Objectives: The aim of this study was to assess the HLA alloreactivity of cold-stored saphenous vein allografts (CSVAs) by identifying the production of HLA donor-specific antibodies (DSAs) in the recipient. The secondary objective was to evaluate CSVA rejection-related complications, such as CSVA thrombosis and/or aneurysmal degeneration in the recipient. Methods: This was a single-center, prospective, experimental before-and-after study which included participants undergoing CSVA placement, either to create a vascular access (VA) for hemodialysis or to create a lower limb arterial bypass. On Day 1, before CSVA placement, total blood samples were taken for HLA typing by sequence-specific primers (SSPs) and anti-HLA antibody detection using a Luminex assay. One month after CSVA placement, a second blood sample was taken to assess the appearance of donor-specific antibodies or an increase in the level of anti-HLA antibodies. Patency of the CSVA and potential aneurysmal degeneration were evaluated at 3 and 6 months with a Doppler ultrasound checkup. Results: From September 2022 to November 2023, 45 patients were included (30 men, 67%; mean age: 71 ± 12 years). One month after CSVA placement, no appearance of de novo anti-HLA antibody was detected in anti-HLA antibody-negative patients at inclusion (n = 28). Among the patients who already had anti-HLA antibodies at inclusion (n = 17), no increase in anti-HLA antibody levels or appearance of de novo anti-HLA antibodies was detected. Conclusions: This prospective study evaluating the immunogenicity of CSVAs through the appearance of anti-HLA antibodies one month after placement demonstrates that they do not seem to induce any HLA alloreactivity. Therefore, they may be used without the risk of HLA immunization in patients awaiting organ transplantation.

Arteriovenous fistulas (AVFs) of the splenic pedicle are rare entities. They are sometimes encountered at the stage of complications. The challenge is to treat patients at an early stage, to avoid complications, and possibly reverse it. Here, we discuss the case of a 72-year-old female patient, that we saw in the Vascular Surgery Unit at Nîmes University Hospital, with an incidentally discovered asymptomatic arteriovenous fistula. The patient presented with a large, asymptomatic arteriovenous fistula of the splenic pedicle, responsible of an isolated heart failure, which was treated by embolization in interventional radiology. The treatment was successful, as the follow-up CT scan showed that the fistula had disappeared. It appears necessary to treat patient patients with AVFs, even if asymptomatic, at an early stage to avoid persistence of a heart failure even after a successful treatment.

Objective: The aim of this study was to evaluate the outcomes of cold stored saphenous vein allografts (CSVAs) for haemodialysis vascular access. Methods: A retrospective, two centre study was conducted between January 2016 and December 2020 of all patients who had CSVA placement for haemodialysis vascular access. Primary, primary assisted, and secondary patency were analysed, as well as procedural complications and re-interventions. Results: One hundred and nine patients (n = 55 women) with a mean age of 67.2 +/- 13.6 years, with no options for creating an autogenous arteriovenous fistula, were included in the study. At one year, primary, primary assisted, and secondary patency were 37.6%, 59.0%, and 73.3%, respectively; and at two years 19.9%, 42.5%, and 54.9%, respectively. During a mean follow up period of 26 +/- 18 months, fi ve patients (4.6%) had an access infection, with no related death. During the follow up period, 32 patients (29.4%) died and 13 patients (11.9%) underwent a kidney transplant. None of these patients showed immunoconversion before transplantation. The cumulative incidence of adverse events by the Fine- Gray method was calculated. Considering competing risks (death and renal transplantation), 9.2% of patients lost their vascular access at one year and 18% at two years. Moreover, 57.8% patients had stenosis, mainly on the outflow fl ow (45.9%), and 49.5% had thrombosis. Conclusion: With a comparable patency rate associated with a low infection rate, CSVA offers a potential alternative to expanded polytetrafluoroethylene grafts. This creates haemodialysis vascular access when the venous capital is exhausted in patients with reported risk factors for vascular access infection, i.e., insertion in the thigh, advanced age, diabetes mellitus, immunocompromised state, obesity, or revision of an infected prosthetic graft.

The vascular lesions of the limbs occurring in the child requiring a bypass revascularization are rare. The objective of this study was to evaluate in the long-term the arterial bypasses of the limbs carried out in childhood with greater saphenous veins (GSV).

Several patches are available on the market to perform carotid endarterectomy (CE) with angioplasty, including prosthetic and biological patches; among these, pericardial patches are relatively recent. In spite of the growing use of biological patches, few data are available in the literature comparing the results of these two types of patches. The aim of this study was to compare the short and long term results of bovine pericardium (BP) and prosthetic patches (PP) used for carotid endarterectomy.

