JMV-Journal de Medecine Vasculaire最新文献

{"title":"Survival within 12 months after stroke in Madagascar","authors":"Rahamefy Odilon Randrianasolo ,&nbsp;Naliniaina Robert Randrianantoandro ,&nbsp;Dolly Tohaina ,&nbsp;Giannie Rasamimanana ,&nbsp;Alain Djacoba Tehindrazanarivelo","doi":"10.1016/j.jdmv.2024.03.004","DOIUrl":"10.1016/j.jdmv.2024.03.004","url":null,"abstract":"<div><p>The data on the long-term prognosis of stroke are scarce in Madagascar. Our objective was to determine survival within 12<!--> <!-->months after a stroke event. A longitudinal study was carried out on a hospital cohort of subjects with stroke in Mahajanga in western Madagascar. We included in the study all subjects admitted to adult emergencies at Mahajanga University Hospitals during the year 2019 and diagnosed with stroke. A follow-up by telephone call or by descent at the home of the patients was carried out after at least 12<!--> <!-->months from the onset of the disease. We analyzed in-hospital mortality and survival within 12<!--> <!-->months after the stroke. At the end of the study period, 144 stroke cases were retained. Strokes accounted for 5.07% of emergency admission causes. Male gender accounted for 51.4% of the population. The average age of the subjects was 60.7<!--> <!-->years. In-hospital mortality was 32.6%. Survival at 1<!--> <!-->month was 50%, at 3<!--> <!-->months 48.4%, and at 12<!--> <!-->months 43%. High blood pressure was found as a risk factor for stroke in 79.9% of patients, 76.5% of whom were undertreated. Stroke mortality was high in our population. Most of the deaths occurred during the first month. Improved prevention and care are needed in Madagascar.</p></div>","PeriodicalId":53149,"journal":{"name":"JMV-Journal de Medecine Vasculaire","volume":"49 2","pages":"Pages 98-102"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of a chronic wound in the special case of a vascular malformation: A proposal of the Wound and Healing Group of the French Society of Vascular Medicine","authors":"Sophie Blaise ,&nbsp;Julie Malloizel-Delaunay ,&nbsp;Monira Nou ,&nbsp;behalf the Wound and Healing Group of the French Society of Vascular Medicine","doi":"10.1016/j.jdmv.2024.03.003","DOIUrl":"10.1016/j.jdmv.2024.03.003","url":null,"abstract":"<div><p>Vascular malformations can present with a variety of symptoms and an unpredictable course with the occurrence of wounds. Ulcerations in patients with vascular malformations are fortunately rare. Although few data exist, complications may involve a variety of mechanistic or hemodynamic factors. A rigorous etiological and vascular assessment is therefore essential. In view of the paucity of recommendations, the Wound and Healing Group of the French Society of Vascular Medicine, based on the literature on the subject, presents a number of suggestions for the diagnosis and management of wounds associated with vascular malformations.</p></div>","PeriodicalId":53149,"journal":{"name":"JMV-Journal de Medecine Vasculaire","volume":"49 2","pages":"Pages 103-111"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S254245132400110X/pdfft?md5=27e07dd2123aef1ec9973f3062632b85&pid=1-s2.0-S254245132400110X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-hospital admission, morbidity and mortality rate in patients undergoing tunnelled catheter implantation for haemodialysis","authors":"Ottavia Borghese ,&nbsp;Margaux Campion ,&nbsp;Marie Magana ,&nbsp;Angelo Pisani ,&nbsp;Isabelle Di Centa","doi":"10.1016/j.jdmv.2023.12.001","DOIUrl":"10.1016/j.jdmv.2023.12.001","url":null,"abstract":"<div><h3>Objective</h3><p>Despite the effort to increase the proportion of patients starting dialysis on native accesses, many of them are still dialyzed on tunnelled catheter. Catheter-related complications are often serious and responsible for re-hospital admission, high morbidity and mortality. Several multicenter trials have reported results in the use of tunnelled dialysis catheter (TDC). However, few single-center studies have been published to verify the outcome from real-world experience. This study presents our center's experience in managing such patients in the context of relevant literature.