Jean-Pierre Dereume

Predominance of type 1 CD4+T cells in human abdominal aortic aneurysm

The functional repertoire of T cells in abdominal aortic aneurysm (AAA) and the exact nature of aortic wall adaptive cellular immune responses still remains a matter of debate. In this study, we sought to determine whether type 1 or type 2 responses occur predominantly in human aneurysmal aortic lesions. We first examined the phenotype and cytokine secretion profile of T lymphocytes freshly isolated from aneurysmal aortic wall for comparison with their circulating counterparts using flow cytometry. We found that both populations of infiltrating CD4+ and CD8+T cells displayed a unique activated memory phenotype. In addition, we identified the presence in human aneurysmal aortic lesion of CD4+T cells producing high levels of interferon (IFN)‐γ but not interleukin (IL)‐4, reflecting their type 1 nature. Quantitative analysis of cytokine gene expression confirmed increased IFN‐γ transcript levels in infiltrating cells compared to controls. We next analysed aortic wall responses using LightCycler‐based quantitative real‐time reverse transcription‐polymerase chain reaction. Compared to control non‐diseased aortic samples, we demonstrated that whole AAA tissues exhibited high mRNA levels of IFN‐γ but not IL‐4. Overexpression of the transcription factor T‐bet in the absence of significant GATA‐3 expression further assessed the type 1 polarization of aortic wall immune responses. These findings indicate that type 1 CD4+T cells predominate in human AAA lesions. This study has important implications for the pathogenesis of aneurysm disease. Through the production of IFN‐γ, T cells may indeed contribute to orchestrate extracellular matrix remodelling.

Emergency embolization of a mycotic aneurysm of the superior gluteal artery : case report

The authors report the unusual presentation of a mycotic aneurysm of the superior gluteal artery in a patient with unsuspected bacterial endocarditis. The diagnosis of this atypically large lesion, the therapeutic considerations, and the technical aspects of the endovascular occlusion are discussed.

Vascular graft infection caused by Aspergillus species: case report and review of the literature.

We report an unusual case of vascular graft infection caused by Aspergillus fumigatus that began with a false aneurysm, major arterial emboli, and septic arthritis. Successful treatment included resection of the infected graft, restoration of circulation by extraanatomic bypass, and administration of amphotericin B and itraconazole, a new antifungal agent. Graft infection in the case reported herein most likely occurred during surgery and took place during an insidious outbreak of postoperative infection.

Embolization of Large Aneurysms with Long Wire Coils

The authors report the experience of using long coils of 2 m length in the management of large anuerysms. Knowledge of the characteristics of these coils is of value for correct placement. These coils are safe and cost-effective for excluding large aneurysms.

Vertebral arteriovenous fistula following central venous cannulation: a case report.

The authors report a case of vertebral arteriovenous fistula that has been disclosed three years after central venous cannulation (CVC). The real inci dence of this complication is discussed and various clinical presentations are enumerated. From a review of the literature, some recommendations are made to prevent the diagnosis from being missed and chiefly to reduce the risk of arterial puncture that results in fistula formation.

CD8+ T-Cell Subpopulations in Human Abdominal Aortic Aneurysm Lesion

To the Editor: We read with interest the article by Duftner et al1 reporting the prevalence of peripheral interferon-γ (IFN-γ)–producing CD4+CD28− and CD8+CD28− T cells in patients with small abdominal aortic aneurysm (AAA). Along with the recent description that Th1-type immune responses predominate in human end-stage AAA lesion,2,3 their observation further supports preference toward polarized type 1 T-cell responses in aneurysm disease. The potential involvement of Th1 cells in the pathogenesis of the disorder is also suggested by the convincing demonstration that absence of CD4+ T cells or targeted deletion of IFN-γ prevents the induction of experimental AAA in a calcium chloride–induced mouse model,4 AAA formation being reconstituted by administration of IFN-γ into CD4−/− mice or infusion of competent splenocytes from wild-type mice into IFN-γ−/− mice. In their study, Duftner et al further established that both circulating CD4+CD28− and CD8+CD28− T cells are highly differentiated cells that display extensive CD45RO to CD45RA reversion and produce large amounts of IFN-γ and perforin. Surprisingly, low percentages of CD8+CD28− T cells were identified in AAA tissue sections using immunohistochemistry compared with flow cytometric analysis of peripheral blood mononuclear cells. In a series of our …

Patient prognosis with critical limb ischemia: an update of 164 patients

It is generally considered that patients with rest pain and/or ulceration have a bad prognosis independent of the type of treatment given. Many factors can reasonably explain this evolution; the main ones are: multifocal atherosclerotic disease in most instances with a high death frequency secondary to myocardial infarction and stroke, morbidity and mortality secondary to amputations, and higher risk of both arterial and venous thromboembolic disease.

Spontaneous vertebrovertebral arteriovenous fistula treated by steel coil embolization: Case report

The authors report 1 case of a spontaneous vertebrovertebral arteriovenous fistula in a fifty-seven-year-old woman. Embolization with a steel coil resulted in complete occlusion of the fistula while maintaining vertebral artery patency.

Long-Term Follow-Up of Intraarterial Infusion of Streptokinase in Acute Lower Limb Ischemia

Twenty-two patients suffering from acute ischemia of the lower limbs were treated with local selective low-dose streptokinase, 2,000 U/min, with a maxi mum dose of 200,000 U, the average time of fibrinolytic infusion being 1.8 hours. Bleeding problems were minimized because of the low dose of fibrino lytic agent. Lysis, demonstrated by radiology, was achieved in 73%, but a good clinical result was obtained only when local fribrinolysis was associated with percutaneous transluminal angioplasty or surgery. Whether or not they had some lytic response, 16 patients required surgical intervention. Limb salvage was achieved in all cases. The long-term follow-up (twenty-six months) in 19 patients was entirely satisfactory with further surgery required later in only 2 cases.

Aorto-iliac Thrombo-endarterectomy

In the surgery of the aortic bifurcation, the controversy between supporters of bypass grafting and those of thromboendarterectomy is not yet settled (1, 2, 6, 11–14).