J Mal Vascul
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Tobacco use causes enormous morbidity and mortality because of the high risk of smoking-related diseases and the high prevalence of cigarette smoking. Existing smoking cessation methods only help motivated smokers who are ready to quit, but the vast majority of smokers are pre-contemplators who are neither ready nor willing to attempt to quit. This means that a high proportion of smokers are not adequately served by current strategies for treating tobacco dependence. ⋯ The corresponding reduction in exposure is associated with tangible health benefits, measured using surrogate markers. Smoking reduction also promotes abstinence in smokers who are unable or unwilling to quit smoking abruptly. NRT is well tolerated for smoking reduction, and nicotine intake does not increase during concomitant use of NRT and smoking.
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Review Case Reports
[Arterial complications of thoracic outlet syndrome and pseudarthrosis of the clavicle: three patients].
During a 3-year period, three patients developed arterial complications related to congenital or post-traumatic old pseudarthrosis of the clavicle. Arterial complications of pseudarthrosis of the clavicle presenting as a thoracic outlet syndrome are very rare. Symptoms are variable and occur late. ⋯ Complementary treatment can be associated: distal bypass, cervicothoracic sympathectomy, in situ thrombolysis or thrombectomy. Endovascular treatment is not indicated. Optimal treatment of clavicular fractures is required to prevent the development of thoracic outlet syndrome.
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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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Axillary crutches may injure the axillary artery. A 65-year-old woman with a leg length discrepancy of 30 cm subsequent to childhood poliomyelitis was seen for subacute ischemia of the right upper limb. Axillary aneurysm with thrombosis due to chronic use of axillary crutches was diagnosed after clinical examinations and surgery. ⋯ Axillary crutches may cause arterial stenosis or aneurysms. Aneurysms may be complicated by acute thrombosis, chronic or acute distal embolization, or axillary mass formation. Besides not using axillary crutches, surgical treatment of crutch-induced axillary aneurysm must be performed before sometimes definitive sequelae develop.
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It is estimated that 1 leg ulcer out of 300 is a carcinoma. In the literature ulceration of skin cancer is distinguished from chronic leg ulcers although this later category remains a subject of debate. We examined the clinical features of suspected malignant leg ulcers and discuss the notion of secondary malignant transformation of leg ulcers. ⋯ Malignant transformation of a vascular leg ulcer was not observed in our series, but has been reported in the literature although a critical analysis of reported data is only significant for squamous cell carcinoma. The frequency is probably overestimated. Our series enabled us to identify the clinical circumstances leading to an early diagnosis of carcinoma of the lower limbs. There are three essential criteria: analysis of the vascular status of the patient, the clinical characteristics of the leg ulcer, and its development on a cicatrix.