JMV-Journal de Medecine Vasculaire最新文献

Obesity is an alarming worldwide public health issue and is defined as a body mass index (BMI) of 30 kg/m² or more. It is considered as a risk factor for first thrombotic event and is associated with a significant risk of recurrence. Consequently, obese patients are often treated by anticoagulant therapy but data from randomised control trial are scarce. We will review in this narrative review the state of the art of the prescription of anticoagulant for the prevention and treatment of venous thromboembolism (VTE) in obese patients.

Venous leg ulcer refers to chronic wounds, generally difficult to heal and often prone to recurrence. The objective of this research was to assess a double layered compression stocking VenoTrain® ulcertec on a population with mostly severe pathologies. This prospective, multicenter, interventional type II study was conducted between September 2018 and January 2022. Out of 124 patients enrolled, 97.6% had a history of previous leg ulceration, 72.6% were already being followed for leg ulcerations, 30.9% were severely overweight and 24.2% diabetic. Overall, a majority of target ulcers were present for 6 months or more, and the ulcer surface area was larger than 8 cm² in nearly one in every five cases. The primary endpoint was the rate of closed ulcer after a maximum follow-up of 20 weeks. While most of the treated venous leg ulcerations may be regarded as hard-to-heal wounds, closure rate at 20 weeks ranged between 50.0% (two severity criteria) and 69.0% (no severity criteria) according to baseline wound severity criteria. Besides, VenoTrain® ulcertec device was particularly well accepted and tolerated by patients. In 93.2% of visits, patients stated using it every day. When managing venous ulcerations not requiring strongly thick absorbent dressings, VenoTrain® ulcertec device represents an efficient and more suitable alternative to venous compression bandaging.

Most anatomic features of the internal carotid artery (ICA) are described as a straight course to the skull base free of branches. In some cases, the excessive elongation of the internal carotid artery in a confined space results in a curvature showing a “C” or “S” shape, or in an abnormal vascular shape made of a single or double vessel loop. These anatomic variants are called dolichoarteriopathies of the internal carotid artery. The correlation between dolichoarteriopathy of the ICA and stroke is still questionable, however it is believed that it can be associated with cerebral ischemia with a clinical symptomatology that accompanies ischemic stroke. We report a case of a 41-year-old patient, with a history of hypertension, who was admitted for right hemiparesis with Broca's aphasia. The rest of the clinical examination was normal. Radiological investigations confirmed an acute left sylvian ischemic stroke with an abrupt occlusion of the posterior trunk of the left M2 segment on the CT angiogram, an excessive elongation of the ICA on both sides, describing a shape of coils or loops. Etiologic workup for ischemic stroke was negative.

An accurate diagnosis of lower limb deep vein thrombosis (DVT) recurrence is mandatory. The diagnosis is difficult and has not been well investigated. Our objective was to define the role of clinical probability assessment, D-dimer assay, venous ultrasound and other imaging methods in the diagnosis of this condition based on a review of published data. Our review did not find any clinical prediction rule (CPR) specific to the diagnosis of DVT recurrence. D-dimer assays have not been sufficiently validated or proved effective either alone or when combined with the assessment of clinical probability or with ultrasound. The only validated ultrasound criteria are a new non-compressible vein segment and a ≥ 2 mm or > 4 mm increase in diameter of the common femoral or popliteal vein under compression in the transverse plane between two examinations. Limitations of these criteria include poor inter-observer agreement, non-availability of previous ultrasound reports and measurements, a high percentage of non-diagnostic ultrasound results, lack of power in diagnostic accuracy and diagnostic management studies, and lack of external validation. The analysis of venous obstruction, thrombus appearance, vein diameter and blood flow based on colour Doppler ultrasound criteria has not yet been validated in studies. Magnetic resonance direct thrombus imaging (MRDTI) is a new promising diagnostic imaging method, but is hardly accessible, costly and needs large scale validation studies. Based on this review, an update of the guidance for clinical practice is proposed for the diagnostic management of patients with clinically suspected lower limb DVT recurrence.