Objective: Three of four patients with infrarenal abdominal aortic aneurysm are now treated with endovascular aneurysm repair (EVAR). The incidence of secondary procedures and surgical conversions is increasing for a population theoretically unfit for open surgery. The indications and outcomes of late open surgical conversions after EVAR in a high-volume tertiary vascular unit are reported. Methods: This retrospective single-center study includes all patients who underwent a late open conversion between January 1996 and July 2018. Data were collected from records on patient demographics, operative indications, surgical strategy, perioperative outcomes, and medium-term survival. Results: Sixty-two consecutive patients (88.7% male) with a mean age of 77.5 years are included. The median duration since index EVAR was 38.5 months; 65% of stent grafts requiring late open conversion had suprarenal fixation. Indications included 22.6% type IA, 16.1% type IB, and 45.2% type II endoleaks; 12.9% graft thrombosis; and 14.5% endoprosthesis infection. Complete endograft explantation was performed in 37.1% of patients and a partial explantation in 54.8%, whereas 8.1% of stent grafts were wholly preserved in situ. Overall 30-day mortality was 12.9% (n = 8) in the cohort and 2.7% for elective patients. The all-cause morbidity rate was 40.1%, and the median length of hospital stay was 9 days. After follow-up of 28.4 months (range, 1.8-187.3 months), all-cause survival was 58.8%. Avoidance of aortic clamping (P =.006) and elective procedures (P =.019) were associated with a significant reduction in the length of hospital stay. Moreover, the 30-day mortality (P =.002), occurrence of postoperative renal dysfunction (P =.004), and intestinal ischemia (P =.017) were increased in the emergency setting. Excluding cases with rupture or infection, survival estimates were 97%, 97%, and 71% at 1 year, 2 years, and 5 years, respectively. Conclusions: Technically more complex than primary open surgery, late open conversion is a procedure that generates an acceptable perioperative risk when it is performed in a high-volume aortic surgical center. Elective open conversion is associated with excellent early and late outcomes. Endograft preservation strategies decrease perioperative morbidity.

Background: Currently, there are various types of patches available on the market for carotid endarterectomy (CEA) with enlargement angioplasty, prosthetic, and biological patches including bovine pericardial patches. Despite the increasing use of these biological patches, there are little data in the literature comparing the results of these 2 types of patch. The purpose of this study is to compare the short-and long-term results of bovine pericardium patches (BPPs) with prosthetic patches (PPs) in carotid thromboendarterectomy. Methods: This study presents a retrospective analysis of all CEAs performed at Montpellier and Ni circumflex accent mes University Hospitals (France) in 2014 and 2015. Patients who underwent eversion were excluded. Preoperative, peroperative, and postoperative clinical and Doppler ultrasound results were collected and analyzed. The primary end point was the comparison of the restenosis rate between the BPP and the PP group. Secondary end points were the analysis of restenosis risk factors (type of patch, gender, renal failure, smoking, diabetes, arterial hypertension, dyslipidemia, and redo surgery were analyzed); the comparison of morbidity-mortality and infection between the BPP and the PP group and the comparison of morbidity-mortality between symptomatic and asymptomatic stenosis. Results: In total, 342 CEAs were performed: 168 (49%) with BPP and 174 (51%) with PP. Median follow-up was 30 months (interquartile range = 24). The stroke rate at day 30 was 3.22% and mortality at day 30 was 1.86%. There was no significant difference between groups concerning anyone of the variables of interest. At the end of follow-up, the restenosis rate >50% was 7.31% (6.45% for the BPP group vs. 8.22% for the PP group, P = 0.55). The severe restenosis rate (>70%) was 4.65% (5.16% for the BPP group vs. 4.11% for the PP group, P = 0.79). The univariate analysis identified renal failure (odds ratio = 2.69) as the main risk factor. The postoperative infection rate was 1.17% (0.59% for the BPP group vs. 1.75% for the PP group, P = 0.62). Conclusions: The rates of stroke and postoperative death, bleeding, infection, and restenosis are comparable between BPPs and PPs in our study. The use of prosthetic or biological patches seems to deliver comparable outcomes. Further studies on larger samples are required.

Several types of patches are available on the market for carotid endarterectomy (CE) with widening angioplasty, including prosthetic and biological patches. The development of pericardial patches is relatively recent. In spite of the growing use of these patches biological, there are few data in the literature comparing the results of these two types of patches. The aim of this study was to compare the short and long term results of bovine pericardium (BP) patches vs. prosthetic patches (PP) for carotid endarterectomy.

Aortic pathologies benefit from imaging innovation and interventional radiology developments in order to improve patient management. At the early phase, vital risk should be considered. Whole body CT scan evaluate the complete aorta and its branches to assess the pathology and to choose the best approach between surgery or interventional radiology (fenestration, stentgraft, peripheral stenting). Algorithms, based on the understanding of the complications mechanisms and evolutive risk, modified the management specifically for aortic dissection. At chronic phase, GPs and angiologists should follow their patients in order to detect aortic complications and to treat cardiovascular risk factors. MRA is well indicated if possible.

