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Journal Article

  • SILHOL F., SARLON-BARTOLI G., DANIEL L., BARTOLI J. M., COHEN S., LEPIDI H., PIQUET P., BARTOLI M. A., VAÏSSE B. “Intranuclear expression of progesterone receptors in smooth muscle cells of renovascular fibromuscular dysplasia: a pilot study.”. Annals of Vascular Surgery [En ligne]. 2015. Vol. 29, n°4, p. 830-835. Disponible sur : < > (consulté le no date)
    Résumé : BACKGROUND: The pathogenesis of fibromuscular dysplasia (FMD) remains poorly understood. Yet, understanding this mechanism has taken on new urgency after recent evidence indicating that FMD is not as rare as previously thought. We speculated that hormonal receptors in the walls of dysplastic renal arteries were implicated in the pathogenesis of FMD. METHODS: We undertook a pilot prospective case-control study comparing histologic findings from renal arteries that were surgically removed in 2 patient groups. The case group included 6 samples from FMD patients who underwent surgery for stenosis or aneurysm caused by FMD. The control group included 3 FMD-free patients who underwent nephrectomy for nonvascular causes. Surgical specimens were sent to the histology laboratory. FMD was defined preoperatively using conventional radiologic criteria and was confirmed by histologic examination. RESULTS: Immunohistochemical staining detected intense progesterone receptor expression in the nuclei of smooth muscle cells in FMD patients. No progesterone receptor expression was found in the FMD-free patients. Estrogen receptor expression was not noted in the 2 groups. CONCLUSIONS: This preliminary finding may suggest that progesterone plays a key role in the pathogenesis of FMD and opens the fields of genetic and therapeutic approaches.
    Mots-clés : Adult, Case-Control Studies, Cell Nucleus, Female, Fibromuscular Dysplasia, Humans, Immunohistochemistry, Male, Middle Aged, Muscle, Smooth, Vascular, Myocytes, Smooth Muscle, Pilot Projects, Receptors, Progesterone, Renal Artery.

  • SOLER R. J., BARTOLI M. A., MANCINI J., LERUSSI G., THEVENIN B., SARLON-BARTOLI G., MAGNAN P. - E. “Aneurysm sac shrinkage after endovascular repair: predictive factors and long-term follow-up.”. Annals of Vascular Surgery [En ligne]. 2015. Vol. 29, n°4, p. 770-779. Disponible sur : < > (consulté le no date)
    Résumé : BACKGROUND: The aim of this study was to determine the predictive factors of reduction in diameter ≥10 mm of the aneurysm sac after endovascular treatment and analyze evolution in these patients. METHODS: Between December 1997 and December 2008, all patients electively treated at our center for an infrarenal abdominal aortic aneurysm (AAA) were included in a prospective registry. We did a retrospective study between patients whose aneurysm was reduced by at least 10 mm in diameter on computed tomography scan during follow-up (Group 1) and the other patients who did not (Group 2). A univariate and multivariate statistical analysis was performed. RESULTS: The files of 197 patients (mean age 74.8 years) with a mean follow-up of 54.8 months were reviewed. One hundred two patients (51.8%) had a reduction of ≥10 mm of AAA diameter (Group 1); this reduction was achieved after an average follow-up of 23.6 months. The delay to obtain at least a 10-mm diameter reduction was not influenced by any preoperative characteristics of patients or characteristics of the AAA. Patients in Group 1 were younger (74 vs. 76 years, P = 0.039), with a longer (31 vs. 27.7 mm, P = 0.038) and narrower upper neck (23.1 vs. 24.0 mm, P = 0.02) compared with Group 2. After multivariate analysis, these 3 variables were independently predictive of reduction in AAA diameter. In Group 1, secondary procedures were performed in 13 patients after a diameter reduction of ≥10 mm, including 3 type 1 endoleaks treated after 36 months (1 case) and after 123 months (2 cases) and 1 type 3 endoleak treated after 78 months. In Group 2, secondary procedures were performed in 28 patients, including 9 type 1 endoleaks treated after a median time of 26 months and no type 3 endoleak. Secondary procedures were significantly more frequent in Group 2 than in Group 1 (29.4% vs. 12.7%, respectively; P = 0.005). Freedom from secondary procedure at 5 years was 87.9% in Group 1 and 65.4% in Group 2 (P = 0.003). Freedom from AAA rupture at 8 years was significantly superior in Group 1 than in Group 2 (100% vs. 83.5%, P = 0.008). CONCLUSIONS: Sac shrinkage after endovascular aortic aneurysm repair is more likely observed in younger patients with long and small proximal neck anatomy and is associated with better long-term outcomes. However, late failures do occur even in those with significant sac shrinkage; therefore, follow-up should continue lifelong.
    Mots-clés : Age Factors, Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal, Aortic Rupture, Aortography, Blood Vessel Prosthesis Implantation, Chi-Square Distribution, Elective Surgical Procedures, Endoleak, Endovascular Procedures, Female, France, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Proportional Hazards Models, Registries, Retrospective Studies, Risk Factors, Time Factors, Tomography, X-Ray Computed, Treatment Outcome.


