A systematic review of infected descending thoracic aortic grafts and endografts

Objective: The objective of this study was to collect and critically analyze the current evidence on the modalities and results of treatment of descending thoracic aortic surgical graft (SG) and endograft (EG) infection, which represents a rare but dramatic complication after both surgical and endovascular aortic repair. Methods: A comprehensive electronic health database search (PubMed/MEDLINE, Scopus, Google Scholar, and the Cochrane Library) identified all articles that were published up to October 2017 reporting on thoracic aortic SG or EG infection. Observational studies, multicenter reports, single-center series and case reports, case-control studies, and guidelines were considered eligible if reporting specific results of treatment of descending thoracic aortic SG or EG infection. Comparisons of patients presenting with SG or EG infection and between invasive and conservative treatment were performed. Odds ratio (OR) meta-analyses were run when comparative data were available. Results: Forty-three studies reporting on 233 patients with infected SG (49) or EG (184) were included. Four were multicenter studies including 107 patients, all with EG infection, associated with a fistula in 91% of cases, with a reported overall survival at 2 years of 16% to 39%. The remaining 39 single-center studies included 49 patients with SG infection and 77 with EG infection. Association with aortoesophageal fistula was significantly more common with EG (60% vs 31%; P = .01). In addition, time interval from index procedure to infection was significantly shorter with EG (17 +/- 21 months vs 32 +/- 61 months; P = .03). Meta-analysis showed a trend of increased 1-year mortality in patients with SG infection compared with EG infection (pooled OR, 3.6; 95% confidence interval, 0.9-14.7; P = .073). Surgical management with infected graft explantation was associated with a trend toward lower 1-year mortality compared with graft preservation (pooled OR, 0.3; 95% confidence interval, 0.1-1.0; P = .056). Conclusions: Thoracic aortic EG infection is likely to occur more frequently in association with aortoesophageal fistulas and in a shorter time compared with SG infection. Survival is poor in both groups, especially in patients with SG infection. Surgical treatment with graft explantation seems to be the preferable choice in fit patients

Detailed cross-sectional study of 60 superficial femoral artery occlusions: morphological quantitative analysis can lead to a new classification.

OBJECTIVE: Current clinical classification of superficial femoral artery (SFA) occlusions as defined by TASC II guidelines is limited to length and calcifications analysis on 2D angiograms, while state-of-the-art cross-sectional imaging like computed tomography angiography (CTA) and magnetic resonance angiography (MRA) provides much more detailed anatomical information than traditional invasive angiography: quantitative morphological analysis of these advanced imaging techniques could therefore be the basis of a refined classification. METHODS AND RESULTS: Forty-six patients (65% men, 68±11.6 years) that underwent lower limb CTA were retrospectively included, totalizing 60 SFA occlusions. Lesions were classified as TASC II stage A in 3% of cases, stage B in 20%, stage C in 2% and stage D in 75%. For each pathological artery, curved multiplanar reconstructions following the occluded SFA course were used to measure the total length and the mean diameter of the occluded segment. Color-coded map provided an accurate estimation of calcifications' volume. Thirty-nine percent of the occlusions were total. Mean occluded segment length was 219±107 mm (range, 14-530 mm); mean occluded segment diameter was 6.1±1.6 mm (range, 3.4-10 mm); mean calcifications' volume in the occluded segment was 1,265±1,893 mm(3) (range, 0-8,815 mm(3)), corresponding to a percentage of 17.4%±20% (range, 0-88.7%). Shrinked occluded occlusions were defined by a mean diameter under 5 mm and heavily calcified occlusions by a mean percentage of calcifications above 4%. Use of these thresholds allowed the distinction of four groups of patients: heavily calcified occlusions with preserved caliber (56%), non-calcified occlusions with preserved caliber (19%), non-calcified occlusions with small caliber (15%) and heavily calcified occlusions with small caliber (10%). CONCLUSIONS: SFA OCCLUSIONS ARE DISPARATE: this simple morphological study points out TASC II classification weaknesses for SFA occlusions, as quantitative cross-sectional imaging analysis with measurement of mean occluded diameter and percentage of calcifications can refine it. This could be particularly useful in the management of TASC II type D lesions, for which new endovascular revascularization techniques are arising, and where a CTA or MRA-based morphological classification could provide support in choosing between them..journal article2014 Aprimporte

Complications neurologiques centrales après chirurgie des sténoses athéromateuses de la bifurcation carotidienne.

