bluuebunny/crossref_metadata_2025 huggingface dataset:
Vascular Pythiosis in a Thalassemic Patient
Authors: Laohapensang Kamphol , Rutherford Robert B. , Supabandhu Jitwadee , Vanittanakom Nongnuch
Published: May 2011

Pythium insidiosum is a fungus that causes disease in both animals and humans. Human pythiosis is an emerging disease in the tropical, subtropical, and temperate regions of the world, occurring in localized and systemic or vascular forms. Most patients with arterial pythiosis have an underlying hemoglobinopathy, such as thalassemia. A case is presented of a thalassemic horse stable worker who developed an ulcerative cutaneous lesion on the lower left leg followed by progressive ascending involvement of the arteries of that extremity with a necrotizing arteritis with aneurysm formation. P. insidiosum was not isolated from the ulcer by culture or wet potassium hydroxide preparations but was diagnosed by histopathologic study of a biopsy. P. insidiosum infection was quickly confirmed by immunoblot method, aiding in preoperative decision making. Many systemic antibiotics or antimycotics have not been effective in the treatment of systemic pythiosis, and radical surgical removal of all infected tissue is the only method to ensure patient survival. An orally administered saturated solution of potassium iodide, amphotericin B-oral solution, and terbinafine has succeeded only in the cutaneous form but had no favorable effect on vascular pythiosis. It is likely that immunotherapy, successfully used in animal pythiosis, may be beneficial in the treatment of human vascular pythiosis.
Superior Vena Cava Perforation Following the Placement of a Superior Vena Cava Filter in Males Less than 60 Years of Age
Authors: Usoh Fred , Hingorani Anil , Ascher Enrico , Shiferson Alexander , Tran Victor , Patel Nirav , Marks Natalie
Published: May 2011

Although the utility of the superior vena cava (SVC) filter remains controversial, the safety and efficacy of SVC filters in patients with upper extremity deep venous thrombosis in whom anticoagulation is contraindicated or ineffective have been well described. However, few complications have been reported. Herein we describe a series of three cases of SVC perforation in three young males following the placement of SVC filters. All three patients had deep venous thrombosis on upper extremity duplex ultrasonography and contraindication to anticoagulation ( n = 1) or failure of anticoagulation ( n = 2). Cardiac tamponade was demonstrated on transthoracic echocardiography in all three cases. The pericardial effusion was evacuated with either median sternotomy or pericardiocentesis in two cases. One of the patients died of cardiac arrest, and an autopsy showed aortic perforation in addition to the SVC perforation. This patient underwent chest compression following the cardiac arrest. One patient was lost to follow-up, and the other patient remained asymptomatic at the 1-year follow-up. This is the first case of SVC perforation that is associated with aortic perforation after the placement of an SVC filter. Owing to this occurrence, one has to be aware of these life-threatening complications when placing an SVC filter, especially in males less than 60 years of age.
Aortic Angiosarcoma with Cutaneous Metastases
Authors: Tsolakis Ioannis , Lampropoulos George , Zolota Vassiliki , Papadoulas Spyros , Christeas Nikolaos
Published: May 2011

Primary aortic tumors are rare and include a variety of histologic types, including aortic angiosarcomas, with less than 100 cases being reported since the first description of these tumors in 1873. The diagnosis of aortic angiosarcoma is usually confirmed by postoperative histopathologic examination or postmortem study. We present a case of primary aortic angiosarcoma presenting with intermittent claudication and radiologic findings of aortoiliac atherosclerotic disease treated initially with stenting; lower extremity embolic skin metastases developed during follow-up that prompted resection of the aortic bifurcation and restoration of the arterial continuity with a bypass. Despite postresection recurrence, a 3-year survival was achieved with aggressive multidisciplinary management.
Use of Extraperitoneal Iliac Artery Endarterectomy in the Endovascular Era
Authors: Metcalfe Matthew J. , Natarajan Ravi , Selvakumar Selva
Published: May 2011

