This study aims to numerically investigate the impact of entrance velocity distributions on wall shear stress in a simplified curved vessel model. The flow in a single-curved vessel is simulated with Reynolds numbers adjusted to a Newtonian blood-analog fluid in an external iliac artery (EIA) model. Simulations are conducted assuming a rigid wall and a steady-state flow regime using OpenFOAM®. Eight entry velocity conditions are implemented, including the effects of flow development, asymmetry, Dean-type secondary flow and rotation. Their influences on hemodynamics features are investigated, focusing on axial wall shear stress (WSS). In the examined configurations of EIA flow, the impact of entrance conditions on WSS distribution is moderate. The maximum WSS is consistently located at the bend exit on the outer wall, except in the case mimicking an upstream curved pipe in the opposite direction of the local curvature. While the entry condition affects the maximum WSS value, this value remains within the same order of magnitude. At Re=560 , the highest WSS value is given by the Poiseuille condition and reaches 4.9 times the value of the laminar straight flow. At Re=1100 , the maximum value provided by the Dean-type condition, particularly in the case mimicking an upstream curved pipe perpendicular to the local curvature, reaching 7.1 times the laminar straight flow, which exceeds the value of the Poiseuille condition by 17

L’endofibrose artérielle est une artériopathie oblitérante non athéromateuse, dont la connaissance clinique et scientifique remonte à 1991. Elle est secondaire à un défaut de remodelage artériel face à des agressions pariétales hémodynamiques, mécaniques dans un contexte de contraintes élevées et répétées. De localisation essentiellement iliaque externe, cette lésion peut également être trouvée au niveau des artères fémorales communes et profondes. Très curieusement, il n’a jamais été publié de forme touchant un axe artériel des membres supérieurs. L’endofibrose artérielle est une atteinte artérielle du sportif de haut niveau, patient jeune, sans FRCV, pratiquant des sports d’endurance. Le cyclisme en est un des facteurs privilégiés. On retrouve cependant d’autres pratiques sportives d’endurance. Son diagnostic se révèle difficile. L’hypothèse de l’existence d’une sténose artérielle chez un patient en très bonne santé n’est souvent pas évoquée. La validation de ce type de lésion demande un parcours et une prise en charge spécifique. La douleur d’origine ischémique touche principalement le quadriceps, lors d’efforts supra-maximaux. Cependant, la sténose peut être beaucoup plus sévère, voire évoluer vers la thrombose. La symptomatologie est alors celle d’une claudication à la marche simple. Outre l’interrogatoire et l’examen clinique au repos (nous permettant d’éliminer plusieurs diagnostics différentiels), le diagnostic repose sur un test d’effort vasculaire périphérique (se rapprochant de la situation sportive du patient), sur des imageries spécifiques (angio-TDM sous protocole spécifique, IRM en contraste de phase 4 QFlow). Le traitement d’une sténose d’endofibrose artérielle ne peut être que chirurgical. Aucun traitement médical ou l’arrêt transitoire de l’activité sportive n’a permis une régression de la lésion. Les traitements chirurgicaux sont bien codifiés. Les traitements endovasculaires actuels, les traitements par pontage prothétique, n’ont pas leur place dans cette indication. On différencie les traitements conservateurs, des remplacements ilio-fémoraux artériels, qui relèvent d’un pontage calibré veineux. Les résultats globaux à court, moyen et long termes sont excellents. Néanmoins, il est nécessaire de maintenir un suivi à long terme. Un protocole de reprise d’activité physique et sportive est toujours discuté et élaboré. L’indication chirurgicale n’est retenue que chez des patients motivés, dont le projet thérapeutique est validé.

