1
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Halleux D, Tchana-Sato V, Lavigne JP, Hans G, Lagny MG, Defraigne JO, Radermecker MA. [First report in the Liege province (Belgium) of a concomitant aortic and mitral valve surgery via a minimally invasive right latero-thoracic approach]. Rev Med Liege 2022; 77:500-504. [PMID: 36082595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Compared to median sternotomy, the potential benefits of minimally invasive single aortic or mitral valve surgery include reduction of blood loss, lower morbidity, and shorter intensive care unit and hospital length of stay. However, there are few reports regarding concomitant aortic and mitral valves minimally invasive surgery via mini-thoracotomy. To the authors knowledge, this is the first report in the Liege area, of a successful minimally invasive right latero-thoracic approach for aortic and mitral valve surgery in a 78-year old woman who presented severe and symptomatic aortic stenosis and mitral insufficiency. In addition to the description of the surgical approach, the authors will summarize the current literature on this approach, as well as the clinical evolution of the patient.
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Affiliation(s)
- D Halleux
- Service de Chirurgie cardiovasculaire, CHU Liège, Belgique
| | - V Tchana-Sato
- Service de Chirurgie cardiovasculaire, CHU Liège, Belgique
| | - J P Lavigne
- Service de Chirurgie cardiovasculaire, CHU Liège, Belgique
| | - G Hans
- Service d'Anesthésie, CHU Liège, Belgique
| | - M G Lagny
- Service de Chirurgie cardiovasculaire, CHU Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie cardiovasculaire, CHU Liège, Belgique
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2
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Ponte C, Kerzmann A, Defraigne JO. [Pulmonary artery percutaneous angioplasty for extrinsic compression induced by squamous cell carcinoma]. Rev Med Liege 2021; 76:592-594. [PMID: 34357709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pulmonary artery stenting is usually performed in congenital heart diseases and in cases of extrinsic compression due to a mediastinal tumor or fibrosis. We report one clinical case of a 61-year-old man treated by radiation and chemotherapy for T3N1M0 non-small cell lung carcinoma. He complained of disabling dyspnea. Pulmonary scintigraphy showed an absence of perfusion in the left lung. Chest computed tomography revealed a severe stenosis of the left pulmonary artery due to tumoral extrinsic compression. Under general anesthesia, we performed percutaneous angioplasty with self expandable nitinol stent. There was no peroperative complication. Dyspnea decreased immediately despite the natural course of the disease was not altered. Percutaneous stenting of pulmonary artery is safe and a feasible option for tumoral extrinsic compression. It is a palliative treatment but it can improve patient's quality of life.
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Affiliation(s)
- C Ponte
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
| | - A Kerzmann
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
| | - J O Defraigne
- Faculté de Médecine, ULiège; Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
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3
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Durieux R, Sakalihasan N, Defraigne JO. [Opportunistic screening for abdominal aortic aneurysm during echocardiography in patients with coronary artery disease: Utility or futility?]. Ann Cardiol Angeiol (Paris) 2021; 71:53-58. [PMID: 33640149 DOI: 10.1016/j.ancard.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Abdominal aortic aneurysm is a chronic degenerative disease that is usually silent until rupture occurs and this complication is still associated in contemporary era with a high rate of mortality. Screening programmes for abdominal aortic aneurysm have been shown to be effective in reducing global mortality in the screened population but these programmes are poorly implemented in the Western countries. As coronary artery disease and abdominal aorta aneurysmal disease share many risk factors, the cardiologist is centrally positioned in the screening strategy, not only to identify patients with higher risk of developing abdominal aortic aneurysm, but also to perform an opportunistic screening during echocardiography. This paper summarises evidence about the feasibility, indications, modalities, benefits and risks related to the opportunistic screening for abdominal aortic aneurysm during echocardiography with a particular emphasis on the population of patients with coronary artery disease.
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Affiliation(s)
- R Durieux
- Service de chirurgie cardio-vasculaire, CHU de Liège, domaine universitaire du Sart-Tilman, B35, 4000 Liège, Belgique.
| | - N Sakalihasan
- Service de chirurgie cardio-vasculaire, CHU de Liège, domaine universitaire du Sart-Tilman, B35, 4000 Liège, Belgique
| | - J O Defraigne
- Service de chirurgie cardio-vasculaire, CHU de Liège, domaine universitaire du Sart-Tilman, B35, 4000 Liège, Belgique
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4
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Kerzmann A, Boesmans E, Holemans C, Quaniers J, Alexandrescu V, Defraigne JO. [Endovascular treatment of femoropopliteal arterial occlusive disease]. Rev Med Liege 2020; 75:717-723. [PMID: 33155445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Endovascular treatment established itself last years as the first choice to treat femoropopliteal arterial occlusive disease. It is less invasive than the surgical approach. Endovascular techniques and devices evolution made it efficient. Use of retrograde puncture or re-entry catheters allows to recanalize more complex lesions. Vessel preparation of stenotic or occluded target lesion becomes an integral part of the therapy. Thanks to a lot of multicenter randomized controlled trials, drug eluting balloons took major place in the armamentarium we have, despite strong controversies last months about their safety. Conventional self-expandable stents with or without eluting drug, and vasculo-mimetic stents allow to treat very calcified lesions or dissected lesions through the recanalization procedure. This paper aims to review endovascular technical developments achieved last years to treat femoropopliteal arterial occlusive disease.
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Affiliation(s)
- A Kerzmann
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
| | - E Boesmans
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
| | - C Holemans
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
| | - J Quaniers
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
| | - V Alexandrescu
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
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5
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Holemans C, Quaniers J, Boesmans E, Kerzmann A, Honoré P, Defraigne JO. [Retroperitoneal cystic lymphangioma treated by sildenafil]. Rev Med Liege 2020; 75:541-543. [PMID: 32779908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cystic lymphangioma is a rare and benign lymphatic malformation found most often in the first two years of life. Clinical manifestations are diverse and depend on size and site of the lesion. The most frequently affected sites are cervicofacial and axillary areas. The retroperitoneal form is rare. Diagnosis requires imaging but can only be confirmed on the basis of an anatomopathological examination. The treatment of choice is complete surgical removal. However, this is not always feasible due to proximity of vital structures. Some alternative therapies like sclerotic injection and oral drugs like immunosuppressive treatment or sildenafil are described. We report the case of a 62-year-old patient with retroperitoneal cystic lymphangioma successfully treated with sildenafil.