Journal Article

  • JEAN-BAPTISTE E., BRIZZI S., BARTOLI M. A., SADAGHIANLOO N., BAQUÉ J., MAGNAN P. - E., HASSEN-KHODJA R. “Pelvic ischemia and quality of life scores after interventional occlusion of the hypogastric artery in patients undergoing endovascular aortic aneurysm repair.”. Journal of Vascular Surgery [En ligne]. 2014. Vol. 60, n°1, p. 40-49.e1. Disponible sur : < >
    Résumé : Objective The aim of this study was to analyze the pelvic ischemic complications and their impact on quality of life after interventional occlusion of the hypogastric artery (IOHA) in patients undergoing endovascular aortic aneurysm repair (EVAR). Methods Between January 2004 and April 2012, 638 consecutive patients with aortoiliac aneurysm treated by EVAR were prospectively registered in two teaching hospitals. We identified all EVAR patients who underwent IOHA. Demographic, clinical, and radiologic data were extracted from electronic databases and patient records as requested. All patients who survived the postoperative period took part in a quality of life survey, the Walking Impairment Questionnaire (WIQ), which included four items: pain, distance, walking speed, and stair climbing. Outcome measures included the 30-day rate of pelvic ischemic complications, the buttock claudication (BC) rate at 30 days and during follow-up, and the comparative WIQ scores between patients with persistent BC, those with regressive BC, and those who never had BC after the IOHA procedure. Results A total of 71 patients (97% men; mean age, 76 years ± 7.69) required 75 IOHA procedures. These were deemed proximal in 44 cases and distal in 31, with use of coil embolization in 64%, Amplatzer plug in 24%, or a combination of coils and plugs in 12%. The technical success rate was 100%. Two patients (2.8%) experienced fatal acute pelvic ischemic complications in the postoperative period after EVAR. Another patient died of iliac rupture during EVAR, leading to an operative mortality rate of 4.3%. Eighteen patients (25.3%) suffered BC, among whom 11 cases resolved at a median follow-up of 42 months. Young age (odds ratio, 0.92; 95% confidence interval, 0.85-0.99; P = .03) and distal IOHA (odds ratio, 3.5; 95% confidence interval, 1.01-11.51; P = .04) were independent predictors of BC occurrence. The actuarial rate of persistent BC was 85% at 18 months. The WIQ scores were lower for patients with persistent BC (median score, 35.04; interquartile range, 16.36; P = .001) compared with patients with regressive BC (median score, 76.5; interquartile range, 36.66; P = .02) or those who never experienced BC after the IOHA procedure (median score, 65.34; interquartile range, 10.94; P &lt; .0003). Conclusions Pelvic ischemia associated with IOHA may be severe and lead to fatality after EVAR. Our data show that BC may lead to severe quality of life impairment when it does not regress during follow-up.

  • PESENTI S., BARTOLI M. A., BLONDEL B., PELTIER E., ADETCHESSI T., FUENTES S. “Endovascular aortic injury repair after thoracic pedicle screw placement.”. Orthopaedics & traumatology, surgery & research: OTSR [En ligne]. 2014. Vol. 100, n°5, p. 569-573. Disponible sur : < > (consulté le no date)
    Résumé : Our objective was to describe the management and prevention of thoracic aortic injuries caused by a malposition of pedicle screws in corrective surgery of major spine deformities. Positioning pedicle screws in thoracic vertebras by posterior approach exposes to the risk of injury of the elements placed ahead of the thoracic spine, as the descending thoracic aorta. This complication can result in a cataclysmic bleeding, needing urgent vascular care, but it can also be totally asymptomatic, resulting in the long run in a pseudoaneurysm, justifying the systematic removal of the hardware. We report the case of a 76-year-old woman who underwent spinal correction surgery for thoraco-lumbar degenerative kypho-scoliosis. Immediately after the surgery, a thoracic aortic injury caused by the left T7 pedicle screw was diagnosed. The patient underwent a two-step surgery. The first step was realized by vascular surgeons and aimed to secure the aortic wall by short endovascular aortic grafting. During the second step, spine surgeons removed the responsible screw by posterior approach. The patient was discharged in a rehabilitation center 7 days after the second surgery. When such a complication occurs, a co-management by vascular and spine surgeons is necessary to avoid major complications. Endovascular management of this kind of vascular injuries permits to avoid an open surgery that have a great rate of morbi-mortality in frail patients. Nowadays, technologies exist to prevent this kind of event and may improve the security when positioning pedicle screws.

  • SALAUN E., BARTOLI M. A., SOLER R., KHIBRI H., EBBO M., BERNIT E., FLAVIAN A., HARLÉ J. R., MAGNAN P. E., SARLON-BARTOLI G. “Severe symptomatic stenosis of visceral and renal arteries leading primary antiphospholipid syndrome diagnosis.”. Annals of Vascular Surgery [En ligne]. 2014. Vol. 28, n°7, p. 1796.e9-1796.e13. Disponible sur : < > (consulté le no date)
    Résumé : Antiphospholipid syndrome (APS) is an autoimmune disorder with combination of at least 1 clinical and 1 laboratory criterion as defined by the SAPPORO statement. Clinical criteria result from vascular thrombosis that can affect artery, venous, or small vessel in any tissue or organ. Arterial stenosis is a rare lesion involved in APS, affecting mainly renal or intracranial arteries. We reported a case of a 33-year-old woman with abdominal angina and high blood pressure (BP). Imaging showed tight, not calcified, and hypodense stenosis of mesenteric superior artery and left renal artery, and a thrombosis of the celiac trunk. Treatment was digestive rest followed by angioplasty and stenting of mesenteric and renal artery, anticoagulation, antiplatelet, and statin therapy. Normal BP and digestive function were obtained postoperatively. Biological tests showed a positive lupus anticoagulant at diagnosis and at 12 weeks, which allowed us to make the diagnosis of APS. Physiopathology of stenosis in APS remains unclear but suggests arterial wall partial thrombosis, accelerated atherosclerosis, and/or proliferation of smooth muscle cells. We recommend screening of arterial stenosis in patients with APS and arterial symptoms, and inversely, searching for APS in young patients with atypical arterial stenosis to allow optimal therapy.

