J Mal Vascul
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Despite standardized tests (PT-INR) and better definition of therapeutic objectives, oral anticoagulation still leads to a significant number of hemorrhagic events. The risk is higher during the initial phase of treatment and for arterial indications, but must also be considered for other situations, including deep vein thrombosis, where the risk is less well defined. This risk can now be quantified on the basis of recent data used to identify at risk populations. ⋯ Besides the patient's clinical status, the risk of hemorrhage is related to compliance, the level of anticoagulation, and drug interactions. Specialized monitoring centers provide a means of reducing the risk of morbidity and mortality. New anticoagulation agents must be developed to reduce the risk of hemorrhage which remains an important cause of morbidity and mortality, particularly in the elderly and patients at risk.
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Acrocyanosis is undoubtedly the most commonplace acrosyndrome, both in terms of pathogenesis and prognosis. Patients experience functional impairment and an esthetic prejudice that must not be neglected. Adopting the nosological classifications described for Raynaud's syndrome, primary acrocyanosis must be distinguished from exceptional secondary phenomena that have a radically different clinical course. ⋯ The hypothesis that a thermoregulation disorder could be associated with weight loss deserves further study. Symptomatic care relies on dietary and hygiene counseling, emphasizing the importance of warm clothing. The psychological element must also be considered even in the most common forms.
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Review Comparative Study
[Prevalence of duplex ultrasonography detectable venous thrombosis in patients with suspected or acute pulmonary embolism].
Duplex ultrasonography performance in detecting embolic foci has not been proven satisfactory compared with phlebography or autopsic findings. In case of suspected pulmonary embolism, the embolic focus is only discovered in 11 to 18% of the cases compared with more than 30% with phlebography. For overt acute pulmonary embolism, the discovery rate is in the 30 to 45% range versus 70 to 80% with phlebography or autopsy findings. This discrepancy might result from the fact that duplex ultrasonographic explorations are generally limited to the deep collectors at the cruropopliteal level. The purpose of this study was to assess the prevalence of duplex ultrasonography detected venous thrombosis in patients with suspected or acute pulmonary embolism when the exploration includes the entire venous system from the inferior vena cava to the ankles and examines not only the deep collectors but also the muscle and superficial networks. ⋯ The prevalence of duplex-ultrasonography detected venous thrombosis in patients with suspected or proven pulmonary embolism found in this series was equivalent to the rates reported in phlebography and autopsy series. The prevalence was higher than usually reported for duplex-ultrasonography studies limited to the cruro-popliteal level. The difference came from the "other venous thrombi" and "distal deep venous thrombi" discovered by exploring the superficial and muscular networks and the calves. This study demonstrates the contribution of duplex-ultrasonography to the diagnostic strategy for pulmonary embolism.
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Atherosclerotic disease is the most common pathologic condition of renal artery stenosis, which typically compromises the ostium or the proximal 1-2 cm of renal arteries and is also usually present in the abdominal aorta. Fibromuscular dysplasia is the second most common cause of renal artery stenosis (RAS) which usually involves the distal two-third of the main renal artery with bed-like stenosis alternating with small fusiform or saccular aneurysms. Magnetic Resonance Angiography (MRA) was initially performed without contrast media injection using two- or three-dimensional Time-of-Flight (TOF) or Phase-Contrast (PC) techniques. ⋯ MRA assessment of hemodynamic significance of RAS can be further refined by considering additional factors (fig. 4): arterial stop of signal, post stenotic dilatation, delayed renal enhancement and functional changes in the renal parenchyma (i.e. reduced kidney length and parenchymal thickness, loss of corticomedullary differentiation) (fig. 1). Precise evaluation of degree of stenosis requires the development of dedicated software such as MARACAS (MAgnetic Resonance Angiography Computer ASsisted analysis) software (fig. 5). In conclusions, 3D enhanced MRA allows an accurate diagnosis of proximal RAS, mainly due to atherosclerosis, without the risks associated with nephrotoxic contrast agents, ionizing radiation or arterial catheterization.
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Coronary artery disease (CAD), arterial hypertension, chronic bronchitis and diabetes mellitus are the most frequently encountered diseases complicating the clinical course of the vascular patient. Clinical signs of cardiac or pulmonary disease are often absent in patients with decreased functional capacity due to claudication. For instance, clinical evidence of coronary artery disease was found in 36% of patients scheduled for different vascular surgical procedures, whereas coronary angiography revealed significant stenoses in as many as 53-68%. ⋯ It remains to be shown if the use of coronary angioplasty prior to peripheral vascular surgery can provide a more satisfactory overall outcome. Several non-invasive techniques have been suggested to improve the identification of high-risk patients undergoing vascular surgery. These tests include exercise ECG, ambulatory ECG, dipyridamolethallium scintigraphy and determination of left ventricular ejection fraction by gated radionuclide imaging. (ABSTRACT TRUNCATED)