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Affiliation(s)
- C Holemans
- Service de Chirurgie cardiovasculaire, CHU Liège, Belgique
| | - J Quaniers
- Service de Chirurgie cardiovasculaire, CHU Liège, Belgique
| | - E Boesmans
- Service de Chirurgie cardiovasculaire, CHU Liège, Belgique
| | - A Kerzmann
- Service de Chirurgie cardiovasculaire, CHU Liège, Belgique
| | - P Honoré
- Service de Chirurgie abdominale, CHU Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie cardiovasculaire, CHU Liège, Belgique
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6
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Bru Ls S, Kerzmann A, Durieux R, Quaniers J, Tchana-Sato V, Lavigne JP, Sakalihasan N, Radermecker MA, Desiron Q, Szecel D, Holemans C, Boesmans E, Defraigne JO. [The opportunities of the minimally invasive approach for the cardiovascular and thoracic surgery]. Rev Med Liege 2020; 75:292-299. [PMID: 32496669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There is a continuous growth in the incidence of cardiovascular and thoracic diseases, especially related to the increased life expectancy. Moreover, the quality and efficacy of care for these pathologies are progressing constantly. The evolution of surgery prompts us to develop less aggressive (minimally invasive), although technically more complex, treatment or diagnostic techniques. Pathologies, which until now required heavy surgeries, are managed today in a less invasive way and become therefore accessible to patients even if they are older or in a poor general condition. In this article, we present our experience in the development of the minimal invasive procedures in cardiovascular and thoracic surgery.
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Affiliation(s)
- S Bru Ls
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - A Kerzmann
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - R Durieux
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - J Quaniers
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - V Tchana-Sato
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - J P Lavigne
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - M A Radermecker
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - Q Desiron
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - D Szecel
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - C Holemans
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - E Boesmans
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
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7
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Brüls S, Tchana-Sato V, Lavigne JP, Durieux R, Sakalihasan N, Radermecker MA, Désiron Q, Creemers E, D'Orio V, Nelessen E, D'Orio V, Ancion A, Lancellotti P, Hans G, Lagny M, Blaffart F, Defraigne JO. [Heart transplantation, indications and results at the University Hospital of Liege]. Rev Med Liege 2020; 75:29-36. [PMID: 31920041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Heart transplantation remains undoubtedly the most effective treatment for end-stage heart failure, whatever its cause. Last decade has witnessed significant improvements in terms of morbidity and mortality following heart transplant. The 5-year survival rate is now beyond 70 %. However, the shortage of potential donors limits its use and requires strict criteria before listing a candidate for heart transplantation. Herein, we present a review of current indications and results of the heart transplantation program at the University hospital of Liège.
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Affiliation(s)
- S Brüls
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - V Tchana-Sato
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - J P Lavigne
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - R Durieux
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - M A Radermecker
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - Q Désiron
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - E Creemers
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - V D'Orio
- Service de Cardiologie, CHU Liège, Belgique
| | - E Nelessen
- Service de Cardiologie CHPLT, Verviers, Belgique
| | - V D'Orio
- Service de Cardiologie, CHU Liège, Belgique
| | - A Ancion
- Service de Cardiologie, CHU Liège, Belgique
| | | | - G Hans
- Service d'Anesthésie-Réanimation, CHU Liège, Belgique
| | - M Lagny
- Secteur perfusion, CHU Liège, Belgique
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8
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Brüls S, Lavigne JP, Durieux R, Tchana-Sato V, Radermecker MA, Desiron Q, Defraigne JO. [Minimally invasive aortic valve replacement through right anterior minithoracotomy: early experience at the University Hospital of Liege]. Rev Med Liege 2019; 74:637-641. [PMID: 31833273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aortic valve replacement is nowadays a safe procedure with low morbidity and mortality. However, the evolution of surgery requires the development of less invasive techniques. Aortic valve replacement through a right mini-thoracotomy, technically more complicated, offers a lower rate of complications including less postoperative pain and less blood loss and transfusion, with a faster recovery. We report our early experience of aortic valve replacement through a right anterior mini-thoracotomy.
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Affiliation(s)
- S Brüls
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - J P Lavigne
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - R Durieux
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - V Tchana-Sato
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - M A Radermecker
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - Q Desiron
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
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9
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Radermecker A, Stiennon L, Leroux A, Sooknunden M, Duysinx B, Guiot J, Davin L, Sakalihasan N, Radermecker MA, Defraigne JO. [Giant pulmonary artery aneurysms. Case report and proposal of management algorithm]. Rev Med Liege 2019; 74:90-94. [PMID: 30793562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Pulmonary artery aneurysm is a rare and multiform pathology related to multiple etiologies and therefore different pathophysiological mechanisms. Delineating homogenous sub-groups is a pre-requisite to refine medico-surgical management. The case of a giant PAA without pulmonary hypertension but associated to a dysplastic pulmonary valve is reported. This association could be in some instances the result of a congenital anomaly in the development of both the pulmonary valve and the root creating the conditions for further development of a pulmonary artery aneurysm. Whilst minor forms are usually asymptomatic, they can lead to lethal complications in huge sizes and are frequently associated via pulmonary valve insufficiency to right ventricular dysfunction. This specific association is discussed and a diagnostic algorithm for nosologic classification and management is proposed.
