Traitement chirurgical et endovasculaire des atteintes aortiques inflammatoires : expérience d’un centre tunisien

Jmaà, H. Ben; Karray, R.; Jmal, H.; Cherif, T; Dhouib, F.; Souissi, I.; Karoui, A.; Bahloul, Z.; Masmoudi, S.; Elleuch, N.; Frikha, Imed

doi:10.1016/j.jdmv.2017.04.006

Cited by 2 publications

(1 citation statement)

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“…Furthermore, extra-anatomical bypass or the use of a normal arterial segment as an interposition graft has been also reported [10]. Moreover, the use of an endovascular covered stent may be a suitable method of aortoiliac aneurysm repair [11]. In addition to operative aneurysm repair and to prevent the development of postoperative pseudoaneurysms and other graft-related complications, pre- and postoperative systemic immunosuppressive agents is recommended, as an adjunctive treatment [12–14].…”

Section: Introductionmentioning

confidence: 99%

Vascular suture line wrapping for Aortoiliac anastomoses following open surgical repair of Infrarenal Behçet’s Aortoiliac aneurysms

Mousa

Hanbal

Sharabi

et al. 2019

Orphanet J Rare Dis

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Background This study was conducted to evaluate our local experiences of adjunctive mechanical prosthetic wrapping for aortoiliac vascular anastomoses as a prophylactic measure following surgical repair of Behçet’s aortoiliac aneurysms. The goal of prosthetic wrapping to reinforce the vascular anastomoses by mechanical protection to reduce the bleeding complications, and consequently pseudoaneurysm formation. This was aided by the administration of pre- and postoperative immunosuppressive therapy as an adjuvant treatment. Methods A seven-year retrospective study was conducted between January 2006 and December 2012, retrieving data of patients with Behçet’s aortoiliac aneurysms. All patients underwent open surgical repair using a heparin-bonded synthetic Dacron® graft. Data for all patients were retrieved and analyzed for diagnostic procedures, graft selection, as well as, different methods of surgical repair. Graft-related complications such as anastomotic pseudoaneurysms, occlusion, and thrombosis were also reported. Results Sixteen patients were recruited in this study. There were 11 (69%) males and 5 (31%) females with the male to female ratio 2:1. The patients’ age ranged between 25 and 47 years with the mean of 36.4 ± 7.3. All Behçet’s aortic/aortoiliac aneurysms were repaired by the application of heparin-bonded Dacron® tube and bifurcated grafts. The anastomotic wrapping technique was performed for both the proximal and the distal vascular anastomoses. The technical success of aortoiliac aneurysm and wrapping techniques was achieved in 100% of patients. All patients were given pre- and postoperative systemic immunosuppressive therapy. No graft-related complications were reported except for only one anastomotic pseudoaneurysm that developed at one of the right iliac anastomoses, that developed within 24 months after follow up. Conclusions Mechanical prosthetic wrapping for vascular anastomoses in patients with Behçet’s aortic/aortoiliac aneurysms is a feasible, simple, and reliable technique with low morbidity and mortality. It was performed as a prophylactic measure to avoid the development of postoperative anastomotic pseudoaneurysms. It must be performed for all patients with Behçet’s arterial aneurysms whenever possible. Furthermore, the supplemental administration of pre- and postoperative systemic immunosuppressive therapy should be considered as an important factor for the prophylaxis and prevention of anastomotic pseudoaneurysms and other graft-related complications.

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