</p></div><div><h3>Methods</h3><p>Demographics and operative data were retrospectively collected from medical charts. A prospective follow-up was performed to investigate complications, number of re-hospitalizations and mortality. Kaplan-Meier estimate was used to evaluate catheter primary patency and patients’ overall survival.</p></div><div><h3>Results</h3><p><span>Among a total 298 haemodialysis accesses interventions, 105 patients (56 men, 53.3% and 49 women, 46.7%) with a median age of 65 years (range 32–88 years) were included in the study. All insertions were successful with an optimal blood flow achieved during the first session of dialysis in all cases. A catheter-related complication was detected in 33.3% (</span><em>n</em> <!-->=<!--> <!-->35) patients (48.6% infections; 28.6% TDC dysfunction; 14.3% local complications; 5.7% accidental catheter retractions; 2.8% catheter migrations). At a median follow-up of 10.5<!--> <!-->±<!--> <span>8.5 months, a total of 85 patients (80.9%) was re-hospitalized, in 28 cases (26.7%) for a catheter-related cause. The median catheter patency rate was 122 days. At the last follow-up, 39 patients (37.1%) were still dialyzed on catheter, 30(28.6%) were dialyzed on an arteriovenous fistula<span><span> and 7(6.7%) received a kidney transplantation. Two patients (2%) were transferred to </span>peritoneal dialysis and two patients (2%) recover from renal insufficiency. Mortality rate was 23.8% (25 patients). Causes of death were myocardial infarction (</span></span><em>n</em> <!-->=<!--> <!-->13, 52%), sepsis (<em>n</em> <!-->=<!--> <span>9, 36%); one patient (4%) died from pneumonia, one (4%) from uremic encephalopathy and one (4%) from massive hematemesis.</span></p></div><div><h3>Conclusion</h3><p>TDCs may represent the only possible access in some patients, however they are burned with a high rate of complications, re-hospital admission and mortality. Results from this institutional experience are in line with previously published literature data in terms of morbidity and mortality. The present results reiterate once more that TDC must be regarded as a temporary solution while permanent access creation should be prioritized. Strict surveillance should be held in patients<span> having TDC for the early identification of complications allowing the prompt treatment and modifying the catheter insertion site whe","PeriodicalId":53149,"journal":{"name":"JMV-Journal de Medecine Vasculaire","volume":"49 2","pages":"Pages 65-71"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140518986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of performing treadmill walking test for patients with peripheral arterial occlusive disease by the advanced practice nurses","authors":"G. Dumas ,&nbsp;A. Danjou ,&nbsp;C. Richaud ,&nbsp;R. Spear ,&nbsp;M. Joly ,&nbsp;S. Blaise","doi":"10.1016/j.jdmv.2024.03.005","DOIUrl":"10.1016/j.jdmv.2024.03.005","url":null,"abstract":"<div><h3>Aim</h3><p>The treadmill walking test with post-exercise pressure measurement can be used as a diagnostic test and could classify peripheral arterial disease of the lower limbs. It can also exclude the diagnosis allowing to raise the possibility of differential diagnoses. In this study, we assessed the feasibility of performing treadmill test by advanced practice nurse to assess suspected lower extremity peripheral artery disease patients.</p></div><div><h3>Design and method</h3><p>This is a longitudinal monocentric study to assess the feasibility of a treadmill walking test performed by an advanced practice nurse. The primary endpoint was the number of tests performed during this period. The secondary objectives were to evaluate the reasons for requesting the test, the main results obtained in terms of the test's contribution and diagnoses, and patients’ clinical characteristics.