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Affiliation(s)
- A Radermecker
- Service de Chirurgie cardio-vasculaire et thoracique, CHU Liège, Belgique
| | - L Stiennon
- Service de Chirurgie cardio-vasculaire et thoracique, CHU Liège, Belgique
| | - A Leroux
- Service de Chirurgie, UCL Mont-Godinne, Belgique
| | - M Sooknunden
- Service de Chirurgie cardio-vasculaire et thoracique, CHU Liège, Belgique
| | - B Duysinx
- Service de Pneumologie, CHU Liège, Belgique
| | - J Guiot
- Service de Pneumologie Allergologie, CHU Liège, Belgique
| | - L Davin
- Service de Cardiologie, CHU Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie cardio-vasculaire et thoracique, CHU Liège, Belgique
| | - M A Radermecker
- Service de Chirurgie cardiovasculaire et Département d'Anatomie humaine, CHU-Uliège, Belgique
| | - J O Defraigne
- Service de Chirurgie cardio-vasculaire et thoracique, CHU Liège, Belgique
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10
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Kaux JF, Janssen L, Drion P, Nusgens B, Libertiaux V, Pascon F, Heyeres A, Hoffmann A, Lambert C, Le Goff C, Denoël V, Defraigne JO, Rickert M, Crielaard JM, Colige A. Vascular Endothelial Growth Factor-111 (VEGF-111) and tendon healing: preliminary results in a rat model of tendon injury. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2014.05] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J.-F. Kaux
- Physical Medicine Service, Department of Motility Sciences, University and University Hospital of Liège, Belgium
| | - L. Janssen
- Culture and Therapy Unit, Assistance Publique des Hôpitaux de Marseille, France
| | - P. Drion
- Culture and Therapy Unit, Assistance Publique des Hôpitaux de Marseille, France
| | - B. Nusgens
- Laboratory of Connective Tissues Biology, GIGA-R, University of Liège, Belgium
| | | | - F. Pascon
- Department ARGENCO, University of Liège, Belgium
| | - A. Heyeres
- Laboratory of Connective Tissues Biology, GIGA-R, University of Liège, Belgium
| | - A. Hoffmann
- Laboratory of Connective Tissues Biology, GIGA-R, University of Liège, Belgium
| | - C. Lambert
- Laboratory of Connective Tissues Biology, GIGA-R, University of Liège, Belgium
| | - C. Le Goff
- Department of Clinical Biology, University and University Hospital of Liège, Belgium
| | - V. Denoël
- Department ARGENCO, University of Liège, Belgium
| | - J.-O. Defraigne
- CREDEC, Laboratory of Experimental Surgery, University of Liège, Belgium
| | - M. Rickert
- Department of Orthopaedic Surgery, University of Giessen, Germany
| | - J.-M. Crielaard
- Physical Medicine Service, Department of Motility Sciences, University and University Hospital of Liège, Belgium
| | - A. Colige
- Animal Facility of University Hospital of Liège, ULg-GIGA-R, University of Liège, Belgium
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11
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Paolucci M, Van Damme H, Boesmans E, Desiron Q, Defraigne JO. [Type A intramural hematoma of aorta: An undervalued clinical entity]. J Med Vasc 2018; 43:206-212. [PMID: 29754731 DOI: 10.1016/j.jdmv.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
Abstract
Intramural hematoma of the ascending aorta occurs after rupture of the vasa vasorum. Previously considered as a first step of acute aortic dissection, it was later defined as a separate entity that may or may not lead to arterial dissection. The debate about the most appropriate treatment for a 69-year-old patient with intramural hematoma of the ascending aorta, led to this extensive review of the literature demonstrating that intramural hematoma type A is a life-threatening condition requiring urgent surgical support.
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Affiliation(s)
- M Paolucci
- Service de chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, avenue de L'Hôpital 1, 4000 Liège, Belgique
| | - H Van Damme
- Service de chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, avenue de L'Hôpital 1, 4000 Liège, Belgique.
| | - E Boesmans
- Service de chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, avenue de L'Hôpital 1, 4000 Liège, Belgique
| | - Q Desiron
- Service de chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, avenue de L'Hôpital 1, 4000 Liège, Belgique
| | - J O Defraigne
- Service de chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, avenue de L'Hôpital 1, 4000 Liège, Belgique
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12
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Kerzmann A, Haumann A, Boesmans E, Detry O, Defraigne JO. [Acute mesenteric ischemia]. Rev Med Liege 2018; 73:300-303. [PMID: 29926570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Acute mesenteric ischemia is a real life-threatening emergency. Mode of presentation is severe abdominal pain with sudden onset. The etiology is most of the time embolus coming from the heart or thrombosis of atherosclerotic vessel wall concerning the superior mesenteric artery. The best investigation is computed tomography with intravenous contrast media injection. Treatment consists of revascularization by open surgery or endovascular approach. Bowel resection may be necessary, as well as delayed second look surgery. This paper aims to review etiologies and therapeutics options for acute mesenteric ischemia.
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Affiliation(s)
- A Kerzmann
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sart Tilman, Liège, Belgique
| | - A Haumann
- Service de Chirurgie Abdominale et de Transplantation, CHU Sart Tilman, Liège, Belgique
| | - E Boesmans
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sart Tilman, Liège, Belgique
| | - O Detry
- Service de Chirurgie Abdominale et de Transplantation, CHU Sart Tilman, Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sart Tilman, Liège, Belgique
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13
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Tchana-Sato V, Sakalihasan N, Defraigne JO. [Ruptured abdominal aortic aneurysm]. Rev Med Liege 2018; 73:296-299. [PMID: 29926569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ruptured abdominal aortic aneurysm is a cardiovascular emergency associated with a 30 day mortality as high as 70 %. However, recent progresses in the management of these patients have improved the results. From a surgical point of view, endovascular methods such as balloon occlusion and endovascular repair (EVAR) in patients with suitable anatomy are recommended in order to reduce mortality.
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Affiliation(s)
- V Tchana-Sato
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
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14
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Tchana-Sato V, Sakalihasan N, Defraigne JO. [Aortic dissection]. Rev Med Liege 2018; 73:290-295. [PMID: 29926568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aortic dissection is a life-threatening condition due to a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of the different layers of the aortic wall. Among the risk factors, age, hypertension, dyslipidemia and genetic disorders of the connective tissue have been identified. A prompt diagnosis and an adequate treatment are important in the management of affected patients. The type of treatment depends on the location and extension of the dissection. Open surgical repair is most commonly used for dissections involving the ascending aorta and the aortic arch, whereas endovascular intervention is indicated for descending aorta dissections that are complicated. In this paper, we will review the epidemiology, and physiopathology of aortic dissection and describe the appropriate management for each type of dissection (open surgery, endovascular or medical treatment).
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Affiliation(s)
- V Tchana-Sato
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
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15
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Scheen AJ, Lancellotti P, Defraigne JO, D'Orio V. [Cardiac and vascular emergencies: from diagnosis to treatment]. Rev Med Liege 2018; 73:221-223. [PMID: 29926558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- A J Scheen
- Service de Diabétologie, Nutrition et Maladies métaboliques et Unité de Pharmacologie clinique, CHU Sart Tilman, Liège, Belgique
| | - P Lancellotti
- Service de Cardiologie, CHU Sart Tilman, Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie cardiovasculaire, CHU Sart Tilman, Liège, Belgique
| | - V D'Orio
- Service des Urgences, CHU Sart Tilman, Liège, Belgique
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16
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Van DH, Boesmans E, Defraigne JO. [Acute limb ischemia]. Rev Med Liege 2018; 73:304-311. [PMID: 29926571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite major advances in the contemporary management of peripheral arterial occlusive disease, acute ischemia of the lower limb is still characterized by an important morbidity, limb threat, and mortality, and continues to pose a challenge to the vascular surgeon. Ageing of the population increases the prevalence of acute lower limb ischemia. The two principal etiologies of acute ischemia of the lower limbs are arterial embolism and in situ thrombosis of an atherosclerotic artery or of a bypass graft. Popliteal aneurysm thrombosis and vascular trauma are less common causes of severe limb ischemia. Prompt recognition and treatment of acute limb ischemia in an urgent setting are crucial, in order to shorten as much as possible the duration of the ischemia. This paper highlights diagnostic work-up (staging of the severity of ischemia) and appropriate management of acute ischemia of the lower limb. Different procedures of revascularization (operative clot removal, catheter-directed thrombolysis, bypass grafting are evaluated and their outcome results are compared.