Although iliac artery (IA) endarterectomy has largely been replaced by bypass and endovascular options, open endarterectomy continues to play an important role in selected patterns of occlusive disease. The objective of this report is to present a contemporary clinical series of patients having undergone IA endarterectomy. Specifically, we define patterns of disease amenable to open endarterectomy and provide an updated technical note of this procedure. A retrospective study on 23 patients with IA occlusions unsuitable for radiologic intervention (TransAtlantic Inter-Societal Consensus [TASC] C and D lesions) underwent extraperitoneal IA endarterectomy. Twenty-five primary IA endarterectomies were performed. Of these, five required more extensive endarterectomy, three of the distal aorta and two of the contralateral IA. Sixteen of the 25 endarterectomies required common femoral artery endarterectomy and 6 required iliofemoral bypass. The average follow-up was 26 months. Procedure-related mortality occurred in one patient (4.3%). Within 4 months, one patient underwent an aortofemoral bypass and two patients required major amputation. Primary patency rates were 96% at 3 months and 88% at 1, 2, and 3 years. This series shows that in selected patterns of aortoiliac occlusive disease, endarterectomy remains an important alternative to consider.
Cardiovascular Involvement of Ankylosing Spondylitis: Report of Three Cases
Authors: Yuan Shi-Min
Published: May 2011

Cardiovascular involvement is one of the extra-articular manifestations of ankylosing spondylitis. Of these, aortic disease and aortic regurgitation are the most commonly associated cardiovascular disorders. Since 2005, three male patients with ankylosing spondylitis were referred to The Chaim Sheba Medical Center for surgical treatment of cardiovascular associations. The diagnosis of ankylosing spondylitis was evidenced by radiography and/or laboratory tests of C-reactive protein or HLA-B27. Apart from the usual cardiac manifestations including heart block and left ventricular hypertrophy, usual associated disorders such as aortic aneurysmal dilation, bicuspid aortic valve, aortic root dilation and myocardial infarction, and solely bicuspid aortic valve that developed in these patients warranted a surgical intervention. Aortic aneurysmal dilation is a recognized rare association with ankylosing spondylitis, and bicuspid aortic valve or coronary artery disease is only occasionally present. Decreased aortic elasticity with impaired endothelial function could be responsible for the development of the aortic complication in ankylosing spondylitis patients. The underlying mechanisms of these associations are discussed.
Abdominal Aortic Embolization of a Figulla Atrial Septum Occluder Device, at the Level of the Celiac Axis, after an Atrial Septal Defect Closure: Hybrid Attempt
Authors: Jahrome A.Kh. , Stella Peter R. , Leijdekkers Vanessa J. , Guyomi Siyrous Hoseyni , Moll Frans L.
Published: May 2011

A 41-year-old woman was treated with a Figulla (Occlutec, Helsingborg, Sweden) atrial septum occluder device with no intraprocedural complications. Five months later, dislocation of the device in the abdominal aorta was detected. The occluder device was located at the level of the celiac axis, nearly obstructing the entire aorta. Owing to total incorporation of the device, endoluminal retrieval was not possible. Through a medial rotation approach, the device was safely removed. This is a rare complication after endoluminal closure of an atrial septum defect. The retrieval possibilities are discussed.
Endovascular Repair of Ruptured Abdominal Aortic Aneurysms in a Rural Center Is Both Feasible and Associated with Reduced Blood Product Requirements
Authors: Vun Simon , Walker Stuart R.
Published: May 2011

Endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) has been shown to be both feasible and associated with a reduced operative mortality when compared with conventional open repair (OR). The aim of this study was to show the feasibility of EVAR of rAAA in a rural vascular unit and to investigate the blood product requirements when compared to OR. The method used in this study was a retrospective case note review of patients presenting with rAAA to a small, rural vascular unit between February 2004 and November 2008. Admission demographics and hematological variables were recorded. Volumes of crystalloid, colloid and blood products were recorded prior to intensive care unit (ICU) admission and for the first 48 hours following ICU admission. Results are expressed as medians and Mann-Whitney U test was used to compare variables. Of 81 patients presenting with rAAA, 36 were treated palliatively. Of 45 patients who underwent intervention, 7 had EVAR and all survived to discharge (0% operative mortality). Of 38 who had OR, 16 died before discharge for an operative mortality of 42%, 36% if the EVAR patients are included. Admission demographics and hematological variables of patients who had EVAR, patients who had OR and survived (ORS) and patients who had OR and died (ORD) showed no significant difference. When compared with ORS patients, those undergoing EVAR had significantly less pre-ICU crystalloid (3 L vs 7.5 L, p = .001), less red blood cell transfusion (1 unit vs 6.5 units, p = .0006), and less colloid (0 L vs 0.5 L, p = .008). When compared with ORD, those undergoing EVAR had less red blood cell transfusion (1 unit vs 7 units, p = .0001) and less fresh frozen plasma (0 units vs 4 units, p = .03). Within the first 48 hours of admission to ICU, the blood product requirements were no different in those undergoing EVAR when compared with OR. EVAR of rAAA is feasible in a small rural vascular unit and appears to be associated with reduced requirements for blood products.
Nonoperative Management of Isolated Celiac and Superior Mesenteric Artery Dissection: Case Report and Review of the Literature
Authors: Mousa Albeir Y. , Coyle Brian W. , Affuso John , Haser Paul B. , Vogel Todd R. , Graham Alan M.
Published: May 2011

Isolated dissection of the origin of both celiac and superior mesenteric arteries is a rare vascular pathology with limited management guidelines. The presentation is generally nonspecific, most often manifesting with epigastric pain radiating to the back. A high diagnostic index of suspicion and stepwise management are essential for a successful outcome. This case report details the clinical course of a 57-year-male who presented with a 2-week history of epigastric discomfort with back pain and was found to have focal celiac artery dissection with aneurysmal dilation of 1.2 cm. His vital signs were stable, and the physical examination was unremarkable. At this time, he was placed on antiplatelet medication and was scheduled for endovascular repair of his celiac aneurysm with a covered stent graft. Two weeks later, recurrent abdominal pain prompted a repeat computed tomographic scan that revealed sequential superior mesenteric artery (SMA) dissection. The patient was admitted and anticoagulated. A complete workup ruled out underlying collagen vascular and autoimmune pathology. He remained stable, with significant symptomatic improvement. After 6 months, anticoagulation was discontinued and antiplatelet therapy was instituted for long-term management. Subsequent operative or endovascular intervention was not required. The patient was continuing to do well on his 18-month clinical follow-up. There are 71 cases of SMA and 12 cases of celiac artery dissection in the literature. This report outlines this rare presentation of isolated, proximal sequential celiac artery and SMA dissection. This case illustrates that conservative management may be warranted in uncomplicated, isolated visceral arterial dissection.
Thoracic Endograft for Abdominal Aortic Aneurysms, an Unusual Application for Severe Neck Angulation: Case Report and Literature Review
Authors: Silingardi Roberto , Tasselli Sebastiano , Gennai Stefano , Saitta Giuseppe , Coppi Gioacchino
Published: May 2011

Our goal was to achieve complete proximal sealing in severe aortic neck angulation (SNA) during endovascular aneurysm repair (EVAR) of a patient with an abdominal aortic aneurysm (AAA) unfit for surgery. An 82-year-old patient with an infrarenal AAA of 9.8 cm with an SNA of 90° was admitted for acute coronary syndrome. Following coronary treatment, the patient was considered unfit for surgery and therefore was evaluated for EVAR. Aneurysm sac exclusion was obtained with the deployment of a Powerlink bifurcated graft (Endologix Inc, Irvine, CA) inside a Relay thoracic endograft (Bolton Medical, Florida) placed just below the most distal renal artery. At 6 months, computed tomographic angiography confirmed correct graft placement, complete aneurysm exclusion, and a reduction in the aneurysmal sac. In AAA patients with an SNA at high risk of EVAR failure, the adaptability of a thoracic endograft could be considered for proximal sealing.
Unilateral Acute Lower Extremity Ischemia with Popliteal Artery Aneurysm as a Result of Vascular Type III Entrapment in an Elderly Patient
Authors: Iwasaki Hiroto , Shibuya Takashi , Ishizaka Toru , Suehiro Shigefumi , Satoh Hisashi
Published: May 2011