</p></div><div><h3>Results</h3><p>From February to May 2023, amongst 31 patients who underwent the treadmill walking test, 4 tests were able to rule out peripheral arterial disease and to detect differential diagnoses. For the remaining 27 patients, 4 had stage IIa of the Leriche classification, 23 had stage IIb, 2 of which were associated with a narrow lumbar spine. In contrast to the usual report, the APN's report on the walking test included an identification of cardiovascular risk factors, as well as a possible medical reorientation linked to the correction of a detected cardiovascular risk factor.</p></div><div><h3>Conclusion</h3><p>The treadmill walking test can be performed by an advanced practice nurse. He/She added a comprehensive/global patient management, with the detection of cardiovascular risk factors. This new profession led to an increase in the number of tests performed of more than 50% over the period and reduced the time to access the test.</p></div>","PeriodicalId":53149,"journal":{"name":"JMV-Journal de Medecine Vasculaire","volume":"49 2","pages":"Pages 90-97"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542451324001123/pdfft?md5=e38f15833802a6b1baa813470be3e5b3&pid=1-s2.0-S2542451324001123-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140790329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent brain infarctions in patients with acute cardioembolic stroke","authors":"Imane Najmi ,&nbsp;Soumaya Benmaamar ,&nbsp;Sara Zejli ,&nbsp;Siham Bouchal ,&nbsp;Samira El Fakir ,&nbsp;Karima El Rhazi ,&nbsp;Mohammed Faouzi Belahsen","doi":"10.1016/j.jdmv.2024.02.003","DOIUrl":"10.1016/j.jdmv.2024.02.003","url":null,"abstract":"<div><h3>Introduction and aim</h3><p>The advances and the wide use of brain imaging have considerably increased the prevalence of silent brain infarctions (SBI). We aim in this study to determine the prevalence of SBI in patients presenting with acute cardioembolic stroke and the predictive cardiovascular risk factors.</p></div><div><h3>Methods</h3><p>This retrospective study included 267 patients presenting with acute cardioembolic stroke in the emergency and/or neurology departments of the Hassan II University Hospital Center. Clinical, biological and echocardiographic characteristics were recorded. All patients were screened for SBI by brain imaging.</p></div><div><h3>Results</h3><p>The prevalence of SBI in our series was 46%. A group of 203 non-valvular patients and a group of 64 valvular patients were distinguished. In non-valvular group, the average age was 72.97<!--> <!-->±<!--> <!-->10.53<!--> <!-->years. The prevalence of SBI was 45.3%. Forty-four percent of patients with SBI had atrial fibrillation (AF). In multivariate regression analysis, the history of previous stroke, CHA₂DS₂-VASc Score<!--> <!-->≥<!--> <!-->4, enlarged left atrium (LA), the association of AF with enlarged LA and the lability of International Normalized Ratio in patients initially treated with anticoagulants were significantly associated with the occurrence of SBI (<em>P</em> <!-->=<!--> <!-->0.013, <em>P</em> <!-->=<!--> <!-->0.032, <em>P</em> <!-->=<!--> <!-->0.0001, <em>P</em> <!-->=<!--> <!-->0.01, <em>P</em> <!-->=<!--> <!-->0.03, respectively). Territorial location was significantly the most frequent (<em>P</em> <!-->=<!--> <!-->0.007). In valvular group, the average age was 57.19<!--> <!-->±<!--> <!-->14.38<!--> <!-->years. The prevalence of SBI was 48.4%. In multivariate regression analysis, SBI were significantly associated with moderate or severe mitral stenosis (<em>P</em> <!-->=<!--> <!-->0.02) and with the enlarged LA (<em>P</em> <!-->=<!--> <!-->0.02). In all patients, Modified Rankin Scale at 3 months of discharge from the acute stroke was significantly higher (mRS<!--> <!-->≥<!--> <!-->3) in patients with SBI (<em>P</em> <!-->=<!--> <!-->0.04).</p></div><div><h3>Conclusions</h3><p>SBI requires good management of associated cardiovascular risk factors in a population presenting with initial cardioembolic stroke.