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Affiliation(s)
- Damme H Van
- Service de Chirurgie Cardiovasculaire, CHU Sart Tilman, Liège, Belgique
| | - E Boesmans
- Service de Chirurgie Cardiovasculaire, CHU Sart Tilman, Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie Cardiovasculaire, CHU Sart Tilman, Liège, Belgique
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17
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Minga Lowampa E, Holemans C, Stiennon L, Van Damme H, Defraigne J. Late Fate of Cryopreserved Arterial Allografts. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Minga Lowampa E, Holemans C, Stiennon L, Van Damme H, Defraigne JO. Late Fate of Cryopreserved Arterial Allografts. Eur J Vasc Endovasc Surg 2016; 52:696-702. [PMID: 27614553 DOI: 10.1016/j.ejvs.2016.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Initial enthusiasm for use of cryopreserved arterial allografts was subsequently tempered by suboptimal long-term outcome. Thrombosis, anastomotic pseudo-aneurysm, allograft disruption, aneurysmal degeneration, recurrent intestinal fistulization, and persistent infection are commonly reported in series with long-term follow-up. The authors reviewed their experience over the past 15 years with the use of cryopreserved arterial allografts as a vascular substitute for vascular prosthetic infection or for primary arterial infection, to investigate allograft-related complications. MATERIAL AND METHODS A retrospective analysis of prospectively collected data was conducted for 103 cryopreserved arterial allografts inserted in 96 patients between July 2000 and July 2015. There were 78 patients with infected vascular prosthesis (IVP), nine patients with an aorto-enteric fistula (AEF), and nine patients with primary arterial infection (PAI). RESULTS The in-hospital mortality was eight out of 78 (9%) IVP patients, three out of nine AEF patients, and zero out of nine PAI patients. Median follow-up was 49 months. Allograft-related re-interventions were necessary in 29% of the patients with IVP and four of the patients with AEF, but none of the patients with PAI. Five-year survival for the IVP, AEF, and PAI patients was 53%, 44%, and 90%, respectively. CONCLUSION This series highlights some shortcomings of cryopreserved arterial allografts in the long term, including suboptimal outcome-results and shortage of material. The authors discuss the allograft-related complications and suggest some tricks to minimize their risk.
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Affiliation(s)
- E Minga Lowampa
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | - Ch Holemans
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | - L Stiennon
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | - H Van Damme
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium.
| | - J O Defraigne
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
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19
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Abstract
Aortic aneurysm rupture in a kidney transplant patient was successfully managed by implantation of an axillary-femoral bypass graft prior to aortic aneurysmectomy. Renal function remained intact during and after the proce dure.
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Affiliation(s)
- J.O. Defraigne
- Department of Cardio-Vascular Surgery, University of Liège, Liège, Belgium
| | - R. Limet
- Department of Cardio-Vascular Surgery, University of Liège, Liège, Belgium
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20
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Bruis S, Radermecker M, Creemers E, Bonnet P, Nellessen E, Van Damme H, De Leval L, Defraigne J. Surgical Treatment of Cardiovascular Complications in Patients with Marfan Syndrome: a Report of two Cases and Literature Review. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2012.11680826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S. Bruis
- Departments of Cardiovascular Surgery, University Hospital of Liège, Liège, Belgium
| | - M.A. Radermecker
- Departments of Human anatomy, University Hospital of Liège, Liège, Belgium
| | - E. Creemers
- Departments of Cardiovascular Surgery, University Hospital of Liège, Liège, Belgium
| | - P. Bonnet
- Departments of Human anatomy, University Hospital of Liège, Liège, Belgium
| | - E. Nellessen
- Departments of Cardiology and “Pathology, University Hospital of Liège, Liège, Belgium
| | - H. Van Damme
- Departments of Cardiovascular Surgery, University Hospital of Liège, Liège, Belgium
| | - L. De Leval
- Departments of Cardiovascular Surgery, University Hospital of Liège, Liège, Belgium
| | - J.O. Defraigne
- Departments of Cardiovascular Surgery, University Hospital of Liège, Liège, Belgium
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21
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Brüls S, Goffin P, Sakalihasan N, Bonnet P, Defraigne JO. [TRAUMATIC RUPTURE OF THE AORTIC ISTHMUS: MODERN PERSPECTIVES]. Rev Med Liege 2015; 70:415-422. [PMID: 26638441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Traumatic aortic rupture of the thoracic aorta (usually at the isthmus) is frequently associated with concomitant life-threatening injuries. Historically, the conventional care consisted of surgical repair of the lesion performed as soon as possible. However, in spite of constant technical improvements the morbi-mortality remains high because of these associated lesions. In addition, their management can have priority and delay aortic surgery. The endovascular approach has been shown to be a feasible and efficient technique and currently represents a valuable alternative to open surgery for patients with multiple traumas. We report a patient presenting with a traumatic aortic rupture of the aortic isthmus, which was successfully treated by delayed combined endovascular (thoracic aortic stentgrafting) and open approach (hemiaortic arch debranching).
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22
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Ouhadi L, Creemers E, Honoré P, Delwaide J, Marchetta S, Defraigne JO. [Budd-Chiari syndrome: a case report and review of the literature]. Rev Med Liege 2015; 70:378-383. [PMID: 26376565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report the history of a 20-year-old woman admitted for thrombosis of the sus-hepatic veins and of the inferior vena cava (IVC) with extension of the thrombus into the right atrium. The etiological research was negative and a diagnosis of idiopathic Budd-Chiari syndrome was retained. In view of the absence of vein repermeabilisation under adequate anticoagulant therapy, a venous thrombectomiy was performed under cardiopulmonary bypass, which improved the hepatic venous drainage. Budd-Chiari syndrome is a very serious disorder. Its treatment implies a step by step procedure. An effective anticoagulation must first be established. The complications of portal hypertension then require attention. For a symptomatic patient, one should assess the possibility of restoring the venous permeability, improving the hepatic drainage and decompressing the liver by radiological interventional or surgical procedures. Finally, an hepatic transplantation should be considered in case of treatment ineffectiveness, of fulminant hepatic failure, or of an evolution towards cirrhosis.