Popliteal artery entrapment syndrome (PAES) is a rare cause of acute limb ischemia in adult patients but commonly demonstrates as claudication in young patients. The most significant, although rare, complication associated with PAES is aneurysm formation. We present the case of an elderly patient with a unilateral popliteal artery aneurysm owing to symptomatic anatomic entrapment. This report presents the oldest patient ever reported with this syndrome and highlights the advantage of multimodal treatment. As multidetector computed tomography highly contributed to the rapid diagnostic confirmation and choice of treatment in the popliteal fossa, limb salvage was achieved in this patient.
Endovascular Repair of Nonruptured Thoracic Aortic Aneurysms: Systematic Review
Authors: Mustafa Syed T. , Sadat Umar , Majeed Muhammad U. , Wong Chih Mun , Michaels Jonathan , Thomas Steve M.
Published: May 2011

Thoracic aortic aneurysms represent a major health problem. Untreated thoracic aortic aneurysms may rupture, which has a dismal outcome. The standard treatment for thoracic aneurysms is open surgical repair, but it is associated with high mortality and morbidity. Endovascular repair provides a less invasive and safer alternative.

A systematic review was performed of all published literature on the above subject. Our primary objective was to measure 30-day mortality for nonruptured thoracic aortic aneurysms. Studies describing other pathologies, such as aortic dissection, mycotic aneurysms, penetrating ulcers, traumatic transactions, and pseudoaneurysms, and studies from which independent data for thoracic aortic aneurysm could not be separately extracted were excluded. Case series describing less than 10 patients and all case series describing ruptures or concealed ruptures were excluded as well.

Twenty-six case series and one comparative study were identified. This formed a cohort of 1,038 patients. Technical success was possible in more than 97% of patients. The 30-day mortality was calculated to be 5.1% even though the group under study was mostly those who were refused surgery by a surgeon or had a higher surgical risk. The incidence of paraplegia and stroke was 3.1% and 4.7%, respectively. Early endoleak was seen in 16.7% of patients, whereas 11.7% of patients developed late endoleak, but most did not require any additional procedure. The rate of reintervention was 14.9%. The 12-month mortality rate was 14.2%.

Endovascular repair shows encouraging short-term results. It is associated with significantly less mortality and morbidity, but long-term results need to be further investigated.
Surgical Management Of Varicose Veins: Meta-analysis
Authors: Brar Ranjeet , Nordon Ian M. , Hinchliffe Robert J. , Loftus Ian M. , Thompson Matthew M.
Published: May 2011

Open surgery remains the gold standard by which endovascular treatment of superficial chronic venous insufficiency is measured. This meta-analysis of randomized controlled trials reviews the current evidence base, comparing open and endovascular treatment of varicose veins. Systematic review of studies reporting duplex scan follow-up after open surgical, laser (endovenous laser therapy [EVLT]), or radiofrequency (VNUS Closure device, VNUS Medical Technologies, San Jose, CA) treatment of refluxing great saphenous veins was completed. Primary outcome measures were occlusion and complication rates and time taken to resume work. No significant difference in recurrence rates at 3 months between open surgery and EVLT (RR 2.19, 95% CI 0.99–4.85, p = .05) or VNUS device (RR 7.57; 95% CI 0.42–136.02) were found. Return to work is significantly faster following VNUS (by 8.24 days; 95% CI 10.50–5.97) or EVLT (by 5.02 days; 95% CI 6.52–3.52). Endovascular treatment of varicose veins is safe and effective and offers the significant advantage of rapid recovery.
Hemodynamic Effects of Closure of Residual Arteriovenous Fistulae during in Situ Graft Procedures
Authors: Laustsen Jesper , Nielsen Henriette Svarre , Pedersen Erik Morre , Paaske William P.
Published: May 2011