Background:Arm transplantation has been proposed as a valid therapeutic option for arm amputees. A bilateral arm transplantation including reconstruction of the left shoulder was performed on January 13, 2021 in Lyon (France).Methods:The recipient was a 48-year-old man with bilateral amputation at proximal arm level on both sides following an electric shock in 1998. He had received a liver transplant in 2002. The donor was a 35-year-old man. On the right side, the donor humerus was fixed on the remaining 9-cm-long proximal stump, and was reinforced with the donor fibula in an intramedullary fashion. On the left side, the whole donor humerus (including the humeral head) was transplanted with reconstruction of the gleno-humeral joint, including a suspension ligamentoplasty. The immunosuppressive protocol was based on antithymocyte globulins as induction therapy, and tacrolimus, steroids and mycophenolate mofetil as maintenance therapy.Results:Good bone healing and a well-positioned ligamentoplasty on the left side were achieved. At 2 years, the recipient was able to flex both elbows, and wrist extension, finger flexion, and extension were appreciated on both sides. Intrinsic muscle activity was detectable by electromyography during the eighth posttransplant month, and sensitivity was recovered. The patient is satisfied with his autonomy in some daily activities, but his greatest satisfaction is the recovery of his body image.Conclusions:These results confirm that it is possible to propose this transplantation to proximal-level arm amputees. The patients' information about risks and limits as well as their compliance and determination remain important prerequisites.

The aim of the study was to determine the flexion point’s location of the ilio-femoral arterial axis and its angulation. Thirty-seven dynamic digital subtraction angiographies were analyzed and were included in the current study. Different lengths were measured, based on specific anatomical landmarks: the origin of the external iliac artery, the inguinal ligament and the bifurcation of the femoral artery. These lengths were measured in extension and during flexion of the hip in order to determine the flexion point of the artery. In extension, some physiological angulations of the external iliac artery were measured. During flexion of the hip joint, the distance from the kink point to the bifurcation of the common iliac artery was respectively 82 ± 21 mm (range 48–116) on the right side and 95 ± 20 mm (range 59–132) on the left side. The distance from the kink point to the inguinal ligament was respectively 38 ± 40 mm (range 12–138) on the right side and 26 ± 23 mm (range 8–136) on the left side. The distance from the kink point to the bifurcation of the femoral artery was respectively 45 ± 29 mm (range 15–107) on the right side and 27 ± 12 mm (range 10–66) on the left side. During flexion, the angulation of the flexion point of the ilio-femoral axis was 114 ± 18° (range 81–136°). The flexion point was located cranially to the inguinal ligament and below the departure of the external iliac artery.

Introduction Aneurysms of the splenomesenteric artery variant are extremely rare with an unusual location; making its management approach challenging. Case presentation We report a case of splenomesenteric artery aneurysms that was managed in an endovascular approach in a 56-year-old gentleman with co-morbidity, obesity and anticoagulation treatment. A computed tomography investigating a left flank pain found a left sub-capsular renal hematoma and an incidental finding of a fusiform splenic artery aneurysm originating from the SMA measuring 3.2 × 3.4 cm. An endovascular intervention was performed by combining an embolization of the aneurysm and emplacement of stent graft at the superior mesenteric artery to isolate the aneurysm and prevent coil migration. The patient was discharged at day 2 post-operatively with excellent clinical and radiographic findings upon follow-ups. Discussion Splenomesenteric artery aneurysms is rare as there are 47 published cases reported in the literature. They may present with abdominal pain, back pain, flank pain or discovered incidentally. Its open surgical management approach pose various potential difficulties due to its retropancreatic location. Other approaches were proposed in the literature including laparoscopic and endovascular managements. Conclusion An appropriate endovascular management can be more feasible and suitable approach management of splenomesenteric artery aneurysms in patients with complicated medical condition.

The development of leadership skills has been the topic of several position statements over recent decades, and the need of medical leaders for a specific training was emphasized during the COVID-19 crisis, to enable them to adequately collaborate with governments, populations, civic society, organizations, and universities. However, differences persist as to the way such skills are taught, at which step of training, and to whom. From these observations and building on previous experience at the University of Ottawa, a team of medical professors from Lyon (France), Ottawa, and Montreal (Canada) universities decided to develop a specific medical leadership training program dedicated to faculty members taking on leadership responsibilities. This pilot training program was based on a holistic vision of a transformation model for leadership development, the underlying principle of which is that leaders are trained by leaders. All contributors were eminent French and Canadian stakeholders. The model was adapted to French faculty members, following an inner and outer analysis of their specific needs, both contextual and related to their time constraints. This pilot program, which included 10 faculty members from Lyon, was selected to favor interactivity and confidence in older to favor long-term collaborations between them and contribute to institutional changes from the inner; it combined several educational methods mixing interactive plenary sessions and simulation exercises during onescholar year. All the participants completed the program and expressed global satisfaction with it, validating its acceptability by the target. Future work will aim to develop the program, integrate evaluation criteria, and transform it into a graduating training.