Introduction - Popliteal aneurysm are the most common of peripheral aneurysm and accounting for at the least 70% of them. Autogenous great saphenous vein (GSV) remains the optimal conduit for popliteal aneurysm treatment. Therefor GSV is unavailable in up to 20% and sometimes present a great under sizing in comparison with the arteries in those patients. The aim of this study was to evaluate the safety and efficacy of the cold stored vein bypass in this indication. Methods - This is a retrospective analysis of 20 exclusions of popliteal aneurysm with cold stored venous allografts in a single institution between January 2007 to December 2017. Results - The mean age was 80,4 (+/-9,7) years , all patients were males. None had a suitable autogenous conduit for a vein by pass. Seventy percent of patients ( n=14) were treated for acute or critical limb ischemia. The distal anastomosis was performed to an infrapopliteal artery in 13 cases (65%). At 30 days, perioperative death rate was 10% (n = 2) and major adverse limb event was 20% (n=4). the mean follow-up was 34,15(+/-30.5) months ; at 1 year freedom for major adverse limb or perioperative death , survival , amputation free survival, primary and secondary patency rates were, respectively, 75%, 85%, 85%, 55% and 60% . Three patients had a major amputation with a permeable bypass. Acute ischemia was the most significant factor predicting failure of revascularisation. Conclusion - Cold stored allograft may be used for popliteal aneurysm treatment with safety and efficacy, this conduit may be usefully in emergency when its available. Their ease of use and avaibility are a major advantage compared with other biologic alternative sources.

Objective: Critical limb ischemia (CLI), the most advanced form of peripheral arterial disease, is associated with strikingly high morbidity and mortality rates. Autogenous single-segment great saphenous vein (GSV) remains the optimal conduit for infrainguinal revascularization. Unfortunately, GSV is unavailable in up to 20% of patients. There is no consensus about the alternative graft that should be used for infragenicular bypass grafting when the GSV is unavailable. Currently, there are no outcome data for cold-stored venous allograft use in regard to recent safety and efficacy objective performance goals described by the Society for Vascular Surgery.Methods: This is a retrospective analysis of 118 infragenicular revascularizations performed for CLI with cold-stored venous allografts obtained from varicose vein stripping surgery in a single institution from November 2002 to August 2013.Results: Mean age (+/- standard deviation) was 75 +/- 12 years (male, 76%; diabetes, 73%; dialysis, 16%), and 38% (n = 45) had a history of failed ipsilateral revascularization. None had suitable autogenous conduit for even composite vein bypass. The distal anastomosis was performed to an infrapopliteal artery in 85 cases (72%). At 30 days, perioperative death rate was 6.8%, major adverse cardiovascular event rate was 7.6%, and major adverse limb event rate was 11.9%. Mean follow-up was 34 +/- 29 months (range, 1-113 months). At 1 year, freedom from major adverse limb event or perioperative death, limb salvage, survival, amputation-free survival, and secondary patency rates were, respectively, 64.9%, 82.5%, 85.4%, 73.3%, and 58.3%. Ejection fraction <45% and dialysis were the most significant factors predicting failure of revascularization.Conclusions: Cold-stored venous allografts may be used for performing infragenicular revascularization for CLI with acceptable safety and efficacy results despite poor long-term patency. Their level of performance remains inferior to autologous vein sources but seems comparable to alternative allografts or prosthetic conduit. Their availability is a major advantage compared with other biologic alternative sources.

La transplantation rénale constitue le meilleur traitement de suppléance de l’insuffisance rénale chronique terminale avec, par rapport aux autres, une survie et une qualité de vie améliorées, une moindre morbidité cardiovasculaire et un coût de traitement inférieur après la première année. Malgré les progrès, la technique de greffe se heurte toujours à un obstacle majeur, la question du rejet.Kidney transplantation is the best replacement therapy for end-stage renal disease. Compared to other replacement therapies it offers a better quality of life and life expectancy, reduced cardiovascular morbidity and a lower treatment cost after the first year. Despite the progress made, transplantation still faces a major hurdle, the question of organ rejection.

Arteriovenous fistula (AVF) is still in 2010 the gold standard of vascular(2) access in haemodialysis (HD) patients. Nevertheless it may be difficult to obtain and/or to use AVF in elderly. With this prospective randomised pilot study, we compare two strategies of vascular access in 70 years old or more new HD patients. AVF were compared to tunnelled jugular vein catheters (TIJC) with taurolidine as bacterial lock solution. Results were as follow: [table: see text] The responses with the visual analogic scale of comfort was 8/10 for TIJC and 5/10 with AVF * P<0.05. In five TIJC patients, heparin was added with success to taurolidine because of partial clotting of catheters. Albuminemia was significantly lower in AVF failure patients compared to AVF success patients (24.8g/L vs 31.1g/L). This pilot study allows to conclude that TIJC is an acceptable challenge to AVF in haemodialysed patients of 70 years or more in a two years long use.

L'invention concerne un systeme qui fournit des liaisons ou qui associe un hyperlien cliquable (304) a un objet (204) apparaissant dans un flux video (200). L'hyperlien peut etre envoye en un flux separe a partir du flux video, et des interfaces utilisateur (300) sont fournis a l'utilisateur pour activer l'hyperlien. L'activation de l'hyperlien peut entrainer une reorientation vers un site web associe (308). De plus, l'information en retour peut etre fournie quant a l'activite de l'utilisateur relative a l'interet et a l'activation portant sur des hyperliens particuliers dans la video.