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23
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Grégoire C, Nellessen E, Defraigne JO, Radermecker MA. [The ideal valvular prosthesis is still to come. Which factors can help decide between mechanical and bioprosthetic heart valve replacement?]. Rev Med Liege 2014; 69:600-604. [PMID: 25796772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The prevalence of valvular heart diseases reaches 2.5% in the overall population. Aortic valve replacement is one of the most common surgical procedures. We report the story of a female patient whose aortic mechanical valve, implanted at the age of 54 years at the time of a mitral valve repair surgery, had to be replaced 14 years later, due to the development of a subvalvular pannus narrowing the valvular orifice. We use this clinical story to compare the advantages and disadvantages of repair surgery and valve replacement with a biological or mechanical prosthesis, and summarize the latest evidence for the choice of the most adequate prosthesis for a particular patient's profile.
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Van Leeuw R, Kevers C, Pincemail J, Defraigne J, Dommes J. Antioxidant capacity and phenolic composition of red wines from various grape varieties: Specificity of Pinot Noir. J Food Compost Anal 2014. [DOI: 10.1016/j.jfca.2014.07.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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25
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Pincemail J, Ricour C, Petermans J, Defraigne J. IS1.10: Anti-oxidants. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Pincemail J, Ricour C, Defraigne JO, Petermans J. [Oxidative stress, antioxydants and the ageing process]. Rev Med Liege 2014; 69:270-275. [PMID: 25065231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Antioxidant supplementation in the form of pills is thought to slow down the aging process through the "free radical" scavenger activity of these compounds. The idea arose from the "Free Radical Theory of Ageing" (FRTA), initially developed by Harman in 1956. In the present paper, we present some arguments against this theory. One of the most pertinent is that "free radicals", more properly renamed as reactive oxygen species (ROS), play important biological roles in defense mechanisms of the organism as illustrated, in particular, by the hormesis phenomenon. Surprisingly, a moderate production of ROS has been shown to extend the life span in animals.
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Allepaerts S, Massin Y, Blaffart F, Pincemail J, Defraigne JO, Petermans JP. Factors likely to contribute to postoperative delirium: The cascade study, confusion after surgical cardiac intervention developed. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Verdin V, Holemans C, Otto B, Van Damme H, Defraigne JO. [Horner's syndrome revealing a spontaneous carotid artery dissection]. Rev Med Liege 2013; 68:11-15. [PMID: 23444822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report a case of spontaneous carotid artery dissection suspected by the appearance of Horner's syndrome. Under medical treatment, the intramural hematoma resolved within 3 months. The patient had an uneventful recovery, without any residual neurologic deficit. Spontaneous arterial dissection is responsible for a hematoma in the arterial wall without significant trauma. The pathogenesis remains unknown. Predisposing factors seem to exist. The clinical presentation is variable mainly due to local compression of adjacent structures which can precede a transient or permanent neurological deficit. The diagnosis is confirmed by Doppler US, CT angiography or magnetic resonance angiography, the best optional investigations. The treatment mainly consists of stroke prevention by anticoagulation versus antiplatelet therapy. The role of surgery and/or endovascular techniques has not yet been confirmed.
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Affiliation(s)
- V Verdin
- Service de Neuro-Radiologie, CHU de Liège, Belgique
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29
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Erpicum M, Blaffart F, Defraigne JO, Larbuisson R. [Blood conservation strategy: a current issue]. Rev Med Liege 2012; 67:593-596. [PMID: 23346830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In view of the demographic evolution, the progress of quality requirements and the shortage of donors, a deficiency of blood components is to be feared in the coming years. This implies the development of a blood conservation strategy, the revision of transfusion practices and the implementation of preventive measures to limit transfusion requirements. Each service caring for patients at high transfusion risk should assess and rationalize its transfusion practices in a structured multidisciplinary way.
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Affiliation(s)
- M Erpicum
- Service de Chirurgie cardiovasculaire et thoracique, CHU de Liège, Belgique
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30
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Holemans C, Van Damme H, Defraigne JO. [Should asymptomatic small popliteal artery aneurysms be operated on?]. Rev Med Liege 2012; 67:576-581. [PMID: 23346827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The authors recently observed two patients who suffered acute lower limb ischemia secondary to thrombosis of a small (diameter of less than 2 cm) popliteal artery aneurysm. A literature search lead to the conclusion that small popliteal aneurysms, covered with mural thrombus and presenting a distorted neck due to elongation, are prone to thrombosis. Another risk factor is a restrained outflow bed as a result of previous micro-embolisations into the tibial arteries. The authors conclude that small popliteal artery aneurysms are not so innocent as is often presumed.
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Affiliation(s)
- Ch Holemans
- Service de Chirurgie Cardio-vasculaire et Thoracique, CHU de Liège, Belgique
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31
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Petermans J, Mathieu S, Pincemail J, Seidel L, Defraigne J. Are there particular clinical and biological parameters that characterize nonagenarian patients hospitalized in geriatrics units (G.U.)? Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Pincemail J, Defraigne JO, Cheramy-Bien JP, Dardenne N, Donneau AF, Albert A, Labropoulos N, Sakalihasan N. On the potential increase of the oxidative stress status in patients with abdominal aortic aneurysm. Redox Rep 2012; 17:139-44. [PMID: 22732574 DOI: 10.1179/1351000212y.0000000012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a major cause of preventable deaths in older patients. Oxidative stress has been suggested to play a key role in the pathogenesis of AAA. However, only few studies have been conducted to evaluate the blood oxidative stress status of AAA patients. METHODS AND RESULTS Twenty seven AAA patients (mean age of 70 years) divided into two groups according to AAA size (≤ 50 or > 50 mm) were compared with an age-matched group of 18 healthy subjects. Antioxidants (vitamins C and E, β-carotene, glutathione, thiols, and ubiquinone), trace elements (selenium, copper, zinc, and copper/zinc ratio) and markers of oxidative damage to lipids (lipid peroxides, antibodies against oxidized patients, and isoprostanes) were measured in each subject. The comparison of the three groups by ordinal logistic regression showed a significant decrease of the plasma levels of vitamin C (P = 0.011), α-tocopherol (P = 0.016) but not when corrected for cholesterol values, β-carotene (P = 0.0096), ubiquinone (P = 0.014), zinc (P = 0.0035), and of selenium (P = 0.0038), as AAA size increased. By contrast, specific markers of lipid peroxidation such as the Cu/Zn ratio (P = 0.046) and to a lesser extent isoprostanes (P = 0.052) increased. CONCLUSION The present study emphasizes the potential role of the oxidative stress in AAA disease and suggests that an antioxidant therapy could be of interest to delay AAA progression.