The objective was to study the intraoperative hemodynamic effects of closure of residual arteriovenous fistulae during in situ saphenous vein graft procedures. Data on 60 residual arteriovenous fistulae in nine patients (five men) with a median age of 74 years (range 64–83 years) with critical lower limb ischemia were obtained. Direct measurements of proximal and distal blood pressures in the graft were taken and simultaneous determinations of volume blood flow proximally and distally in the graft with ultrasound transit time technique before and after closure of residual fistulae were made. Closure of a fistula with blood flow around or below 100 mL/min did not increase distal outflow, whereas closure of fistulae with higher blood flow resulted in unpredictable changes in distal outflow. Only fistulae with a blood flow above approximately 100 mL/min may be of hemodynamic significance.
Asymptomatic Carotid Stenosis: Mainly a Medical Condition
Authors: Spence J. David
Published: May 2011

At present ≈ 70% of carotid endarterectomy and stenting in the United States is being performed for asymptomatic carotid stenosis (ACS). This is based on historical risks of ACS that no longer pertain in the era of intensive medical therapy with statins and other therapies. In the past, the surgical risk of 3% in clinical trials was marginally better than medical therapy for male patients with ACS; however, this is no longer the case. Even in the past, women with ACS did not benefit from endarterectomy. Except for patients with microemboli on transcranial Doppler (who have a 2-year risk of stroke of ≈ 14%), the 2-year risk of stroke in ACS is now 1% or less. Endarterectomy or stenting should be reserved for the < 5% of patients with microemboli on transcranial Doppler ultrasonography. In future, 3 dimensional ultrasound detection of ulceration, and magnetic resonance imaging of vulnerable plaque may provide additional approaches to identifying those patients with ACS who may benefit from endarterectomy or stenting. Routine endarterectomy or stenting for patients with ACS should now be regarded as inappropriate.
Vertebral Artery Aneurysms and Cervical Arteriovenous Fistulae in Patients with Neurofibromatosis 1
Authors: Higa Guillermo , Pacanowski John P. , Jeck David T. , Goshima Kaoru R. , León Luis R.
Published: May 2011

Vascular involvement in the setting of neurofibromatosis type 1(NF1) has been well described. However, the coexistence of NF1 with vertebral artery (VA) aneurysms and arteriovenous fistulae (AVFs) is a rare occurrence. A 60-year-old female with NF1 and other severe comorbidities presented with acute respiratory insufficiency caused by a ruptured large VA aneurysm and an associated AVF that required emergent intubation and eventual repair through endovascular techniques that resolved her symptoms. A detailed description of this case and a comprehensive review of the literature are also presented.
Factors Influencing Outcome after Open Surgical Repair of Juxtarenal Abdominal Aortic Aneurysms
Authors: Speziale Francesco , Ruggiero Massimo , Sbarigia Enrico , Marino Mario , Menna Danilo
Published: May 2011

The purpose of this study was to seek factors predicting outcome after open surgical repair of juxtarenal abdominal aortic aneurysms (AAAs). From a series of 733 patients treated for AAAs, 92 patients underwent elective conventional open repair with suprarenal clamping. We assessed postoperative cardiorespiratory and renal morbidity and mortality and survival at 1, 3, and 5 years. One patient (1.1%) died after an acute myocardial infarction. Postoperative complications including myocardial infarction and renal failure arose in 22 patients (23.9%). Significant predicting factors of renal failure were a preoperative creatinine clearance ≤ 40 mL/min ( p = .03) and female sex ( p = .004). Kaplan-Meier survival analysis showed an overall survival rate of 98.9% at 1 year and 88.6% at 3 and 5 years. In patients carefully selected by preoperative imaging criteria to undergo open juxtarenal AAA repair, appropriate intraoperative management guarantees a good immediate postoperative outcome.
Effect of Anastomotic Length on the Development of Intimal Hyperplasia in the Distal Anastomosis of Bypass Graft
Authors: Elsharawy Mohamed A. , Naim Magda M. , Ali El-Daharawy Mohamed Hussein , Ali Shekidef Mohammed Hassan , Ahmed Ibrahim Hussein
Published: May 2011