Upper limb lymphedema after breast cancer treatment including axillary dissection occurs in almost 20% of women. Its treatment consists of complete decongestive physiotherapy based on low-stretch bandage to reduce volume, followed by elastic compression to maintain it. In this article, we will detail recent data on lymphedema risk factors with possible genetic predisposition, prevention (surgical, compression), manual lymphatic drainage, physical activity, weight, advice, and treatments including gene therapy.

Behçet's disease is a systemic vasculitis of unknown origin. It mainly affects young men. Vascular involvement mainly affects the veins and may manifest as deep or superficial thrombosis. Arterial involvement is rare and serious. Arterial thrombosis or aneurysms/false aneurysms can be life threatening in case of rupture. All the arteries in the body can be affected, with widely varying frequencies. Involvement of the renal arteries is very rare. We report the case of a young patient followed for schizophrenia and known to have Behçet's disease, in whom a false aneurysm of the right renal artery was diagnosed during hematuria. He unfortunately refused any type of intervention.

Superficial vein thrombosis (SVT), a manifestation of venous thromboembolism (VTE), is a common condition, yet of all the types of VTE, it has been the least well studied. Recent studies have challenged the conception that SVT is a benign disease, showing that its risk factors overlap with those of deep-vein thrombosis (DVT) and that it is frequently associated with DVT or pulmonary embolism (PE). In 2010, the CALISTO trial demonstrated the benefit of treatment with fondaparinux at the dose of 2.5 mg (one injection per day) for 45 days for lower limb SVT. Prior to CALISTO, the treatment of SVT was based on venous compression therapy, nonsteroidal anti-inflammatory drugs (NSAID) and anticoagulation using various therapeutic regimens. Surgery could also be envisaged in certain cases. In CALISTO, the inclusion criteria designed to obtain a homogeneous population meant that numerous questions remained unanswered with respect to SVT occurring in other locations and under other circumstances, notably in pregnant women, patients with renal insufficiency, and patients with recurrent SVT or superficial vein thrombosis less than 5 cm long. The aim of this section is to review the current state of knowledge of SVT and to propose or recommend therapeutic strategies for the management of SVT according to the clinical context, the location of the thrombosis, and the presence of particular risk factors.

Several aspects of the management of post-thrombotic syndrome (PTS) are still a matter of debate, or not yet addressed in international guidelines. The objective of this expert consensus from the French Society of Vascular Medicine (SFMV) and the French Society of Cardiovascular Imaging (SFICV) was to define the main elements of diagnosis and treatment of this syndrome, and to develop a proposal for its preoperative, procedural and follow-up management. In this consensus, the following issues were addressed: clinical and ultrasound diagnosis; pre-procedural workup; indications and contraindications to venous recanalisation; procedures; clinical and duplex ultrasound reports; follow-up; long-term treatment; management of great saphenous vein incompetency; anticoagulant and antiplatelet therapy after venous stenting.

Background

Our study aimed to describe the clinical, paraclinical, therapeutic and outcomes of patients with venous thromboembolic event (VTE) associated with cancer in the context of limited resources.

Materials and methods

This was a descriptive cross-sectional study over a period of six years from March 1, 2016 to March 31, 2022, in the cardiology department and the oncology unit of the Sylvanus Olympio Teaching Hospital of Lome. Our study examined medical records of patients who were at least 18 years old and had venous thromboembolic disease and cancer that was histologically confirmed. This study did not include records that were incomplete or records from patients with coronavirus disease.

Results

Our study included 87 patients with average age of 56.36 ± 15.26 years. The discovery of VTE occurred incidentally in 28.74%. Venous thrombosis was isolated in 68.96% and proximal in 95%. Pulmonary embolism was bilateral in 77.77%. Gynaecological and urological cancers were found in 33.33% and 32.19% respectively. Adenocarcinoma was the histological type of cancer found in 47.13%. Cancers were at a very advanced stage in 74.71%. Treatment with antivitamin K was prescribed in 12.65%. In our study, there were 58 patients who passed away with a mortality rate of 66.66%. The cause of death was a complication of VTE in 22.42% and related to the course of cancer in 63.79% of cases.

Conclusion

VTE during cancer is particular with a fatal evolution due to the severity of VTE and the very advanced stage of cancer.