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Affiliation(s)
- J Pincemail
- Department of Cardiovascular Surgery, University of Liège, CHU Sart Tilman, Liège, Belgium.
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33
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Bruls S, Radermecker MA, Creemers E, Bonnet P, Nellessen E, Van Damme H, De Leval L, Defraigne JO. Surgical treatment of cardiovascular complications in patients with Marfan syndrome: a report of two cases and literature review. Acta Chir Belg 2012; 112:213-218. [PMID: 22808762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. The most life threatening complication is aortic root aneurysms leading to aortic dissection or rupture. It can be prevented by regular aortic follow-up and prophylactic aortic surgery. Modern aortic surgery has led to a substantial increase in the life expectancy of these patients. We report two cases of Marfan syndrome with cardiovascular complications. Their management is discussed according to the most recent literature.
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Affiliation(s)
- S Bruls
- Department of Cardiovascular Surgery, University Hospital of Liège, Belgium
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Bruls S, Quaniers J, Tromme P, Lavigne JP, Van Damme H, Defraigne J. Comparison of laparoscopic and open aortobifemoral bypass in the treatment of aortoiliac disease. Results of a contemporary series (2003-2009). Acta Chir Belg 2012; 112:51-8. [PMID: 22442910 DOI: 10.1080/00015458.2012.11680795] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The study objective was to describe and evaluate our single center (University Hospital Liège) experience with totally laparoscopic bypass surgery compared with conventional open surgery to treat aortoiliac occlusive disease. MATERIAL AND METHODS A retrospective database review of all patients undergoing aortobifemoral bypass for aortoiliac occlusive disease in our center, between 2003 and 2009, was performed. During this period, a total of 251 consecutive patients were identified. Among these patients, 95 underwent totally laparoscopic aortobifemoral bypass (group I) and 156 conventional open surgery (group II). Demographic data, operative data, postoperative recovery data, complications, two-year follow-up, morbidity and mortality were analysed according to the laparoscopic and conventional open group. RESULTS Patients included 160 men and 91 women. The mean age was 61 years (range, 40 to 88 years) in both groups. Indications for surgery were invalidating claudication in 87%, rest pain in 7%, trophic disorders in 5%, impotence in 1.6% and digestive claudication in 1.2%. Prior to bypass surgery, 11 (11.6%) for the group I and 41 (26.3%) for the group II had undergone one or more abdominal surgical procedures. A transperitoneal and retrocolic approach was preferred in all laparoscopic procedures. Laparoscopic aortobifemoral bypass (LABF) required an operative time of 242 minutes (range, 129 to 465) and open aortobifemoral bypass (OABF), 200 minutes (range, 105 to 430). The mean aortic cross clamping time was 62 minutes in group I and 33 minutes in group II. Mean blood loss was more important in group II (1010 ml) than in group I (682 ml). The average length of hospital stay was 8.1 days for LABF compared with an average of 12 days for OABF. In 21 cases (20%) conversion to open surgery was necessary in the laparoscopic group. Systemic morbidity was significantly higher in the OABF group. Thirty-day postoperative mortality was 2% for group II. There was no hospital mortality in the laparoscopic group. Twenty nine patients were lost to follow-up and the mean follow-up was 23.5 months. CONCLUSION Analysis of the results shows that laparoscopic aortobifemoral bypass for aortoiliac occlusive disease is a safe procedure. The statistically significant advantages observed in the majority of our patients were decreased blood loss, faster post-operative recovery and shorter hospital stay. In the two groups, late morbidity attributable to the bypass prosthesis was minimal compared with other causes.
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Affiliation(s)
- S. Bruls
- Department of Cardio-Vascular and Thoracic surgery, University Hospital, Liège, Belgium
| | - J. Quaniers
- Department of Cardio-Vascular and Thoracic surgery, University Hospital, Liège, Belgium
| | - P. Tromme
- Department of Cardio-Vascular and Thoracic surgery, University Hospital, Liège, Belgium
| | - J.-P. Lavigne
- Department of Cardio-Vascular and Thoracic surgery, University Hospital, Liège, Belgium
| | - H. Van Damme
- Department of Cardio-Vascular and Thoracic surgery, University Hospital, Liège, Belgium
| | - J.O. Defraigne
- Department of Cardio-Vascular and Thoracic surgery, University Hospital, Liège, Belgium
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35
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Johnen J, Radermecker MA, Defraigne JO. [Constrictive pericarditis: case report and review]. Rev Med Liege 2012; 67:107-112. [PMID: 22611825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Constrictive pericarditis (CP) is a common disease with difficult diagnosis. We report a well-documented case of CP with extended pericardial calcification treated by total pericardiectomy. A brief review of symptoms and signs of CP is presented, as well as additional examination allowing the diagnosis to be confirmed. The differential diagnosis with restictive cardiomyopathy is also discussed.
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36
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Péters P, Defraigne JO, Gothot A. [Oral anticoagulants: new horizons]. Rev Med Liege 2012; 67 Spec No:37-44. [PMID: 22690484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Anticoagulation is at the dawn of a new era. Dominated for a long time by heparins and vitamin K antagonists, the anticoagulant arsenal is growing up. With a direct and reversible action targeting specifically thrombin (IIa) or factor Xa, these new synthetic agents, given orally, have large therapeutic windows and predictable pharmacokinetics. Their properties allow them to avoid tight monitoring improving patient comfort and security. Pharmacological studies are promising. Regarding some indications, these new drugs seem better than "classical" anticoagulants either in efficacy or in security terms. However, they increase the hemorrhagic risk and particularly in fragile populations like elderly patients or with renal insufficiency. Only few assays are available in the laboratory to evaluate their effects and no antidote is currently on the market. The way to new anticoagulant therapies is now open. In the future, specific indications of vitamin K antagonists, heparins and these new molecules will have to be determined.
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Affiliation(s)
- P Péters
- Service d'Hématologie et d'Immunohématologie, CHU de Liège,Belgique.