Many hemodynamic factors have been shown to be associated with increased intimal hyperplasia at the distal anastomosis of arterial bypass graft. However, the relationship between the length of anastomosis and the development of such a complication has not been studied before. The aim of this study was to assess this relationship at the distal anastomosis with a Dacron graft. Iliofemoral bypass using 6 mm Dacron grafts was performed in 10 German shepherd dogs. In accordance with preoperative randomization to individual animal legs, distal anastomoses were reconstructed using four different groups (A, B, C, and D), depending on the length of the arteriotomy: 3.0, 3.5, 4.0, and 4.5 times the internal diameter of the artery, respectively. The vessels were harvested 6 months after the operation, and specimens were processed for histologic and transmission electron microscopic (TEM) studies. Quantitative analysis was performed to assess the extent of intimal hyperplasia at three zones (heel, toe, and midzone of the arterial bed) of the distal anastomosis. Sixteen arterial bypasses were included in this study. Both light and TEM studies revealed evidence of intimal hyperplasia in the four groups. Quantitative analysis showed a significant decrease in intimal hyperplasia with increasing the length of the anastomosis at the heel, toe, or midzone of the arterial bed. Mean (μm ± SD) intimal hyperplasia of the three zones together was significantly higher in group A than group B (585 ± 106 vs 423 ± 8.6, p < .001) and in group B than group C (423 ± 8.6 vs 202 ± 15, p < .001). However, the difference between group C and group D (202 ± 15 vs 162 ± 8.6; p = .13) was statistically insignificant. The present study showed that the length of the anastomosis is one of the hemodynamic factors involved in the development of intimal hyperplasia. Anastomotic techniques that resulted in the least intimal hyperplasia were end to side, with length 4 or 4.5 times the internal diameter of the artery.
Recurrent Aortic Aneurysms In Behçet Disease
Authors: Adams Corey , Zhen-Yu Tong Michael , Kirk Lawlor D. , DeRose Guy , Forbes Thomas L.
Published: May 2011

The following is a case of a 22-year-old male with recurrent thoracic aneurysms with several constitutional symptoms, including gastrointestinal discomfort, irritable bowel syndrome, lactose intolerance, and a 2-week history of severe lower back pain. The patient underwent an initial thoracoabdominal repair of a visceral aneurysm followed by endovascular repair of a recurrent thoracic pseudoaneurysm. The etiology of the visceral aneurysm was initially hypothesized to be mycotic; however, further information revealed signs and symptoms consistent with the diagnostic criteria for Behçet disease (BD). We suggest that BD be considered in younger patients who present with an aortic aneurysm. Although open repair is the traditional approach for arterial lesions in BD, the role for endovascular intervention should be considered as it represents a surgical repair with a significant reduction in morbidity.
Proteomics and Pitfalls in the Search for Potential Biomarkers of Abdominal Aortic Aneurysms
Authors: Nordon Ian M. , Brar Ranjeet , Hinchliffe Robert J. , Cockerill Gillian , Thompson Matthew M.
Published: May 2011

