Background: Pseudoaneurysm is the usual complication of arterial injury. The aim of this study is to describe the etiology and the management of post-traumatic peripheral arterial pseudoaneurysm in Antananarivo. Methods: This is a bicentric retrospective study for 10 years period (January 2010 to December 2019), performed in Cardiovascular Unit in Joseph Ravoahangy Andrianavalona Teaching Hospital and in Vascular Unit in Soavinandriana Hospital Center, including all patient who underwent a surgical procedure of post-traumatic peripheral arterial pseudoaneurysm. Results: 38 patients were recorded in 10 years period, which 26 patients recorded in JRA hospital and 12 patients in Soavinandriana Hospital. Patients were 33 males (86.84%) and 5 females (13.15%). Gunshots wounds (47.36%) and stabs wounds (34.21%) were the commonest circumstances of etiology. Pulsatile mass (84.21%), pain (60.52%) and palpable thrill (71.05%) were the usual of peripheral pseudoaneurysm. Doppler ultrasound (94.73%) and computed tomographic angiography (13.15%) performed the diagnosis of the pseudoaneurysm. Femoral artery (39.47%) and brachial artery (31.57%) were the most involved vessels. All patients underwent an open surgery. Surgical procedures were arterial repair in 26 patients (68.42%), reversed saphenous vein interposition in 5 patients (13.15%), PTFE graft in 2 patients (5.26%) and ligation excision in 5 patients (13.15%). There was no reoperation or mortality in early postoperative period. Conclusion: Trauma is the most common etiology of pseudoaneurysm in Antananarivo. Open surgical repair remains the procedure to treat the post-traumatic peripheral arterial pseudoaneurysm in our experience.
Introduction: The aim of this study was to describe the principle of the management for non-infectious aneurysm of the sub-kidney abdominal aorta at the university teaching hospital/JRA Ampefiloha. Materials and methods: It was a retrospective, descriptive study conducted at cardiovascular surgery department of the university teaching hospital/JRA Ampefiloha, for a period of 14 years old (January 2005 to December 2019), including all patients who had an non-infectious aneurysm of the subrenal abdominal aorta at the CHU/JRA Ampefiloha operated on or not. Results: Sixty-one cases were included, with an mean age of 61.71 years old (from 16 to 82 years old), a male predominance (sex ratio-1.34), high blood pressure, dyslipidemia, active smoking and physical inactivity were the predominant risk factors. The circumstances of discovery were often abdominal pain (52.45%) and a flapping abdominal mass (47.54%). Aortic doppler ultrasound and/or CT angiography allowed the diagnosis and describe the type of aneurysm. Most of them was fusiform in 49 cases (80.32%) and sacciform in 12 cases (19.67%), the majority of which had a diameter of between 50 and 60 mm (36.06%). Thirty-nine patients were operated on (63.93%). Conventional surgery with the flattening of the aneurysm followed by a replacement with a prosthetic graft was our reference technique. Postoperative development was favorable in 82.05% of cases. The mortality rate was 6.56%. Conclusion: The hospital frequency of an abdominal aortic aneurysm was 1.53% at the university teaching hospital/JRA Ampefiloha. Conventional surgery was our reference technique, saving the lives of our patients. Keywords: Aneurysm, subrenal abdominal aorta, surgery, prosthesis.
Introduction: Patent ductus arteriosus (PDA) is a congenital heart disease whose seriousness lies in the risk of pulmonary hypertension, congestive heart failure and death. The aim of this study was to describe the surgical closure of an isolated patent ductus arteriosus (PDA) performed in Soavinandriana Teaching Hospital. Methods: This was a retrospective and descriptive study, during thirteen-years-period (January 2004 to December 2016), performed at Cardiac surgery unit of Soavinandriana Teaching Hospital, including all children underwent surgical closures of an isolated PDA. Demographic data, birth weight, clinical signs, diagnostic imaging, time between diagnosis and surgery and hospital left stays were analyzed. Results: A total of eighty-six children were recorded, including 21 males (24.42%) and 65 females (75.58%), giving sex ratio of 30%. The average age was 33.91 months. Children were born with a low birth weight in 12.79% of cases. PDA was symptomatic in 81.39%. The most circumstances of discovery were recurrent lung infections (31.40%), dyspnea (24.41%) and failure to thrive (19.76%). Echocardiography showed left ventricular dilatation (63.95%), pulmonary hypertension (73.25%). The ductus was large in 97.67% and the mean diameter was 5 mm. Chest X-ray showed cardiomegaly (97.67%) and increased pulmonary vascularity (86.04%). Mean delay of surgical procedures after diagnosis was 15.16 months. Surgical procedures consisted left posterolateral thoracotomy with a section and suture after clamping the ductus. Earlier postoperatives courses were simple in all children. The mean duration of hospitalization was 8.93 days. Conclusion: PDA
Introduction: The post-thrombotic syndrome (PTS) is the most complication of deep vein thrombosis who deserves an early management. The aim of this study was to determine the epidemio-clinical profile and the management of PTS. Methods: This was a retrospective and descriptive study for a period of 6 years from January 2013 to December 2018, performed at the Cardiovascular Surgery Unit in JRA Teaching Hospital Antananarivo, including all patients who presented post-thrombotic syndrome after an acute episode of deep venous thrombosis. Results: 106 patients were recorded among 315 patients who presented an episode of DVT (33.65%) and 14110 patients admitted in this period (0.75%). The average age was 46.18 years old. There were 30 males (28.30%) and 76 female (71.69%). The most important risk factors of PTS were previous history of varicose veins (50%), sedentary lifestyle (45.28%), insufficiency of anticoagulant therapy (68.86%) and proximal DVT (47.16%). Delayed of diagnosis were greater than or equal to 2 years after an acute DVT in 86 patients (81.13%). The most clinical signs were edema (56.60%) and varicose veins (54.71%). According the Villalta’s score, PTS were mild in 48 patients (45.28%), moderate in 47 patients (44.33%) and severe in 11 patients (10.37%). Management was lifestyles change (45.28%), compression stockings (100%), anticoagulant therapy (100%) and surgical treatment (65.09%). Conclusion: The frequency of PTS was 33.65% in our study. PTS reduces quality of life of patients, but it can be avoided if the treatments of DVT are adapted. Keywords: Deep vein thrombosis, Post-thrombotic syndrome, Epidemiology, Management
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