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37
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Abstract
UNLABELLED Some controversy exists on the best moment to treat symptomatic carotid artery disease. This controversy concerns mainly neurologically unstable patients and patients who suffered a minor stroke. The authors discuss recent literature data on the feasibility and the safety of performing urgent (within 24 to 72 hours) carotid endarterectomy (CEA) in patients presenting repetitive transient ischaemic attacks or progressing stroke. Neurologically unstable patients, suffering ischemic brain deficit caused by carotid artery stenosis, are defined according to the following criteria: two or more transient ischaemic attacks (crescendo TIAs) or a fluctuating neurological deficit evolving no longer than 24 hours (progressing stroke), no impairment of consciousness, cerebral infarct of limited size on diffusion-weighted magnetic resonance imaging of the brain and a carotid artery stenosis of 70% or more on the appropriate side. In the past, these patients were often considered at too high risk to undergo immediate carotid surgery. Many neurologists remain reluctant to confine these neurologically unstable patients for urgent carotid endarterectomy and prefer to stabilise the neurological status, arguing the increased stroke morbidity in the urgent setting. Nevertheless, the natural history of stroke- in-evolution or repetitive transient ischemic attacks is far from benign, exposing the patient to a high risk of subsequent spontaneous stroke, even under best medical treatment. Another controversy exists on the timing of surgery in patients who suffered a minor, non-disabling stroke. Is a waiting period of 6 weeks safe? Once more, the operative risk should be balanced against the anticipated natural history. Published series, and sub-analysis of the recent carotid surgery trials (NASCET, ECST) plaid for carotid surgery within two weeks of a minor stroke. CONCLUSIONS Contemporary literature argues that neurologically unstable patients, presenting repetitive transient ischaemic attacks or progressing stroke, should be managed by urgent (within 24 to 72 hours) carotid endarterectomy, even if the peri-operative stroke-death rate is slightly higher than in the elective setting. Despite an inherent increased operative morbidity-mortality, urgent carotid endarterectomy seems to us justified by the fact that waiting for the surgery may lead to the development of a more profound stroke in these neurologically unstable patients. Their only chance for neurological recovery (partial or complete) is in the early phase (12 to 60 hours after the acute onset of the neurological syndrome of crescendo-TIAs or stroke-in-evolution). For patients presenting a minor stroke, with limited brain infarction, carotid endarterectomy should preferentially be done in a semi-urgent fashion, within two weeks.
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Affiliation(s)
- S. Bruls
- Departement of Cardio-Vascular Surgery, University Hospital Liège
| | - H. Van Damme
- Departement of Cardio-Vascular Surgery, University Hospital Liège
| | - J.-O. Defraigne
- Departement of Cardio-Vascular Surgery, University Hospital Liège
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38
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Bruls S, Creemers E, Trotteur G, Firket L, Chauveau R, Magotteaux P, Desiron Q, Defraigne JO. [Endoleak, a specific complication of the endovascular treatment of aortic aneurysms]. Rev Med Liege 2011; 66:559-563. [PMID: 22216727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Endoleaks represent the most common complication of endovascular aortic aneurysm repair. With the increasing use of endovascular techniques for aortic aneurysm repair, the prevalence of endoleaks has risen. While maintaining pressurization of the aneurysm sac, endoleaks expose to persistent risks of an evolution towards rupture. Long-term surveillance with imaging studies is necessary to reduce the incidence of these specific complications that may require intervention. The objective of this article is to draw the attention to the possible occurrence of these complications and to report the elements of diagnosis and treatment.
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Affiliation(s)
- S Bruls
- Service de Chirurgie Cardio-vasculaire et Thoracique, CHU de Liège, Belgique
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Kaux J, Dion P, Colige A, Pascon F, Libertiaux V, Le Goff C, Gothot A, Cescotto S, Defraigne J, Rickert M, Crielaard J. Platelet-rich plasma and tendon healing: Rat model. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kaux JF, Dion P, Colige A, Pascon MF, Libertiaux MV, Le Goff C, Gothot A, Cescotto S, Defraigne JO, Rickert M, Crielaard JM. Plasma enrichi en plaquettes et cicatrisation tendineuse : modèle sur rats. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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41
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Erpicum M, Radermecker M, Defraigne J, Legrand V. P180 Poster Nursing care after Transcatheter Aortic Valve Implantation with the Medtronic CoreValve Revalving system. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-51511160125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - V. Legrand
- University Hospital of Liege, Liege, Belgium
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Figiel S, de Leval L, Rousié C, Duysinx B, Louis R, Defraigne JO, Radermecker M. [Clinical case of the month. The "classic" triad presentation of mucinous bronchiolo-alveolar carcinoma]. Rev Med Liege 2010; 65:611-614. [PMID: 21189525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The case of a 59-year-old female complaining of cough of recent onset, abundant salty expectoration and lung condensation is presented. This "triad" constitutes a rare but nearly pathognomonic presentation of mucinous bronchioloalveolar carcinoma (BAC) of the lung.
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Affiliation(s)
- S Figiel
- Service de Chirurgie Cardio-Vasculaire, Université de Liège, Belgique.
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Bruls S, Goffin P, Creemers E, Trotteur G, Joskin J, Bonnet P, Defraigne JO. [Image of the month. Discovery of a post-traumatic aortic isthmus pseudoaneurysm 15 years after a traffic accident]. Rev Med Liege 2010; 65:603-605. [PMID: 21189523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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44
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Blaffart F, Defraigne JO. Gestion de la volémie durant la circulation extracorporelle en chirurgie cardiaque. Ing Rech Biomed 2010. [DOI: 10.1016/s1959-0318(10)70005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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Van Damme H, Defraigne J. Do we need a new carotid artery stenting trial? Acta Chir Belg 2010; 110:432-44. [PMID: 20919666 DOI: 10.1080/00015458.2010.11680652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Four well-conducted carotid artery trials comparing carotid artery stenting with carotid artery endarterectomy (EVA-3S, SPACE, ICSS and CREST) could not demonstrate the superiority of carotid artery stenting (CAS) over carotid artery endarterectomy (CEA). There is at the moment no level-I evidence to support widespread use of endovascular management of carotid artery disease in routine practice. In order to shead some light on the continuing debate on the role of carotid artery stenting, the authors conducted a search in contemporary published literature concerning carotid artery stenting. This extensive literature review reveals a higher peri-procedural stroke-death rate after CAS and a higher cost. Two other events hamper the value of CAS: a higher late restenosis rate and a higher risk of micro-embolisation during the procedure, compared with CEA. The authors conclude that the prevailing overenthusiasm of interventionalists (vascular surgeons, radiologists, cardiologists) for carotid artery stenting is not justified.