  • SARLON-BARTOLI G., MAGNAN P. E., LÉPIDI H., BARTOLI M. A. “Celiomesenteric and renal common trunk associated with distal thoracic aorta coarctation and three saccular aneurysms.”. Journal of Vascular Surgery [En ligne]. 2014. Vol. 59, n°5, p. 1432. Disponible sur : < > (consulté le no date)
    Mots-clés : Abnormalities, Multiple, Adult, Aorta, Thoracic, Aortic Aneurysm, Thoracic, Aortic Coarctation, Aortography, Blood Vessel Prosthesis Implantation, Celiac Artery, Female, Humans, Mesenteric Arteries, Renal Artery, Tomography, X-Ray Computed, Treatment Outcome.


Journal Article

  • MAUREL B., BARTOLI M. A., JEAN-BAPTISTE E., REIX T., CARDON A., GOUEFFIC Y., MARTINEZ R., COCHENNEC F., ALBERTINI J. - N., CHAUFFOUR X., STEINMETZ E., HAULON S. “Perioperative Evaluation of Iliac ZBIS Branch Devices: A French Multicenter Study.”. Annals of Vascular Surgery [En ligne]. 2013. Vol. 27, n°2, p. 131-138. Disponible sur : < >
    Résumé : Background The purpose of this study was to evaluate short-term results of endovascular treatment of common iliac artery (CIA) aneurysms without a distal neck by using iliac branch devices (IBDs), which enable maintenance of antegrade perfusion to the internal iliac artery (IIA). Methods Our investigation was done in a prospective, multicenter, nonrandomized manner. IBD were implanted to exclude CIA aneurysms with a diameter &gt;25 mm in patients unfit for open repair. The stent grafts were designed based on preoperative angio-CT findings. A covered stent implantation between the IBD and the target IIA was performed during the same surgical procedure. Angio-CT was performed within the 30 days after the procedure. From January 2009 to April 2010, 39 patients were included in our study (38 men and 1 woman, mean age 73 years). Results The CIA aneurysm (mean diameter 32.3 mm) was isolated in 15 patients and associated with an abdominal aorta aneurysm (mean diameter 66 mm) in 24 patients. The IBD was systematically connected to a bifurcated aortobiiliac stent graft. The bifurcated stent graft was implanted during the same procedure in all patients, except for two who had a bifurcated stent graft history. Median surgery time, fluoroscopy time, and volume of contrast product were 192 (range 90–360) minutes, 32 (10–120) minutes, and 150 (60–352) mL, respectively. In 37 patients (95%), the internal iliac branch was patent at the end of the surgery. In two patients (5%), it was occluded, entailing a subischemic colic episode and buttock claudication in one of them. To treat a type I endoleak, a proximal extension partially covering a renal artery was implanted during the same surgery. A type III endoleak was diagnosed on the postoperative angio-CT. In three patients, a cross-over femorofemoral bypass was performed for an external iliac leg thrombosis (and for an internal iliac branch thrombosis in one case). In all, at 30 days, no death was reported and the success rate was 90% (three leg stenoses and a type III endoleak). Conclusions IBD implantation to maintain an antegrade internal iliac perfusion is possible and has shown promising early success. Our results can be compared with those in the published literature. A learning curve will be needed to improve the technical success rate.

