Nizar Elleuch

Popliteal pseudoaneurysm and arteriovenous fistula after acupuncture

Most popliteal arteriovenous fistula and pseudoaneurysm formation are related to trauma. Few cases have previously been reported after acupuncture therapy. Such events are typically observed when the procedure is performed by non-medical acupuncturist. They may present with acute ischemia, recent claudication, distal emboli, or less commonly rupture. Duplex ultrasound should be considered as the 1st method of investigation. Computed tomography scanning is particularly accurate in making the diagnosis. Treatment strategies consist of surgery or endovascular management. The most commonly performed surgical technique for popliteal pseudoaneurysm repair is resection with bypass grafting, whereas popliteal arteriovenous fistula are usually treated surgically with ligation and primary repair. Endovascular procedure using a stent-graft is thought to be a reasonable option for treating popliteal false aneurysm or even arteriovenous fistula. We will describe two cases of an arteriovenous fistula and pseudoaneurysm of the popliteal artery that developed after acupuncture needling in the region of the popliteal artery.

Faux anévrisme de l’artère poplitée secondaire à une exostose fémorale chez un enfant : à propos d’un cas opéré

Exostoses, or osteochondromas are benign bone tumors that have developed on the bone surface. These benign tumors can be asymptomatic or lead to complications, for instance arterial pseudoaneurysm. We report a case of a pseudoaneurysm of the popliteal artery treated surgically in a 17-year-old girl with a solitary exostosis of the right femur. Surgery was closure of the pseudoaneurysm and a bypass using a venous graft.

Primary Hydatid Cyst of the Thoracic Aorta Revealed by Peripheral Arterial Embolism

Primitive aortic hydatidosis is exceptional. We report the case of a 55-year-old woman who had pain in her left lower limb for a week. A computed tomographic angiogram showed a multivesicular and fluid-density mass intimately contiguous to the descending thoracic aorta seen on an endoluminal subtraction image and hydatid cysts in the spleen. The surgical approach was through a thoracophrenolombotomy with right femorofemoral bypass. Complete resection of the destroyed aortic portion was performed, and continuity was restored by an aortoaortic bypass using a Dacron (INVISTA, Kennesaw, Georgia) prosthesis. Hydatid fragments were evacuated after thrombectomy of the left iliac artery. The surgical procedure was completed by a splenectomy. Postoperative follow-up was uneventful. After 6 months, computed tomographic angiography showed a patent bypass.

Surgical management of internal carotid artery aneurysm near the skull base

Extracranial carotid artery aneurysms are rare. The most common location is the common carotid artery near the bifurcation. The mid to distal internal carotid artery is the second most common location. We are reporting the case of a 64-year-old woman who was admitted to our department for management of an asymptomatic left internal carotid artery aneurysm. Physical examination revealed a pulsatile mass, and imaging confirmed the aneurysm diagnosis. Computed tomography angiography detailed a 28mm×3cm×6cm aneurysm of the left cervical internal carotid artery with tortuous outflow the aneurysm sac. Open repair was undertaken. Exposure with incision anterior to the sternocleidomastoid was performed although extended more superiorly than usual because of the distal aneurysm location. After carotid clamping, the aneurysm was resected and an end-to-end anastomosis with prosthesis was performed. After closure, the patient was extubated demonstrating baseline neurologic function. Histologic examination of the arterial wall confirmed the diagnosis of fibromuscular dysplasia.

Fistule carotido-jugulaire post-traumatique : à propos d’un cas opéré

The neck, being not protected by skeleton, is vulnerable to external trauma and injury which can involve blood vessels, muscles, nerves, and trachea. Carotid injuries can be potentially life-threatening by hemorrhage and stroke. We present a case of a 26-year-old manual worker who presented a neck injury caused by a metallic projectile. The injury involved the right common carotid artery with an internal jugular vein fistula, and tracheal damage. The patient was managed with surgical repair of the tracheal lesion, reconstruction of the carotid section using a PTFE graft bypass, and ligation of the internal jugular vein. In the immediate postoperative period, the patient presented with no neurological deficits, but he did develop a pulmonary infection that resolved with antibiotic therapy. The follow-up is now 3months. The patient is doing well without any neurological disorder.

Traitement des anévrismes iliaques isolés : expérience d’un centre tunisien

Isolated aneurysms of the iliac arteries are rare. The diagnoses of these aneurysms become easier with non-invasive radiologic investigations. The development of endovascular treatment is a recent alternative to surgical treatment. We report our experience in the management of 8 cases of isolated iliac aneurysms in the department of cardiovascular and thoracic surgery of the Habib Bourguiba Hospital of Sfax.