In France, since March 2020, the healthcare system has experienced a significant decrease or even suspension of surgical activity and admissions due to the coronavirus disease 2019 (COVID-19). This activity is essential to the acquisition of technical skills for all trainees enrolled in the Vascular and Endovascular Surgery Training Program either as residents or fellows. The crisis may have affected the training of vascular surgery trainees. We describe the consequences and effects of the COVID-19 crisis on the training of vascular surgery trainees. A cross-sectional study using an anonymous survey of 12 items was sent to all surgeons in training, registered at the French College of Vascular and Endovascular Surgery (CFCVE). Responses were collected between July and November 2021. Fifty-two responses were collected from trainees (residents=48%; fellows=52%), seven of who contracted COVID-19 disease. The crisis affected their scheduled and emergency surgical activities, in 96% and 77%, respectively. Thirty-one percent of responders stopped all activity, for an average of 1.5 months. Eighteen percent of responders were reassigned to other services (emergency department, ICU, vascular access unit, etc...) for an average duration of two months. Sixty-seven percent of responders believe that their level of surgical training was affected due to the crisis. Fifty-six percent of responders do not think they have achieved their training objectives (55% for fellows, 65% for senior vascular surgery residents (4th, 5th, and 6th year), and 92% for junior vascular surgery residents (year 1, 2, and 3), contributing that to the COVID-19 crisis and its effect on the flow of patients during the crisis. Additional training time (> 3 months) and the utilization of simulation training to reduce the gap produced by the COVID-19 crisis were favored in 60% and 73% of cases respectively. The COVID-19 health crisis has affected the training of surgical trainees in vascular and endovascular surgery in France. Endovascular and vascular surgical French students in training are waiting now, for additional educational proposals, allowing them to make up for their lack of practice.

Major defects of the facial structures cause severe functional and esthetic impairment. Difficulty in head and neck reconstruction lies in cases of secondary, tertiary, or further reconstruction. This is not a rare situation for patients who had cancer of the upper airways, since the rate of recurrence, second location, or osteoradionecrosis is high. Multiple surgeries and radiation therapy cause significant fibrosis and scar tissues, making any further reconstruction a major challenge for the surgeon when operating patients with vessel- depleted neck. We report our experience with a clinical case of a patient to whom we performed a double free flap reconstruction anastomosed on a vascular loop in a context of vascular cervical desert. In our case, the use of an arteriovenous loop proved to be a reliable approach for a vessel-depleted free tissue reconstruction. This technique has received insufficient attention, yet it provides a means to establish dependable vascular alternatives.

L’endométriose polypoïde est une forme rare d’endométriose qui correspond à une variante bénigne mais qui peut mimer une lésion maligne. L’imagerie par résonance magnétique (IRM) est la modalité d’imagerie privilégiée pour évoquer ce diagnostic. Nous présentons le cas d’une femme de 48 ans chez qui une endométriose polypoïde du paramètre gauche avec envahissement de l’uretère à la fois extrinsèque et intrinsèque a été découverte devant une hydronéphrose mise en évidence lors d’un bilan d’hypertension artérielle. L’IRM retrouvait une lésion infiltrante du paramètre gauche à point de départ de la fossette ovarienne. La lésion avait un signal intermédiaire en pondération T2 et un pourtour fibreux en hyposignal, et contenait des spots hémorragiques. Aucun signe défavorable en diffusion ou après injection dynamique n’étaient présents. Cette lésion s’entendait également en endo-urétérale jusqu’au méat où elle se prolabait en endovésical. Le diagnostic prospectif d’endométriose polypoïde a été évoqué. La patiente a été opérée avec la réalisation d’une hystérectomie élargie à gauche, et associé à une néphro-urétérectomie et cystectomie partielle emportant le méat gauche. L’examen histopathologique a confirmé le diagnostic d’endométriose polypoïde. Dans le cas présenté, l’IRM en évoquant le diagnostic et en réalisant un bilan d’extension locorégional précis, a aidé à la décision d’une prise en charge chirurgicale pluridisciplinaire avec une résection complète mais raisonnable, et après information éclairée de la patiente.

