RF power has been coupled to the plasma and divertor heat flux of up to 6 MW m−2 were reached. Long pulse operation was started, using the upper actively cooled divertor, with a discharge of about 1 min achieved. This paper gives an overview of the results achieved in phase 1. Perspectives for phase 2, operating with the full capability of the device with the complete ITER-grade actively cooled lower divertor, are also described

Étude au scanner multibarrettes des dissections aigues de type A opérées (cartographie, planimétrie et angioscopie virtuelle)

La dissection aortique de type A est une pathologie grave dont le pronostic a été amélioré grâce à l amélioration des techniques chirurgicales depuis 15 ans. Les résultats tardifs sont en partie dépendants de l évolution anévrismale et de la rupture potentielle du reste de l aorte. Dans la littérature, l aspect morphologique des dissections de type A opérées a été peu étudié. Cette étude se propose d effectuer une analyse scannographique très précise à un temps tardif de l ensemble de l aorte et de ses branches des patients opérés d une dissection de type A. Matériels et méthodes :de janvier 1982 à février 2006, 160 patients ont été opérés de dissection aortique de type A dans le service de chirurgie cardiaque de l hôpital Henri Mondor (Pr Loisance, Dr Hillion, Dr Kirsch). Soixante et onze patients (42 %) sont décédés en peri opératoire ou dans le suivi, 13 patients ont été perdus de vue (8%) et 17 patients ont eu une chirurgie aortique distale et n ont pas été inclus dans notre étude (10%). Nous avons effectué une étude scannographique intermédiaire chez 20 des 59 patients restants. Les scanners (64 barrettes, General Electric) ont été effectués dans le service d imagerie médicale (Pr Rahmouni, Dr Kobeiter). Plus de 400 items par scanner ont été analysés sur console Light Speed et regroupés en 3 catégories : cartographie, planimétrie avec analyse des surfaces du vrai et du faux chenal, et angioscopie virtuelle. Résultats La cartographie a permis la séparation des patients en 2 groupes : les patients ayant une dissection de l aorte résiduelle (groupe I, n=12, 60%) et les patients sans dissection résiduelle (groupe II, n=8, 40%). Les dissections artérielles des branches aortiques ont intéressé respectivement dans le groupe I et II le tronc artériel brachio-céphalique dans 33% vs. 12,5% ( ns), les artères viscérales dans 60% vs 0% (p50mm) a été découvert chez n=6, 50% des patients du groupe I vs. n=2, 25% des patients du groupe II (ns).Une dilatation de la crosse (>35mm) a été observée chez 10 patients (83%) du groupe I vs. 6 patients (75%) du groupe II (ns). Dans le groupe I, il y avait 6 thromboses du faux chenal associées dans 3 cas à un anévrisme et dans 3 cas à une aorte disséquée non anévrismale. La planimétrie a montré que dans le groupe I, le rapport moyen de surface du vrai chenal sur la surface du faux chenal au niveau de l aorte thoracique haute a été 0,5 chez les patients ayant une aorte disséquée mais de calibre normal, et compris entre 0,3 et 0,5 chez les patients ayant une aorte dilatée (> 35mm, 55mm) have been discovered in n=6, 50% of patients in the group I versus n=2, 25% of patients of group II (ns). A aortic dilatation have been observed in 10 patients (83%) in group I versus 6 patients (75%) in group II (ns). In the group I, there were 6 thrombosis of the false lumen associated in 3 cases to an anevrysm and in 3 cases to non anevrismal aortic dissection. The planimetry have showed in the group I, than the average rapport of the truth lumen surface on the false lumen surface at the thoracic aorta level has been inferior to 0,3 in anevrism group. The rapport has been superior to 0,5 in patients with aortic dissection but a normal size, and incluted between 0,3 and 0,5 in patients with a dilatated aorta (>35mm, <50mm). The virtual angioscopy has been contributed in 75% of patients ( 7 patients, 67% in group I versus 8 patients 100% in group II). The virtual angioscopy has been contributed to find 5 entry door in the patients of group II.PARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Ruptures traumatiques de l'aorte thoracique (place du traitement endo-vasculaire)