  • SARLON-BARTOLI G., BENNIS Y., LACROIX R., PIERCECCHI-MARTI M. D., BARTOLI M. A., ARNAUD L., MANCINI J., BOUDES A., SARLON E., THEVENIN B., LEROYER A. S., SQUARCIONI C., MAGNAN P. E., DIGNAT-GEORGE F., SABATIER F. “Plasmatic Level of Leukocyte-Derived Microparticles Is Associated With Unstable Plaque in Asymptomatic Patients With High-Grade Carotid Stenosis.”. Journal of the American College of Cardiology [En ligne]. 2013. Vol. 62, n°16, p. 1436-1441. Disponible sur : < >
    Résumé : Objectives This study sought to analyze whether the plasmatic level of leukocyte-derived microparticles (LMP) is associated with unstable plaques in patients with high-grade carotid stenosis. Background Preventive carotid surgery in asymptomatic patients is currently debated given the improvement of medical therapy. Therefore, noninvasive biomarkers that can predict plaque instability are needed. The LMPs, originating from activated or apoptotic leukocytes, are the major microparticle (MP) subset in human carotid plaque extracts. Methods Forty-two patients with &gt;70% carotid stenosis were enrolled. Using a new standardized high-sensitivity flow cytometry assay, LMPs were measured before thromboendarterectomy. The removed plaques were characterized as stable or unstable using histological analysis according to the American Heart Association criteria. The LMP levels were analyzed according to the plaque morphology. Results The median LMP levels were significantly higher in patients with unstable plaque (n = 28; CD11bCD66b+ MP/μl 240 [25th to 75th percentile: 147 to 394], and CD15+ MP/μl 147 [60 to 335]) compared to patients with stable plaque (16 [0 to 234] and 55 [36 to 157]; p &lt; 0.001 and p &lt; 0.01, respectively). The increase in LMP levels was also significant when considering only the group of asymptomatic patients with unstable plaque (n = 10; CD11bCD66b+ MP/μl 199 [153 to 410] and CD15+ MP/μl 78 [56 to 258] compared with patients with stable plaque (n = 14; 20 [0 to 251] and 55 [34 to 102]; p &lt; 0.05 and p &lt; 0.05, respectively). After logistic regression, the neurologic symptoms (odds ratio: 48.7, 95% confidence interval: 3.0 to 788, p &lt; 0.01) and the level of CD11bCD66b+ MPs (odds ratio: 24.4, 95% confidence interval: 2.4 to 245, p &lt; 0.01) independently predicted plaque instability. Conclusions LMP constitute a promising biomarker associated with plaque vulnerability in patients with high-grade carotid stenosis. These data provide clues for identifying asymptomatic subjects that are most at risk of neurologic events.
    Mots-clés : Atherosclerosis, high-grade carotid stenosis, leukocyte-derived microparticles, unstable plaque.


Journal Article

  • BARTOLI M. A., KOBER F., COZZONE P., THOMPSON R. W., ALESSI M. C., BERNARD M. “In vivo assessment of murine elastase-induced abdominal aortic aneurysm with high resolution magnetic resonance imaging.”. European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery [En ligne]. 2012. Vol. 44, n°5, p. 475-481. Disponible sur : < > (consulté le no date)
    Résumé : OBJECTIVES: There are, to date, no published non-invasive or longitudinal studies performed in mice to measure aortic diameter and wall thickness in an elastase-induced abdominal aortic aneurysm. This MRI study at 11.75 T aimed at evaluating the reliability of longitudinal in vivo aortic diameter and wall thickness measurements in this particular model. METHODS: Adult male C57BL/6 mice underwent transient elastase or heat-inactivated elastase perfusion (controls). Aortic dilatation was measured before, during and immediately after elastase perfusion, and again 14 days after, with a calibrated ocular grid. MRI was performed just before initial surgery and at day 14 before harvest using an 11.75 T MR microscopy imager. RESULTS: Aortic diameter was significantly greater in elastase-perfused mice compared to controls as measured by optic grid (1.150 ± 0.153 mm vs 0.939 ± 0.07 mm, P = 0.038) and according to MRI measurement of the outer diameter on spin echo images (1.203 ± 0.105 mm vs 1070 ± 0.048 mm, P = 0.0067). Aortic wall thickness was found to be significantly increased in elastase-perfused mice at day 14. CONCLUSIONS: This study demonstrates in the mouse elastase-induced aneurysm model that characterization of aneurysm development by its inner and outer vessel diameter and vessel wall thickness can be carried out longitudinally using high resolution MRI without significant mortality.
    Mots-clés : AAA, Animals, Aorta, Abdominal, Aortic Aneurysm, Abdominal, crmbm, Dilatation, Pathologic, Disease Models, Animal, High resolution MRI, Magnetic Resonance Imaging, Male, Mice, Mice, Inbred C57BL, Murine elastase-induced abdominal aortic aneurysm, Pancreatic Elastase, Time Factors.
  • BARTOLI M. A., SQUARCIONI C., NICOLI F., MAGNAN P. E. “Management of symptomatic carotid stenosis after IV thrombolysis: a word of caution.”. The Journal of Cardiovascular Surgery. 2012. Vol. 53, n°3, p. 407-408.
    Mots-clés : Angioplasty, Carotid Stenosis, Emergencies, Humans, Stents, Stroke.

  • BARTOLI M. A., THEVENIN B., SARLON G., GIORGI R., ALBERTINI J. N., LERUSSI G., BRANCHEREAU A., MAGNAN P. - E. “Secondary Procedures After Infrarenal Abdominal Aortic Aneurysms Endovascular Repair With Second-Generation Endografts.”. Annals of Vascular Surgery [En ligne]. 2012. Vol. 26, n°2, p. 166-174. Disponible sur : < >
    Résumé : Background To study the incidence, the types, and the results of secondary procedures performed after endovascular treatment of infrarenal abdominal aortic aneurysm (AAA). To compare the population of patients who underwent secondary procedure (P2) with the population of those who did not require it. Material and Methods Between 1998 and 2008, this study included all the patients electively treated for AAA with stentgrafts that were still available on the market on January 1, 2009. Data were prospectively collected and retrospectively analyzed. The postoperative follow-up included at least a systematic computed tomography scan at 6, 12, 18, and 24 months and then every year. P2 were defined as any additionnal procedures performed to treat aneurysm related complications after initial stentgraft implantation. Results We studied 162 patients with a mean 40 ± 31 months’ follow-up. In 32 patients (19.7%), there were 46 P2, 3 of them were surgical conversion and 1 with endovascular conversion. Thirty-nine P2 were scheduled, and seven were performed in emergency. Nine patients underwent more than one P2. P2 was indicated for type II endoleak in 17 cases, 13 of them with a diameter increase; for type I endoleak in 10 cases; for AAA rupture in 3 cases; for occlusion or stentgraft stenosis in 13 cases; and for 1 type III endoleak, 1 endotension, and 1 femoro-femoral crossover bypass infection. Two ruptures occurred in patients who had undergone P2. The immediate technical success was 89.1%. At 30 days, morbidity was 10.9%, and there was no mortality. Survival rates at 3 and 5 years were respectively 85.2% and 71.9% in patients with secondary procedure and 70.6% and 47.5% in the others (p = 0.046). Conclusions In patients treated for AAA with second generation stentgrafts, in the long term, secondary procedure rate was 19.7%. Survival rate for patients who underwent a secondary procedure was better, which was probably related to the fact that they were younger at the time of stentgraft implantation. Large AAA diameter was a secondary-procedure risk factor.