We use in silico experiments to study the role of the hemodynamics and of the type of disendothelization on the physiopathology of intimal hyperplasia. We apply a multiscale bio-chemo-mechanical model of intimal hyperplasia on an idealized axisymmetric artery that suffers two kinds of disendothelizations. The model predicts the spatio-temporal evolution of the lesions development, initially localized at the site of damages, and after few days displaced downstream of the damaged zones, these two stages being observed whatever the kind of damage. Considering macroscopic quantities, the model sensitivity to pathology-protective and pathology-promoting zones is qualitatively consistent with experimental findings. The simulated pathological evolutions demonstrate the central role of two parameters: (a) the initial damage shape on the morphology of the incipient stenosis, and (b) the local wall shear stresses on the overall spatio-temporal dynamics of the lesion.

PURPOSE:To describe and compare mid-term outcomes from 2 real-world data collection efforts on fenestrated and branched endovascular aortic repair (fbEVAR) for complex abdominal aortic aneurysms (AAAs) in France and to evaluate the potential of health care databases for long-term post-market surveillance (PMS) and continued reimbursement approval. METHODS:Two real-world studies were conducted in France: a retrospective health care database study (SNDS) and a prospective clinical study. In the SNDS study, data from implantation and/or hospital stays occurring during follow-up were extracted for all patients treated with the study devices from April 2012 to December 2018. In the clinical study, high-risk patients undergoing fbEVAR with the study devices were enrolled consecutively at 15 sites in France from December 2016 to November 2018. RESULTS:Data from 1073 patients were extracted from SNDS and compared with analogous variables from 186 patients in the clinical study. Most demographic details were similar between studies (SNDS vs clinical: mean age, 71.9 vs 71.8 years; men, 91.0% vs 89.8%), as was 30-day mortality (SNDS: 5.5%, clinical: 4.3%). Patients received custom-made fenestrated or branched devices (SNDS: 80.7%, clinical: 96.2%) or CE-marked Zenith Fenestrated devices (SNDS: 19.3%, clinical: 3.8%). Initial or technical success was above 94% for both studies. Two-year freedom from all-cause mortality was 80.0% (SNDS) and 85.1% (clinical study). Two-year freedom from aneurysm-related mortality was 93.8% (SNDS) and 94.6% (clinical study). Detailed imaging outcomes were not captured within SNDS; however, information on secondary procedures to restore patency was available and used as a surrogate measure for secondary interventions. Two-year freedom from secondary interventions was 73% for the SNDS study. In the clinical study, at 2 years, aneurysm stability or shrinkage was observed in 92.3% of patients, freedom from target vessel primary patency loss was above 95% for all visceral target vessels, and freedom from secondary interventions was 79.1%. CONCLUSION:Real-world outcomes from the SNDS and clinical study suggest positive mid-term outcomes in high-risk populations following fbEVAR for complex AAAs. The similarities between these studies suggest that the use of health care databases may be an alternative to prospective clinical studies for long-term follow-up and PMS.Clinical ImpactPositive results following endovascular repair of complex abdominal aortic aneurysms are observed from data extracted from both the French health care database and a post-market clinical study despite initial high-risk patient status and diverse center experience. These outcomes parallel more rigorously designed studies and suggest that with careful study design, real-world data collections have high translatable value to add to the clinical understanding of fenestrated and branched endovascular aortic repair (fbEVAR).

Acquired stenosing arterial wall lesions are secondary to vascular insults. They may be hemodynamic, metabolic, and/or inflammatory. Among all disorders, myointimal hyperplasia and arterial endofibrosis have similar characteristics and etiopathogenesis. Intimal hemodynamic insult causes initial and focused de-endothelialization of the arterial wall. It was hypothesized that the progression of stenotic conditions could be predicted by numerical simulation using a multiscale model.