PARIS13-BU Serge Lebovici (930082101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Résultats de la reconstruction in-situ dans les infections aortiques natives et prothétiques utilisant des allogreffes artérielles cryopréservées

Les allogreffes artérielles cryopréservées représentent une alternative au matériel prothétique ou autologue dans la reconstruction aortique en cas d'infection native ou prothétique, mais les résultats restent discutables. L'objectif de cette étude est d'évaluer à court et moyen terme le recours aux allogreffes cryopréservées en situation aortique. Tous les patients ayant présenté, entre septembre 2004 et juin 2012, une infection aortique native ou prothétique pour laquelle une implantation in-situ d'une allogreffe artérielle a eu lieu, ont été identifiés à partir d'une base de données locale prospectivement constituée. Les données concernant la population, l'indication opératoire, les événements péri-opératoires, la bactériologie, le protocole de cryopréservation et le suivi ont été analysées. Les greffons ont été prélevés chez un donneur en état de mort encéphalique et congelés à - 150C ou à -80C. 54 patients ont été traités par une reconstruction aortique in-situ utilisant une allogreffe artérielle cryopréservée. L'âge moyen était de 66,2 ans (40-83). L'indication reposait sur une infection native chez 16 patients, prothétique chez 37 patients, dont 7 présentaient une fistule aorto-digestive. 12 reconstructions aortiques (22,2%) ont eu lieu dans un contexte d'urgence. Les germes ont été identifiés sur un échantillon peropératoire chez 66,6% des patients, et formaient un spectre large où prédomine le Staphylococcus Aureus (34,4%). La mortalité post-opératoire précoce était de 27,8%, et le taux de complications significatives précoces de 51,8%. Les complications liées au greffon (thrombose, rupture) sont survenues chez 18,5 % des patients. Pendant le suivi ont été observées 2 rechutes infectieuses, et une occlusion de jambage d'allogreffe. Le taux de ré-intervention précoce était de 35,2%, et global de 38,8%. En analyse multivariée, cinq facteurs indépendants étaient prédictifs de décès post-opératoire : l âge > 65 years (p=0.001), l insuffisance rénale chronique (p=0.001), l infection prothétique (p=0.02), les procédures en urgence (p=0.03), et la coronaropathie (p=0,045)La reconstruction aortique par allogreffe cryopréservée s'accompagne d'un taux de mortalité précoce et de complications liées au greffon non négligeables. Ces résultats restent cependant multifactoriels, comparables aux techniques alternatives, et nécessitent une attention particulière quant au comportement précoce du greffon.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Is UO2 irradiation resistance due to its high temperature behaviour?

International audienceUO2 is the main component of nuclear fuel for most of nuclear power plants. In operation in these plants, it withstands irradiation damage without major changes. Szenes proposed a simple criterion for determining an amorphisation threshold due to swift heavy ions, which works reasonably well for many ionio-covalent compounds. In the case of UO2, this criterion predicts that this threshold is reached for 8.6 keV/nm, which means well under the electronic energy loss of fission products, for example 19.7 keV/nm for 72 MeV iodine. We will address this apparent contradiction. In fact the resistance of a given material to irradiation damage depends on the way it can absorbs the deposited energy by electronic losses before reaching an energy density, generally associated with a threshold temperature that leads to metastable changes. In this paper we will discuss the equilibrium properties of UO2 and how UO2 can absorb energy before reaching this threshold. At thermodynamic equilibrium, the way by which a solid stores energy can be estimated by its heat capacity. In order to better understand UO2 resistance to irradiation, we discuss how the properties of uranium and oxygen sublattice have a drastic impact on the thermodynamic properties of UO2 compared to other fluorite compounds. We will discuss why the unusual behaviour of uranium sublattice is associated with the formation of polarons at high temperature and how this gives UO2 an enhanced irradiation resistance