Étude préliminaire d'évaluation du risque de rupture des anévrismes de l'aorte abdominale par l'indice du potentiel de rupture

Le risque de rupture des anévrismes de l'aorte abdominale est très variable et la prise en charge thérapeutique est directement liée à ce risque. Nous avons donc étudié la faisabilité d'une étude sur la simulation de l'indice du potentiel de rupture pour les anévrismes de l'aorte abdominale ce qui correspond à déterminer le rapport des efforts/la résistance de la paroi aortique par simulation informatique. Après étude de la population des anévrismes rompus au CHU de Brest entre janvier 2001 et décembre 2008, nous avons retrouvé 87 patients hospitalisés pour cette pathologie mais dont seulement 11 scanners étaient utilisables en vu d'une modélisation. Nous avons créé un modèle à partir de ces angioscanners grâce au logiciel Osirix 3.5.1, puis remaillé le fichier grâce au logiciel Rhinocéros 4.0 afin d'obtenir un modèle utilisable pour un logiciel d'analyse d'éléments finis à savoir Abaqus 6.8 Student Edition. Les résultats obtenus ne sont pas assez précis, du fait de la limitation de la version du logiciel de simulation, mais cela a permis de créer une méthodologie afin de développer un outil plus performant pour l'analyse du risque de rupture ciblé pour chaque patient.BREST-BU Médecine-Odontologie (290192102) / SudocSudocFranceF

Traitement endovasculaire des anévrysmes de l'aorte abdominale au CHU de Brest (à propos de 63 patients)

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La dissection spontanée et isolée de l'artère mésentérique supérieure (à propos d'un cas)

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Place de l'angioscanner dans la stratégie thérapeutique de l'artériopathie oblitérante des membres inférieurs

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Multi-detector row computed tomography angiography: an alternative imaging method for surgical strategy in lower extremity arterial occlusive disease.

International audienceIn order to show the value of CT angiography in the pretherapeutic assessment of lower leg ischemia, we studied 93 CT angiographies in 85 patients. Two groups were defined according to the level of revascularization: 52 angioscanner were made prior to suprainguinal revascularization and 41 prior to infrainguinal reconstruction. Two decision attitudes were chosen by two different physicians, a radiologist and vascular surgeon, members of the same team. The attitudes where then compared in order to evaluate the value of CT angiography. The first attitude was a pragmatic strategy based on the images as interpreted by the first physician and on the intraoperative information including surgical treatment and, if necessary, angiography. This indicates that the results of this attitude cover the performed revascularizations. The second attitude determined a virtual strategy and was chosen by the second physician a posteriori, based solely on the medical file with the same CT angiography images. These two strategies were compared in order to assess the agreement on the level of the lesion and the choice of revascularization. In 84 CT angiographies (90.3%), the analysis of the lesions and the choice of lesions to be treated were identical. In 9.6% of scans the strategies were not comparable because the lesions were interpreted differently or the scans were difficult to read. The sensitivity of CT angiography in detecting lesions and guiding the therapeutic strategy was 96% and its positive predictive value was 93%. Follow-up was reported according to the life-table method to assess the overall outcome and the results in both groups. The overall survival rate at 12 months for 85 patients was 90%. Secondary patency rates at 12 months in the group of patients who underwent a suprainguinal and infrainguinal revascularization were 98% and 71% respectively. Overall limb salvage at 12 months was 94%. In this setting, CT angiography allowed us to select adequate treatment in the majority of cases. These results obtained after a strategy based on CT angiography images are comparable with the results as published in the literature after the strategy based on conventional angiography

[MR angiography of peripheral arterial disease of the distal legs: is time resolved MRA (TRICKS) necessary?].

International audiencePURPOSE: To demonstrate the added diagnostic value of time-resolved imaging of contrast kinetics (TRICKS) in the evaluation of lower limb arteries compared to standard 3 level MRA with stepping table method. PATIENTS AND METHODS: Forty patients (30% diabetics) with lower extremity peripheral arterial disease (87.5% with chronic ischemia) underwent standard contrast MRA including TRICKS of the distal arteries. Five arterial segments were defined per leg, and 395 arterial segments were compared (one patient with amputation). Two reviewers evaluated the quality of arterial imaging, presence of venous return and degree of stenosis per segment. The degree of interobserver agreement for arterial stenosis measurement was calculated. RESULTS: More arterial segments could be analyzed on the TRICKS sequence (good or excellent analysis in 63.03%-66.32% of arterial segments compared to 41.51%-47.08% on routine MRA). There was less venous contamination on TRICKS images (25.57% to 27.60% gain). The degree of interobserver agreement was superior with TRICKS compared to standard MRA (kappa 0.85 vs 0.69). CONCLUSION: The TRICKS sequence can be added to standard MRA for pre-therapeutic evaluation of distal arteries in patients with peripheral arterial disease, especially with chronic ischemic with rest pain and/or trophic changes

Citrulline/malate promotes aerobic energy production in human exercising muscle

International audienc