  • SARLON-BARTOLI G., BOUDES A., BUFFAT C., BARTOLI M. A., PIERCECCHI-MARTI M. D., SARLON E., ARNAUD L., BENNIS Y., THEVENIN B., SQUARCIONI C., NICOLI F., DIGNAT-GEORGE F., SABATIER F., MAGNAN P. E. “Circulating Lipoprotein-associated Phospholipase A2 in High-grade Carotid Stenosis: A New Biomarker for Predicting Unstable Plaque.”. European Journal of Vascular and Endovascular Surgery [En ligne]. 2012. Vol. 43, n°2, p. 154-159. Disponible sur : < >
    Résumé : Objective To test plasma levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with high-grade carotid stenosis according to plaque histology. Methods This cross-sectional single-centre study included patients with ≥70% North American Symptomatic Carotid Endarterectomy Trial (NASCET) carotid stenosis, who were treated surgically. Serum Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) were determined on the day of surgery. Histopathological analysis classified carotid plaque as stable or unstable, according to AHA classification. Results Of the 42 patients (mean age 70.4 ± 10.5 years; 67% men), neurological symptoms were present in 16 (38%). Unstable plaques were found in 23 (55%). Median plasma level of Lp-PLA2 was significantly higher in patients with unstable plaque compared to those with stable plaque (222.4 (174.9–437.5) interquartile range (IQR) 63.5 vs. 211.1 (174.9–270.6) IQR 37.2 ng ml−1; p = 0.02). Moreover, median Lp-PLA2 level were higher in asymptomatic patients with unstable plaque (226.8 ng ml−1 (174.9–437.5) IQR 76.8) vs. stable plaque (206.9 ng ml−1 (174.9–270.6) IQR 33.7; p = 0.16). Logistic regression showed that only the neurological symptoms (OR = 30.9 (3.7–244.6); p &lt; 0.001) and the plasma Lp-PLA2 level (OR = 1.7 (1.1–12.3); p = 0.03) were independently associated with unstable carotid plaque as defined by histology. Conclusions This study showed that circulating Lp-PLA2 was increased in patients with high-grade carotid stenosis and unstable plaque. Lp-PLA2 may be a relevant biomarker to guide for invasive therapy in asymptomatic patients with carotid artery disease.
    Mots-clés : Atherosclerosis, high-grade carotid stenosis, Lp-PLA2, unstable plaque.


Journal Article

  • BÉLÉNOTTI P., SARLON-BARTOLI G., BARTOLI M. - A., BENYAMINE A., THEVENIN B., MULLER C., SERRATRICE J., MAGNAN P. - E., WEILLER P. - J. “Vena Cava Filter Migration: An Unappreciated Complication. About Four Cases and Review of the Literature.”. Annals of Vascular Surgery [En ligne]. 2011. Vol. 25, n°8, p. 1141.e9-1141.e14. Disponible sur : < >
    Résumé : Inferior vena cava filter placement is performed to prevent pulmonary risk secondary to deep venous thrombosis. Indications for this treatment are limited to patients experiencing recurrences under well-managed anticoagulant treatment or presenting with contraindication to anticoagulant treatment. Nowadays, as these clinical situations are rare, this device is less and less used, all the more since, for several years now, thrombosis, fracture, or infectious complications as well as filter migration have been reported. Filter migrations are responsible for atypical and varied clinical presentations likely to defer diagnosis. To treat them, the filter is extracted, which is very risky in patients with a thromboembolic history. In our center, during a period of 14 years, we retrospectively collected and studied partial or complete vena cava filter migration cases that had been treated by extraction. We are reporting four very different clinical cases and, more specifically, the second published case of migration to a renal vein, which mimicked a systemic disease. Because of its very atypical clinical presentations, cava filter migration is an unappreciated and certainly underdiagnosed complication. However, this complication must not question cava filter placement when it is justified. In contrast, it prompts early filter extraction or long-term radiological surveillance.