</p></div>","PeriodicalId":53149,"journal":{"name":"JMV-Journal de Medecine Vasculaire","volume":"49 2","pages":"Pages 80-89"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiplaquettaires, anticoagulants dans l’AOMI : quelles indications ?","authors":"Alessandra Bura-Rivière ,&nbsp;Céline Boidin ,&nbsp;François-Xavier Lapébie","doi":"10.1016/j.jdmv.2024.01.022","DOIUrl":"https://doi.org/10.1016/j.jdmv.2024.01.022","url":null,"abstract":"<div><p>Les antithrombotiques constituent la pierre d’angle du traitement des patients atteints de pathologie athéromateuse symptomatique. Depuis plus de 30 ans, l’aspirine et le thiénopyridines sont les reines incontestées de la prise en charge de l’artériopathie athéromateuse des membres inférieurs (AOMI). Le risque d’évènement cardiovasculaire majeur ainsi que le risque d’amputation et d’aggravation locale restent très élevés, malgré une prise en charge pharmacologique moderne, qui vise à réduire le risque métabolique, par les statines, les antihypertenseurs et les antidiabétiques. Un rôle bénéfique sur la réduction du risque CV a été démontré avec le rivaroxaban à la dose de 2,5<!--> <!-->mg deux fois par jour, en combinaison avec 100<!--> <!-->mg d’aspirine, chez des patients avec une AOMI à risque élevé et chez les patients avec une AOMI récemment revascularisée. La balance bénéfice/risque de cette combinaison doit être attentivement évaluée, car ces patients peuvent présenter un risque hémorragique non négligeable et l’association de plusieurs antithrombotiques véhicule presque toujours un surrisque hémorragique. Pendant cette séance, seront présentés les critères pouvant aider en pratique dans le choix du meilleur traitement antithrombotique dans l’AOMI.</p></div>","PeriodicalId":53149,"journal":{"name":"JMV-Journal de Medecine Vasculaire","volume":"49 1","pages":"Page 24"},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139935523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La radiale distale : une excentricité de « radialiste » ?","authors":"Jean-Marc Pernès","doi":"10.1016/j.jdmv.2024.01.034","DOIUrl":"https://doi.org/10.1016/j.jdmv.2024.01.034","url":null,"abstract":"<div><p>Récemment, l’artère radiale distale, en regard de la tabatière anatomique sur la face dorsale de la main (« ARD distale » ou « dorsale » ou « accès à la tabatière »), est apparue comme un accès alternatif à l’artère radiale conventionnelle de l’avant-bras pour l’angiographie coronarienne et les interventions. Elle a été « inventée » pour la canulation de l’artère radiale en anesthésie-réanimation par Stephen Pyles en 1982 et proposée en cardiologie interventionnelle par Avtandil Babunashvili (Moscou) dès la fin des années 1990, qui l’a initialement utilisée pour désobstruer de manière rétrograde des occlusions thrombotiques de l’artère radiale à l’avant-bras, survenues dans les 6<!--> <!-->jours après une coronarographie par voie radiale traditionnelle. Il y a environ 10 ans, indépendamment les uns des autres, 3 cardiologues interventionnels russes (Babunashvili A., Kaledin A., Korotkikh A.) ont commencé à développer activement l’abord de l’artère radiale dans la tabatière anatomique pour les procédures endovasculaires, en avoir révélé certains avantages, notamment la réduction du risque de complications locales. On distingue deux voies d’abord, dans la tabatière anatomique (au bord externe du poignet) et au dos de la main (voie radiale très distale) même s’il s’agit plus ou moins du même espace anatomique, qui est séparé en deux par le tendon de l’extenseur long du pouce. Au-delà des avantages potentiels liés à l’amélioration du confort de l’opérateur, à une hémostase plus facile et plus courte due à la position plus superficielle de l’artère radiale distale, l’abord de l’artère radiale distale présente une justification physiologique et anatomique solide pour réduire le taux d’occlusion de l’artère radiale de l’avant-bras. En effet, une