ResumenLos autores presentan el estudio anatomo-radiológico de 100 angioplastias transluminales percutáneas (A TP) de miembros inferiores.La lesión dilatada era en dos tercios de los casos dominante y determinante de la sintomatología.Esta lesión era en un 46 % de los casos preoclusiva; oclusión completa de la arteria en un 23 % y en los casos restantes se trataba de una estenosis hemodinámicamente significativa.Los resultados radiológicos son satisfactorios en el 80 % de los casos, con un 37 % de restitución a la normalidad y un 43 % de reducción de la estenosis a límites no significativos.La ~orbilidad ha sido del 7 %.

La función del aparato circulatorio consiste en transportar la sangre, y por tanto el oxígeno, de uno a otro sector del organismo. La fisiología arterial se basa en el estudio de numerosos factores, como la velocidad de flujo de la sangre en las arterias, el flujo arterial, la presión arterial, las resistencias arteriales, la energía de un fluido, la hemorreología y el endotelio vascular. Este sistema complejo está regulado por mecanismos locales y sistémicos. La circulación arterial se explora, en el aspecto hemodinámico, a través de la medición de la presión arterial, de la velocimetría ultrasónica por efecto Doppler y del flujo arterial. El aspecto metabólico se explora con la oximetría tisular. La valoración morfológica se efectúa sobre todo con la ecografía.

Long-term therapy with low-molecular-weight heparin (LMWH) is the treatment of choice for cancer patients with venous thromboembolism (VTE). However, the ideal doses of LMWH have not been thoroughly studied. We used the RIETE Registry data to assess the influence of the daily LMWH dosage on outcome during the first three months after VTE. We used propensity score-matching to compare patients who received <150 vs. those receiving ≥150 UI/kg/day LMWH. Up to July 2010, 3,222 cancer patients with VTE received long-term therapy with fixed doses of LMWH. Of these, 1,472 (46%) received <150 IU/kg/day (mean, 112 ± 28), and 1,750 received ≥150 IU/kg/day (mean, 184 ± 32). Results of the propensity score matching involved 1269 matched pairs. During follow-up, the incidence of pulmonary embolism (PE) recurrences was similar (1.2% vs. 1.9%), but patients receiving <150 IU/kg/day LMWH had a lower incidence of fatal PE than those treated with ≥150 IU/kg/day (0.2% vs. 1.0%; p=0.004). Multivariate analysis confirmed that patients receiving <150 IU/kg/day LMWH had a lower risk for fatal PE (odds ratio [OR]: 0.2; 95% confidence interval [CI]: 0.06-0.8) and for major bleeding (OR: 0.6; 95% CI: 0.3-1.0) than those treated with ≥150 IU/kg/day. In real life, one in every two cancer patients with VTE received lower doses of LMWH than those used in randomised trials, with large variations from patient to patient. Unexpectedly, patients treated with <150 IU/kg/day LMWH had fewer fatal PE cases and fewer major bleeding events than those receiving ≥150 IU/kg/day LMWH. This finding, however, should be validated in prospective clinical trials.

Dans le but de valider une stratégie standardisée pour le diagnostic des thromboses veineuses profondes (TVP) des membres inférieurs au centre hospitalier universitaire de Toulouse, nous avons étudié les performances du score de Wells et du score de Wells modifié pour les TVP proximales et distales. Les patients hospitalisés ou ambulatoires adressés à la consultation de médecine vasculaire pour suspicion de TVP ont été inclus prospectivement et de manière consécutive d’avril 2006 à mars 2007. Pour chacun, les résultats des scores ont été comparés au résultat de l’échodoppler veineux. Au total, 297 patients ont été inclus. La prévalence globale de la TVP était de 13,5 %. La valeur prédictive négative était de 99 % pour le score de Wells et de 97 % pour le score modifié. Concernant les thromboses proximales et les thromboses distales, les résultats sont superposables. Chez 48 % des patients, le dosage des D-dimères n’aurait pas été contributif. Dans le groupe avec un score de probabilité faible représentant 70 % des patients, l’incidence de la TVP était de 0,6 %. Le score de Wells et le score de Wells modifié présentent d’excellentes performances. La forme modifiée n’apporte pas dans ce contexte d’avantage supplémentaire. Le nombre croissant de demandes d’examens complémentaires, le nombre important de patients chez qui le dosage des D-dimères serait non contributif et l’excellente performance du score de Wells pour les patients à bas risques de TVP nous encourage à développer pour ces derniers une stratégie diagnostique alternative. In order to validate a standardized strategy for the diagnosis of lower limb deep vein thrombosis (DVT) in the regional university hospital of Toulouse, we decided to study the performances of Wells’ score and the modified Wells’ score for the diagnosis of proximal and distal DVT. Inpatients or outpatients referred to the vascular medicine department from April 2006 to March 2007 with suspected DVT were included prospectively and consecutively. Wells’ score was determined for each patient and compared with the duplex ultrasound result. Two hundred and ninety-seven patients were included. The prevalence of DVT was 13.5%. The negative predictive values of Wells’ score and the modified Wells’ score were 99 and 97% respectively. Similar results were found for proximal or distal thrombosis. The performances of the modified Wells’ score were not statistically better than those of the original score. In 48% of patients, the determination of the D-dimers would not have been contributory. In the group with low probability (70% of patients), the incidence of thrombosis was 0.6%. Wells’ score and Wells’ modified score have shown excellent performances. The value of the modified Wells’ score is not superior and our preference, for practical reasons, goes to the original score. The widespread use of duplex ultrasound, the large proportion of patients in which D-dimers would not have been contributory and the excellent results of Wells score for patients with a low probability of DVT are encouraging arguments in favor of the development of an alternative strategy for these patients.