  • SARLON G., BARTOLI M. A., MULLER C., ACID S., BARTOLI J. - M., COHEN S., PIQUET P., MAGNAN P. - E. “Congenital Anomalies of Inferior Vena Cava in Young Patients with Iliac Deep Venous Thrombosis.”. Annals of Vascular Surgery [En ligne]. 2011. Vol. 25, n°2, p. 265.e5-265.e8. Disponible sur : < >
    Résumé : Venous thromboembolism (VTE) in young patients is frequently associated with hereditary biological thrombophilia, autoimmune disorders, or neoplasia. Advances in venous ultrasound and contrast-enhanced computed tomography have allowed for the identification of inferior vena cava (IVC) anomalies as newly considered etiologic factor. We present two cases of VTE in young patients: the first case involves left IVC in a 22-year-old man and the second involves IVC atresia in a 39-year-old man. IVC anomalies should be identified in young patients with spontaneous VTE involving the iliac veins because they are at a high risk for thrombotic recurrence and adaptation to long periods of antithrombotic therapy.


Journal Article
  • BARTOLI M. A., LERUSSI G. B., GULINO R., SCHROEDER M., BRANCHEREAU A. “False aneurysm at the origin of the anterior tibial artery after opening wedge osteotomy.”. Vascular. 2010. Vol. 18, n°1, p. 45-48.
    Résumé : We report the case of a false aneurysm at the origin of the anterior tibial artery complicating upper tibial osteotomy. The proximally located lesion compressed the posterior tibial nerve, and despite successful decompression, the patient suffers from probably irreversible neurologic after-effects. Even though it is rare, this complication must be considered when faced with leg pain consecutive to upper tibial osteotomy without deep venous thrombosis.
    Mots-clés : Aneurysm, False, Decompression, Surgical, Humans, Male, Middle Aged, Nerve Compression Syndromes, Osteotomy, Pain, Saphenous Vein, Tibial Arteries, Tibial Neuropathy, Tomography, X-Ray Computed, Treatment Outcome.

  • SARLON G., BARTOLI M. - A., MALIKOV S., THEVENIN B., BRANCHEREAU A., MAGNAN P. - E. “[Long-term patency of a popliteal venous aneurysm treated surgically].”. Journal Des Maladies Vasculaires [En ligne]. 2010. Vol. 35, n°6, p. 369-372. Disponible sur : < > (consulté le no date)
    Résumé : Popliteal venous aneurysms are infrequent but should be screened for with venous ultrasound in patients with acute or chronic venous diseases because of the unpredictable high risk of thromboembolism and potential curability. Therapeutic alternatives are discussed: follow-up, anticoagulation, surgery with different techniques. To illustrate this, we report the case of a 51-year-old woman presenting pulmonary embolism and left popliteal venous aneurysm treated surgically. Anticoagulation was stopped 12 months after surgery and primary patency was maintained 40 months after surgery. In patients with thromboembolism disease, clinicians should search for popliteal venous aneurysms in order to prevent recurrent thrombosis and adapt follow-up and treatment.
    Mots-clés : Aneurysm, Female, Humans, Middle Aged, Popliteal Vein, Time Factors, Vascular Patency.


Journal Article

  • BARTOLI M. A., SQUARCIONI C., NICOLI F., MAGNAN P. - E., MALIKOV S., BERGER L., LERUSSI G. B., BRANCHEREAU A. “Early Carotid Endarterectomy after Intravenous Thrombolysis for Acute Ischaemic Stroke.”. European Journal of Vascular and Endovascular Surgery [En ligne]. 2009. Vol. 37, n°5, p. 512-518. Disponible sur : < >
    Résumé : After intravenous thrombolysis (IVT) for acute ischaemic stroke (AIS), a severe cervical internal carotid artery (ICA) stenosis may remain and increase the risk of recurrent stroke. Carotid endarterectomy (CEA) has been shown to be effective in reducing the risk of stroke. However, it is not well known whether CEA can be performed safely after thrombolysis, and, if so, when. We report a prospective study of CEA for residual high-grade cervical ICA stenosis performed within 15 days after IVT for AIS. Methods All the patients had a brain magnetic resonance imaging (MRI) within 3 h of the stroke onset. One day after IVT in neurovascular unit, computed tomography (CT) angiography was performed to assess the brain and the patency of cervical arteries. CEA was performed on neurologically stable patients after full cerebral artery re-canalisation. Blood pressure was controlled with particular caution before and after CEA. Results Between January 2005 and January 2008, we operated consecutively on 12 patients. Their median National Institutes of Health Stroke Scale (NIHSS) score was 12 (range: 5–21). Combined intracranial (ICA)–middle cerebral artery (MCA) occlusion was present in 58.3% of the patients. The median time between onset of symptoms until CEA was 8 days (range: 1–16 days). Stroke and death rate at 30 days was 8.3% (one nonfatal haemorrhagic stroke). At 90 days, nine patients had a Rankin score of 0–1, one had a score of 2 and two had a score of 3. Conclusion In patients with residual cervical ICA stenosis after IVT, we achieved full patency of the occluded artery and good functional prognosis at 3 months in all cases. We advocate for an extremely close monitoring of the blood pressure in the pre-, peri- and post-operative course and a close collaboration between neurologist and surgeon to determine the best timing for CEA.
    Mots-clés : Acute ischaemic stroke, Early carotid endarterectomy, Extra-cranial internal carotid artery stenosis, Intravenous thrombolysis.