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Affiliation(s)
- H. Van Damme
- Department of cardiovascular and thoracic surgery, University Hospital Sart Tilman, Liège, Belgium
| | - J.O. Defraigne
- Department of cardiovascular and thoracic surgery, University Hospital Sart Tilman, Liège, Belgium
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Abstract
BACKGROUND Thrombosis of an infra-inguinal bypass graft often results in a limb-threatening ischemia. There is no consensus on the optimal management strategy. AIM OF THE STUDY To analyse safety and efficacy of catheter-guided intra-arterial thrombolysis to re-open thrombosed infra-inguinal bypass grafts and to identify factors that influence graft patency and limb salvage rate after thrombolytic procedures. METHODS A continuous cohort-study of 106 thrombolytic procedures between 1993 to 2008. RESULTS Despite a high initial success rate (76%), the mid-term results are less convincing, with a 58% re-occlusion rate at 45 months follow-up. Thrombosed vein grafts, old (2 weeks or more) occlusions, poor run-off and failure to identify or rectify an underlying causative stenosis are determinant for a poor long-term outcome of thrombolytic procedures. COMMENTS The outcome results of author's experience are consistent with literature reports. Thrombolysis of occluded infra-inguinal bypass grafts should be limited to selective cases (recent occlusion, prosthetic or vein graft in place since 1 year or more, critical limb ischemia). Despite its obvious advantages, the long-term outcome of thrombolytic procedures is deceiving. The inherent risk of hemorrhagic complications should also be taken in account at the decision making of treatment strategy. The question whether, in general, catheter-guided selective intra-arterial thrombolysis offers a significant advantage over operative revascularisation (thrombectomy or new bypass) remains unanswered. A more selective approach seems to favour thrombolysis as most appropriate strategy in the management of recent (< 2 weeks) thromboses of grafts in place since at least 1 year.
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Affiliation(s)
- S. Bonhomme
- Service des Urgences, CHU de Liège, Liège, Belgium
| | - G. Trotteur
- Département de l’Imagerie Médicale, CHU de Liège, Liège, Belgium
| | - H. Van Damme
- Département de Chirurgie Cardiovasculaire, CHU de Liège, Liège, Belgium
| | - J.O. Defraigne
- Département de Chirurgie Cardiovasculaire, CHU de Liège, Liège, Belgium
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Massion PB, Ledoux D, Piret S, Morimont P, Nellessen E, Durieux R, Radermecker M, Defraigne JO, Canivet JL, Damas P. [Extracorporeal membrane oxygenation (ECMO) in ICU patients suffering from cardiogenic shock, refractory hypoxemia or cardiac arrest]. Rev Med Liege 2010; 65 Spec no.:23-28. [PMID: 21302517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
ExtraCorporeal Membrane Oxygenation (ECMO) is a cardiopulmonary assistance device able to support patients in cardiac arrest, refractory cardiogenic shock or refractory hypoxemia otherwise sentenced to death. Recent technical progresses, early indication decision, bedside multidisciplinary implant, specific complications screening and echocardiographic weaning testing are crucial points to allow success of this exceptional technique.
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Affiliation(s)
- P B Massion
- Service des Soins Intensifs, CHU de Liège, Belgique.
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Xu XY, Borghi A, Nchimi A, Leung J, Gomez P, Cheng Z, Defraigne JO, Sakalihasan N. High levels of 18F-FDG uptake in aortic aneurysm wall are associated with high wall stress. Eur J Vasc Endovasc Surg 2009; 39:295-301. [PMID: 19926315 DOI: 10.1016/j.ejvs.2009.10.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Functional imaging using positron emission tomography (PET) showed increased metabolic activities in the aneurysm wall prior to rupture, whereas separate studies using finite element analysis techniques found the presence of high wall stresses in aneurysms that subsequently ruptured. This case series aimed to evaluate the association between wall stress and levels of metabolic activities in aneurysms of the descending thoracic and abdominal aorta. METHODS Five patients with aneurysms in the descending thoracic aorta or abdominal aorta were examined using positron emission tomography-computed tomography (PET-CT). Patient-specific models of the aortic aneurysms were reconstructed from CT scans, and wall tensile stresses at peak blood pressure were calculated using the finite element method. Predicted wall stresses were qualitatively compared with measured levels of 18F-fluoro-2-deoxy-glucose (18F-FDG) uptakes in the aneurysm wall. RESULTS The distribution of wall stress in the aneurysm wall was highly non-uniform depending on the individual geometry. Predicted high wall stress regions co-localised with areas of positive 18F-FDG uptake in all five patients examined. In the two ruptured cases, the locations of rupture corresponded well with regions of elevated metabolic activity and high wall stress. CONCLUSIONS These preliminary observations point to a potential link between high wall stress and accelerated metabolism in aortic aneurysm wall and warrant further large population-based studies.
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Affiliation(s)
- X Y Xu
- Department of Chemical Engineering, Imperial College London, UK
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Abstract
In the trend of the endovascular revolution for occlusive arterial disease, management of aneurysmal disease has known an analogous change in the nineties. Elective endo-aneurysmal stentgrafting (EVAR or endovascular aneurysm repair) is nowadays of widespread application in contemporary practice all over the world, sometimes by over-enthusiast proponents. There is a burden of recent publications on that topic. Critical analysis of relevant data reveal compelling evidence that elective EVAR is a safe procedure with a threefold reduced 30-day morbidity-mortality, when compared to conventional open aneurysm repair. EVAR also deemed efficace in terms of AAA rupture prevention. At the other hand, mid-term follow-up revealed that EVAR does not endure at the long-term in any late survival benefit, compared to open AAA repair. The major concern and drawback of EVAR is its higher cost and the need for indefinite, life-long surveillance, with a 20% reintervention rate (almost catheter-based endovascularly) at 5-year follow-up. In this review-paper, short-term gains of EVAR are balanced against the inherent disadvantages and long-term losses. According best available evidence, EVAR should not longer be the first choice for high-risk patients, judged unfit for open aneurysm repair. There also exist doubt on the use of EVAR in young fit patients with an anticipated long life expectancy. In approximately half of the AAA patients, EVAR can be considered as the appropriate treatment option.
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Haleng J, Pincemail J, Defraigne JO, Charlier C, Chapelle JP. [Oxidative stress]. Rev Med Liege 2007; 62:628-638. [PMID: 18069575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Oxidative stress is defined as an imbalance between the production of reactive oxygen species (ROS) and the antioxidant network, in favour of the former. Our lifestyle (smoking, alcoholism, obesity, intense physical exercise), but also our inadequate diet, contributes to significantly increase the production of ROS in our organism. This is potentially associated with an increased risk of developing ageing-related pathologies such as cardiovascular diseases and cancer. As a matter of prevention, it is necessary to have in hands a high technology allowing to correctly evidence the oxidative stress status of an individual in order to render optimal our antioxidant defences and to decrease the oxidative damages in DNA, proteins and lipids.
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Affiliation(s)
- J Haleng
- Service de Chimie Médicale, CHU Sart Tilman, Liège, Belgique
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