Background The choice of noninvasive tests used in primary prevention of cardiovascular diseases must be based on medical evidence. The aim of this study was to assess the additional prognostic value, over conventional risk factors, of physical examination, exercise testing, and arterial ultrasonography, in predicting a first coronary event.Methods A prospective cohort study was conducted between 1996 and 2004 (n = 2,709), with follow-up in 2006 (response rate 96.6%). Participants had no history or symptoms of cardiovascular disease and had a standardized physical examination, a cardiac exercise testing, and carotid and femoral ultrasonography at baseline. Incident cases of definite coronary events were recorded during follow-up.Results Over the Framingham risk score, femoral bruit, positive exercise test, intima-media thickness >0.63 mm, and a femoral plaque provided significant additional information to the prediction model. The addition of the exercise test to the traditional risk factors, then the intima-media thickness and lastly the presence of femoral plaques, produces incremental increases in the area under the receiver operating characteristic curve (0.73-0.78, P = .02) and about a 50% increase in the positive predictive value (15.8%-31.4%), with no effect on the negative predictive value (96.4%-96.9%).Conclusion Physical examination, exercise testing, and arterial ultrasonography provide incremental information on the risk of coronary event in asymptomatic adults. Exercise testing and femoral ultrasonography also improve the accuracy of the risk stratification. (Am Heart J 2009; 158:845-51.)

Aim of the study. - In order to validate a standardized strategy for the diagnosis of lower limb deep vein thrombosis (DVT) in the regional university hospital of Toulouse, we decided to study the performances of Welts' score and the modified Welts' score for the diagnosis of proximal and distal DVT.Method. - Inpatients or outpatients referred to the vascular medicine department from April 2006 to March 2007 with suspected DVT were included prospectively and consecutively. Welts' score was determined for each patient and compared with the duplex ultrasound result.Results. - Two hundred and ninety-seven patients were included. The prevalence of DVT was 13.5%. The negative predictive values of Welts' score and the modified Welts' score were 99 and 97% respectively. Similar results were found for proximal or distal thrombosis. The performances of the modified Wells' score were not statistically better than those of the original score. In 48% of patients, the determination of the D-dimers would not have been contributory. In the group with tow probability (70% of patients), the incidence of thrombosis was 0.6%.Conclusion. - Welts' score and Welts' modified score have shown excellent performances. The value of the modified Welts' score is not superior and our preference, for practical reasons, goes to the original score. The widespread use of duplex ultrasound, the Large proportion of patients in which D-dimers would not have been contributory and the excellent results of Welts score for patients with a Low probability of DVT are encouraging arguments in favor of the development of an alternative strategy for these patients. (C) 2009 Published by Elsevier Masson SAS.

Introduction. - Peripheral arterial disease (PAD) is a frequent and serious condition with a risk of mortality comparable to that of certain cancers. However, in France, the literature on this medical condition is scarce and data on management, incidence of complications and prognosis are tacking.Purposes. - The COPART I registry, set up in June 2004, in the Vascular Medicine Department of the University Hospital of Toulouse, France, constitutes an observational database on hospitalized patients with PAD, in order to evaluate management, follow-up and prognosis of the patients. The aim of the present work is to compare medical prescriptions at hospital discharge, with the recent guidelines of the French High Authority of Health.Methods. - All consecutive patients with PAD, hospitalized in the Vascular Medicine Department of the University of Toulouse, between June 1, 2004 and July 31, 2006 were included. Only surviving patients were analysed.Results. - Four hundred patients were included in the study. As expected, the majority were mate (70%). Common cardiovascular risk factors were: arterial hypertension (66.7%), dyslipidemia (58.9%), diabetes (42.9%), and smoking (27.4%). Three patients out of 10 had claudication intermittens, nearly two out of 10 patients complained of persistent pain, and four out of 10 patients had Leriche and Fontaine stage IV arteriopathy. At hospital discharge, 86.9% of the patients were taking at least one antiptatetet treatment, 71.2% a statin, 54% a renin-angiotensin-system inhibitor. Nearly 66% of the patients (65.8%) received at least one antiplatelet agent and a statin. Nearly 50% of the patients (49.4%) had the three drugs recommended by the French High Authority of Health. We observed a change in prescription practices for statins (+30%), as welt as for prescription of evidence-based tri-therapy (+29%) between 2004 and 2006.Conclusion. - Treatments prescribed at hospital discharge of patient with PAD included in the COPART I registry are in compliance with the French High Authority of Health guidelines concerning antiplatelet drugs and statins. Inhibitors of the renin-angiotensin system seem insufficiently used. However, favorable trends in medical practices between 2004 and 2006 have been observed. (C) 2007 Elsevier Masson SAS. Tous droits reserves.