  • SARLON G., LAPIERRE F., SARLON E., BARTOLI M. - A., MAGNAN P. E., BRANCHEREAU A. “[Endovascular aneurysm repair follow-up by unenhanced and contrast-enhanced duplex ultrasound].”. Journal Des Maladies Vasculaires [En ligne]. 2009. Vol. 34, n°1, p. 34-43. Disponible sur : < > (consulté le no date)
    Résumé : OBJECTIVE: Long-term surveillance is needed after endovascular aneurysm repair to monitor the aneurysm and search for persistent endoleaks. Our aim was to compare follow-up with duplex ultrasound, with and without a new contrast agent to track endoleaks, versus computed tomography angiography taken as the gold standard. MATERIAL AND METHOD: Patients treated with endograft were included prospectively from December 2005 to July 2006. Aortic duplex ultrasound and computed tomography were used to measure maximal aneurysm diameter and detect endoleaks. Patients with a high risk of endoleaks had a contrast-enhanced ultrasound with Sonovue (Bracco, Milan, Italy). We compared echographic and tomographic diameter and studied the sensitivity of ultrasound endoleak diagnosis. RESULTS: Sixty-seven patients were included. There was a good correlation between maximum anteroposterior diameters (CCI=0.98) measured by ultrasound and tomography, as well as mean maximum cross section diameters (CCI=0.96). Compared to tomography, the sensitivity of ultrasound endoleaks diagnosis was 44% (kappa=0.58). Contrast injection improved this sensitivity significantly (p<0.001) (sensitivity=88%; kappa=0.72). CONCLUSION: These findings confirmed the performance of our ultrasound method for endograft surveillance. Contrast-enhanced ultrasound significantly improves the sensitivity of detection of endoleaks. We suggest alternating ultrasound and tomographic exams. A unique report chart for use nationwide would be useful for standardizing follow-up.
    Mots-clés : Aortic Aneurysm, Abdominal, Blood Vessel Prosthesis Implantation, Coronary Disease, Echocardiography, Doppler, Echocardiography, Doppler, Color, Follow-Up Studies, Heart Failure, Humans, Renal Insufficiency, Tomography, X-Ray Computed, Ultrasonography, Doppler, Duplex.


Journal Article
  • BARTOLI M. A., MILLON A., MAGNAN P. E., BRANCHEREAU A. “Endovascular management of a significantly kinked aortomonoiliac stent graft.”. Vascular. 2008. Vol. 16, n°2, p. 112-115.
    Résumé : We report our endovascular management of a highly kinked aortomonoiliac stent graft. This complication is unusual because kinks generally occur in bifurcated stent grafts and they are managed with extra-anatomic bypass. We will then expose the possible reasons for such complication. With long term follow-up severe kink might be reported more often.
    Mots-clés : Aged, 80 and over, Aortic Aneurysm, Abdominal, Aortography, Blood Vessel Prosthesis Implantation, Graft Occlusion, Vascular, Humans, Iliac Artery, Minimally Invasive Surgical Procedures, Stents.


Journal Article

  • PAGANO M. B., BARTOLI M. A., ENNIS T. L., MAO D., SIMMONS P. M., THOMPSON R. W., PHAM C. T. N. “Critical role of dipeptidyl peptidase I in neutrophil recruitment during the development of experimental abdominal aortic aneurysms.”. Proceedings of the National Academy of Sciences of the United States of America [En ligne]. 20 February 2007. Vol. 104, n°8, p. 2855-2860. Disponible sur : < >
    Résumé : Dipeptidyl peptidase I (DPPI) is a lysosomal cysteine protease critical for the activation of granule-associated serine proteases, including neutrophil elastase, cathepsin G, and proteinase 3. DPPI and granule-associated serine proteases have been shown to play a key role in regulating neutrophil recruitment at sites of inflammation. It has recently been suggested that neutrophils and neutrophil-associated proteases may also be important in the development and progression of abdominal aortic aneurysms (AAAs), a common vascular disease associated with chronic inflammation and destructive remodeling of aortic wall connective tissue. Here we show that mice with a loss-of-function mutation in DPPI are resistant to the development of elastase-induced experimental AAAs. This is in part because of diminished recruitment of neutrophils to the elastase-injured aortic wall and impaired local production of CXC-chemokine ligand (CXCL) 2. Furthermore, adoptive transfer of wild-type neutrophils is sufficient to restore susceptibility to AAAs in DPPI-deficient mice, as well as aortic wall expression of CXCL2. In addition, in vivo blockade of CXCL2 by using neutralizing antibodies directed against its cognate receptor leads to a significant reduction in aortic dilatation. These findings suggest that DPPI and/or granule-associated serine proteases are necessary for neutrophil recruitment into the diseased aorta and that these proteases act to amplify vascular wall inflammation that leads to AAAs.