caractéristique importante de cette technique est une ponction distale à l’arc palmaire superficiel. En tant que telle, la ponction radiale distale a le potentiel de maintenir le flux antérograde dans l’artère radiale de l’avant-bras pendant la compression hémostatique ou en cas d’occlusion distale de l’artère radiale, réduisant ainsi le risque de formation de thrombus rétrograde. Les données actuellement disponibles sur l’abord distal se limitent à des séries de cas observationnels examinant principalement la faisabilité et les taux de réussite de cette approche. Fait intéressant, la plupart des études ont rapporté un taux d’occlusion de l’artère radiale<!--> <!-->&lt;<!--> <!-->1 %. Ce nouvel abord vasculaire associé à la miniaturisation contemporaine des dispositifs de cathétérisme peut ainsi être privilégié pour la réalisation d’angioplastie périphérique en mode ambulatoire, en particulier des artères iliaques, en s’affranchissant du risque des complications locales de la ponction fémorale et des surcoûts liés à l’emploi des systèmes mécaniques d’hémostase.</p></div>","PeriodicalId":53149,"journal":{"name":"JMV-Journal de Medecine Vasculaire","volume":"49 1","pages":"Page 28"},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139935708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lithotripsie intravasculaire : quand les ultrasons s’attaquent au calcaire !","authors":"Costantino Del Giudice","doi":"10.1016/j.jdmv.2024.01.033","DOIUrl":"https://doi.org/10.1016/j.jdmv.2024.01.033","url":null,"abstract":"<div><p>La maladie vasculaire périphérique est fréquemment caractérisée par la médiacalcose, particulièrement chez le sujet affecté par diabète, insuffisance rénale chronique et hypertension artérielle. Les calcifications intravasculaires sont associées à un mauvais pronostic avec une augmentation de la mortalité et morbidité cardiovasculaires. Les calcifications peuvent réduire l’efficacité de l’angioplastie périphérique et la pose d’endoprothèse pour une expansion suboptimale et risquent d’augmenter les complications telles que la resténose, la dissection, la perforation et l’embolisation distale. La présence de calcifications peut aussi rendre nécessaire la dilatation du vaisseau avec ballonnet à haute pression pour obtenir un résultat satisfaisant, en augmentant la réaction inflammatoire liée à l’angioplastie et le risque de complications ultérieurement. Le cathéter de lithotripsie est un ballon d’angioplastie dont la particularité est la présence de micro-émetteurs à l’intérieur même du ballonnet. Le principe de la lithotripsie consiste à créer un influx électrique à partir d’un générateur, provoquant alors une étincelle qui, à son tour, va générer, par vaporisation, des microbulles dans le fluide du ballon d’angioplastie. La genèse et la déflagration de ces microbulles entraînent alors une onde acoustique circonférentielle qui va être transmise par le ballon à la paroi vasculaire et interagir avec les tissus de haute impédance acoustique comme la plaque calcique. Au contact du calcium, elle va libérer son énergie et entraîner des fractures longitudinales multiplans sans affecter les tissus sains en raison de leurs impédances acoustiques proches de celle de l’eau. On estime que l’onde acoustique peut pénétrer jusqu’à 7<!--> <!-->mm dans la paroi artérielle, affectant donc les lésions calcifiées superficielles, mais également profondes non atteignables par les systèmes d’athérectomie. Une fois la plaque calcaire fragilisée par ces ondes de choc, la lésion permettra de mieux répondre au ballon conventionnel et <em>in fine</em> de mieux préparer la mise en place de l’endoprothèse active. Plusieurs essais multicentriques ont démontré la sécurité et l’efficacité de ce dispositif qui aujourd’hui peut être utilisé pour améliorer la prise en charge des lésions calcifiées et permettre le traitement de cette pathologie, qui avant était réservée seulement à la chirurgie.