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

INTERETS DES COLLERETTES DE MILLER DANS LES REVASCULARISATIONS ARTERIELLES DISTALES DES MEMBRES INFERIEURS (A PROPOS DE 46 CAS (DES CHIRURGIE GENERALE))

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Modifications de surfaces de prothèses vasculaires en polyéthylène de térephtalate (Optimisation de l étanchéité et de l endothélialisation)

Trois types de films multicouches ont été construits sur des prothèses en polyéthylène de térephtalate : le Poly(Styrène Sulfonate)/Poly(Allylamine Hydrochloride), le Poly(L-Lysine)/acide hyaluronique, le poly(L-lysine)/poly(L-acide glutamique). Après caractérisation statique, nous avons testé leurs propriétés mécaniques par soumission des films appliqués aux constituants d une prothèse, à une traction longitudinale puis à des forces de cisaillement (flux pulsé simulant le débit sanguin), avec une bonne tenue. La dynamométrie a démontré l absence de modification de la force à la rupture d un filament traité. Les trois systèmes ont permis une amélioration significative de l étanchéité par rapport à la prothèse contrôle. Le système (PAH/PSS) a été le plus apte à la croissance et l adhésion cellulaire après culture de cellules HUVEC sur une prothèse traitée.Three films of polyelectrolytes were tested on polyethylene terephthalate: poly(allylamin hydrochlorid)/poly(sodium styrenesulfonate), poly(L-lysine)/hyaluronan polysaccharide and poly(L-lysine)/poly(L-glutamic acid).Static characterizations were carried out, of filaments, threads and prosthesis treated by the three systems. Longitudinal traction have been applied, with constatation of a good resistance. Dynamometric tests demonstrated the absence of modification of the behaviour of a treated filament. Shear stress have been applied with an hydraulic circuit on treated prosthesis, with good resistance of the three systems. Tests of water etancheity were carried out with an improvement between non treated and treated prosthesis. Biocompatibility has been assessed by HUVEC culture upon treated PET and demonstrated better cellular adhesion and proliferation for (PAH/PSS) system.Layer-by-layer films present good mechanical and biological properties for an application in vascular use.STRASBOURG-Sc. et Techniques (674822102) / SudocSudocFranceF

Unsupervised segmentation of stents corrupted by artifacts in medical X-ray images

International audienceWe propose a new methodology for the segmentation of stents in 3D X-ray acquisitions. Such data are often corrupted by strong artifacts around the stent, requiring the development of a robust algorithm: because of the medical application, we need to produce an accurate segmentation. Moreover, we aim at developping a robust technique that can handle heterogeneous data. We propose a two-step, coarse-to-fine approach, that handles the corrupted cases. This approach leads to better results illustrated in the context of metallic artefact reduction

Segmentation de stents dans des données médicales à rayons-X corrompues par les artéfacts

International audienceWe propose a new methodology for the segmentation of stents in 3D X-rays acquisitions. Such data are often corrupted by the stent beam hardening, requiring the development of a robust algorithm. Because of the medical application, we need to produce an accurate segmentation. We propose a two-step, coarse-to-fine approach, which leads to satisfying results.Nous proposons une nouvelle méthodologie pour la segmentation de stent dans des images scanners 3D à rayons-X. La robustesse de la méthode est mise à l’épreuve par les artéfacts causés par le dispositif métallique et la nécessité d’obtenir des résultats précis liés à l’application médicale. Nous proposons une approche "coarse-to-fine", en deux étapes qui conduit à des résultats satisfaisants

Effects of Aortic Graft Implantation on Heart and Downstream Vessels: An Artery is not a Rigid Pipe.

peer reviewe

Remote Ischaemic Preconditioning in Vascular Surgery: Is it Worth the Effort?

peer reviewe