Journal Article

  • BARTOLI M. A., PARODI F. E., CHU J., PAGANO M. B., MAO D., BAXTER B. T., BUCKLEY C., ENNIS T. L., THOMPSON R. W. “Localized administration of doxycycline suppresses aortic dilatation in an experimental mouse model of abdominal aortic aneurysm.”. Annals of Vascular Surgery [En ligne]. 2006. Vol. 20, n°2, p. 228-236. Disponible sur : < > (consulté le no date)
    Résumé : Treatment with doxycycline suppresses the development of abdominal aortic aneurysms (AAAs) in experimental animal models, but its use in humans can be accompanied by dose-related side effects. We sought to determine if localized administration of doxycycline can achieve inhibition of AAAs equivalent to that achieved by systemic treatment. C57BL/6 mice underwent transient elastase perfusion of the abdominal aorta to induce the development of AAAs. After 14 days, the mean increase in aortic diameter was reduced from 167.2+/-7.8% in untreated mice to only 129.7+/-13.8% in mice treated with 100 mg/kg/day oral doxycycline (p<0.05). Using osmotic minipumps to provide continuous periaortic infusion of doxycycline, localized infusion at rates of 0.75 to 1.0 mg/kg/day suppressed AAAs to an equivalent or even greater extent than systemic treatment [mean increase in aortic diameter 131.5+/-14.4% at 0.75 mg/kg/day, p<0.05; 103.2+/-13.5% at 1.0 mg/kg/day, p<0.01). Mean plasma doxycycline levels reached 332+/- 62 ng/mL during oral administration, but the drug was undetectable in the circulation during localized infusion. The doxycycline concentration in aortic tissue extracts was 22+/- 6 ng/mL during systemic treatment compared to only 5.6+/- 2.2 ng/mL [at 0.75 mg/kg/day] and 7.8+/- 4.0 ng/mL [at 1.0 mg/kg/day] during localized infusion (p<0.05). Localized administration of doxycycline can effectively suppress experimental AAAs with undetectable plasma drug levels, even at doses 100-fold lower than those used during oral drug administration. Localized delivery of doxycycline holds promise as a novel strategy to inhibit the progressive expansion of aortic aneurysms, perhaps as a pharmacological adjunct to endovascular (stent graft) treatment.
    Mots-clés : Administration, Oral, Animals, Anti-Bacterial Agents, Aorta, Abdominal, Aortic Aneurysm, Abdominal, Dilatation, Pathologic, Disease Models, Animal, Dose-Response Relationship, Drug, Doxycycline, Infusion Pumps, Implantable, Male, Mice, Mice, Inbred C57BL, Pancreatic Elastase.


Journal Article

  • PARODI F. E., MAO D., ENNIS T. L., BARTOLI M. A., THOMPSON R. W. “Suppression of experimental abdominal aortic aneurysms in mice by treatment with pyrrolidine dithiocarbamate, an antioxidant inhibitor of nuclear factor-kappaB.”. Journal of Vascular Surgery [En ligne]. 2005. Vol. 41, n°3, p. 479-489. Disponible sur : < > (consulté le no date)
    Résumé : OBJECTIVE: Proinflammatory cytokines and matrix metalloproteinases (MMPs) are prominent mediators of the connective tissue destruction that characterizes abdominal aortic aneurysms (AAAs), and nuclear factor (NF)-kappaB is a cytokine-responsive transcription factor that promotes macrophage MMP expression. The purpose of this study was to determine whether aneurysmal degeneration is influenced by pyrrolidine dithiocarbamate (PDTC), a pharmacologic inhibitor of NF-kappaB. METHODS: Adult male C57BL/6 mice underwent transient elastase perfusion of the abdominal aorta to induce the development of AAAs. Animals were treated every 48 hours by intraperitoneal injection with either saline (n = 34) or PDTC 20 mg/kg (n = 49). Aortic diameter (AD) measurements were used to determine the extent of aortic dilatation before and immediately after elastase perfusion and again at day 14. RESULTS: All saline-treated mice developed AAAs associated with mononuclear inflammation and destruction of medial elastin (overall increase in AD, mean +/- SEM, 169.1% +/- 7.5%). In contrast, the incidence of AAAs was only 63% in PDTC-treated mice, with a reduction in the overall increase in AD to 109.8% +/- 4.2% ( P < .0001 vs saline), decreased inflammation, and structural preservation of aortic wall connective tissue. Although aneurysm development in saline-treated mice was associated with a marked increase in aortic tissue NF-kappaB and activator protein 1 DNA-binding activities, both activities were substantially reduced in PDTC-treated animals. PDTC-treated mice also exhibited significantly lower serum and aortic wall concentrations of interleukin 1beta and interleukin 6, as well as lower amounts of aortic wall MMP-9, as compared with saline-treated controls. CONCLUSIONS: Treatment with PDTC inhibits elastase-induced experimental AAAs in the mouse, along with suppression of aortic wall NF-kappaB and activator protein 1 transcription factor activities, reduced expression of proinflammatory cytokines, and suppression of MMP-9. NF-kappaB is therefore a potentially important therapeutic target for the suppression of aneurysmal degeneration. CLINICAL RELEVANCE: Development and progression of human AAAs is associated with inflammation and enzymatic degradation of connective tissue proteins. MMP-9 is one of the enzymes involved in aneurysm disease, and its production may be induced in part by activation of the transcription factor NF-kappaB. In this mouse model, treatment with pyrrolidine dithiocarbamate (a pharmacologic inhibitor of NF-kappaB) acted to suppress MMP-9 and aneurysm development. It is hoped that treatment strategies that target NF-kappaB may eventually be shown to suppress the growth of small aortic aneurysms in patients.
    Mots-clés : Animals, Aortic Aneurysm, Abdominal, Disease Models, Animal, Disease Progression, Electrophoretic Mobility Shift Assay, Interleukin-1, Interleukin-6, Male, Matrix Metalloproteinase 9, Mice, Mice, Inbred C57BL, NF-kappa B, Pyrrolidines, Thiocarbamates, Transcription Factor AP-1.
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