</p></div>","PeriodicalId":53149,"journal":{"name":"JMV-Journal de Medecine Vasculaire","volume":"49 1","pages":"Pages 27-28"},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139935709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Les ischémies digitales de la sclérodermie systémique","authors":"Patrick Carpentier","doi":"10.1016/j.jdmv.2024.01.031","DOIUrl":"https://doi.org/10.1016/j.jdmv.2024.01.031","url":null,"abstract":"<div><p>Le modèle pathologique de la sclérodermie systémique permet d’illustrer l’ensemble des problématiques de l’ischémie digitale. Sur le plan clinique, outre l’ischémie transitoire du phénomène de Raynaud qui est présent chez presque tous les patients, on rencontre souvent les ulcérations millimétriques ou leurs séquelles cicatricielles rétractiles, plus rarement les ulcérations centimétriques ou les plaques nécrotiques qui mettent en jeu le pronostic du doigt. Dans tous les cas, l’invalidation du patient est importante. Sur le plan physiopathologique, la microangiopathie est au premier plan, mais l’artériopathie digitale joue aussi un rôle très important, ainsi que les facteurs vasospastiques et rhéologiques, et chez certains patients aux ulcères périarticulaires, la pression tissulaire. Sur le plan diagnostique, le Raynaud est le signe d’appel le plus fréquent, et permet de faire précocement le diagnostic des formes incipientes, mais les ulcérations ou leurs cicatrices ont également une haute valeur reconnue dans les récentes classifications. La capillaroscopie péri-unguéale, qui est désormais un examen central dans la prise en charge de la maladie, et l’exploration artérielle notamment par la mesure des pressions digitales, sont les explorations vasculaires les plus utiles dans cette pathologie. Enfin, sur le plan thérapeutique, l’ischémie digitale sclérodermique reste un challenge, malgré un nombre conséquent d’essais thérapeutiques qui ont mis en avant les bénéfices malheureusement limités des calcium-bloqueurs, des prostaglandines, des inhibiteurs de l’endothéline et de PDE5, mais aussi de la toxine botulique. Les mesures d’hygiène de vie et notamment la protection contre le froid restent primordiales.</p></div>","PeriodicalId":53149,"journal":{"name":"JMV-Journal de Medecine Vasculaire","volume":"49 1","pages":"Page 27"},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139935711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sport : les recommandations après une dissection artérielle","authors":"Tristan Mirault","doi":"10.1016/j.jdmv.2024.01.073","DOIUrl":"https://doi.org/10.1016/j.jdmv.2024.01.073","url":null,"abstract":"<div><p>Quand vient la question d’autoriser une activité sportive après une dissection artérielle, on ressent flotter dans le box de consultation l’inquiétude de la patiente ou du patient et la perplexité de son médecin. Les données de la littérature sont en effet inexistantes et la prudence du médecin se confronte au désir de vouloir tourner la page du patient ou de la patiente. D’un côté, la bibliographie regorge de cas isolés de dissection d’artère cervicale <span>[1]</span> ou d’artère coronaire <span>[2]</span> ou d’artère viscérale <span>[3]</span> survenant au décours d’une activité sportive. De l’autre côté, la récidive de dissection après un évènement est très faible alors qu’on ne peut imaginer des patientes et des patients se soustraire totalement à toute activité physique <span>[4]</span>, <span>[5]</span>. Nous essayerons donc dans cette présentation d’analyser les données existantes notamment après dissection aortique <span>[6]</span>, <span>[7]</span> ou dissection coronaire spontanée <span>[8]</span>, <span>[9]</span>, <span>[10]</span>, <span>[11]</span>, <span>[12]</span>, <span>[13]</span> et d’évaluer si une extrapolation aux autres territoires est raisonnable.</p></div>","PeriodicalId":53149,"journal":{"name":"JMV-Journal de Medecine Vasculaire","volume":"49 1","pages":"Page 13"},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139936497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}