Proteomics is evolving as an important research technique in cardiovascular disease. We present exploratory research for a systemic biomarker of abdominal aortic aneurysm (AAA) in serum. Forty patients, 20 with large AAAs and 20 matched controls, were prospectively recruited. Serum was harvested, enriched, and mined for differential protein expression. Difference in gel electrophoresis using a two-dimensional platform, cyanine labeling, and Progenesis SameSpots software identified protein spots with significantly altered intensity. Liquid chromatography mass spectrometry aligned to the Seaquest protein database characterized proteins of interest, and 436 protein spots were demonstrated from the 20 processed gels. Thirteen spots of interest, demonstrating fold change (1.7–4) between the two patient cohorts and consistent significant differential expression (analysis of variance, p ≤ .003), were picked for identification. Four of 13 spots were identified according to their tandem mass spectra. These were fragments of serum albumin, hemoglobin, and apolipoprotein C-II precursor. Identified spots represented proteins highly abundant in serum, not candidate biomarkers. Issues of variability surrounding serum harvest, processing, enrichment, and the challenge of identifying minimally expressed proteins currently limit this avenue of research. No proteins identified in this study had the biologic plausibility to represent a possible biomarker of aneurysmal disease. The tissue proteome may be a more rewarding approach for preliminary investigation of plausible biomarkers.
Repeat Endovascular Exclusion For Distal Tear After Treatment Of Primary Aortic Dissection By Endovascular Exclusion
Authors: Yuan Liangxi , Bao Junmin , Zhao Zhiqing , Jing Zaiping
Published: May 2011

An obese, hypertensive, 70-year-old man was found to have an extensive chronic Stanford type B aortic dissection. The dissection was treated by placement of a stent graft. One year later, he developed a small protrusion of the intimal flap at the distal end of the stent graft that gradually enlarged, until 4 years after the procedure, it had become disrupted, and angiography showed contrast medium entering the false lumen. A second stent graft was successfully placed, and imaging 2 years later indicated no recurrence of the tear, endoleak, or malperfusion of the aortic arch vessels.
Management Of The Immature Autogenous Arteriovenous Fistula
Authors: Saad Theodore F.
Published: May 2011

A high-quality autogenous arteriovenous fistula provides the optimal access for hemodialysis. Following initial surgical construction of a fistula, the maturation process is driven by hemodynamic, cellular, and humoral factors that must result in increased blood flow, vessel dilation, and thickening of the vessel wall before the fistula can be successfully used for dialysis needle access. Different demands are placed on each fistula depending on the individual patient's hemodialysis requirements, which must be clearly understood to properly assess and treat the immature fistula. When spontaneous maturation fails to achieve a functional fistula, additional surgical or minimally invasive interventional procedures may be necessary to enhance the maturation process. Various techniques have been reported to achieve successful fistula maturation. The purpose of this article is to review the concepts of fistula maturation and the interventions that may be performed in cases where there is failure to mature spontaneously.
Technique of Adding a Diameter-reducing Wire to the Modified TX2 Fenestrated Stent Graft
Authors: Oderich Gustavo S.
Published: May 2011

One of the technical limitations of surgeon-modified fenestrated stent grafts is the lack of a diameter-reducing wire, which facilitates catheterization of target branches if there are errors of device design, alignment, or implantation. This article describes a technique of adding a diameter-reducing wire to the modified TX2 fenestrated stent graft for compassionate use in aortic emergencies or high-risk patients who do not have access to manufactured devices. The modified Cook TX2 stent graft was created using reinforced fenestrations with gold nitinol markers. After the TX2 stent was fully unsheathed, one of the nitinol wires located in the inner cannula was withdrawn and redirected externally through and through the fabric of the stent graft. Each Z stent was constrained using the nitinol wire for support and two nonlocking polypropylene loops. The use of a diameter-reducing wire facilitates side branch catheterization by allowing longitudinal and rotational movement to the modified fenestrated stent graft in patients where there is misalignment between the fenestration and the origin of the target vessel.
Géographie des types climatiques mensuels en Arabie séoudite
Authors: Kerbe J.
Published: May 2011

L'étude de ce qu'on a appelé les «types climatiques mensuels» est fondée sur l'analyse des fréquences sur dix ans et quatre données : les températures maxima et minima absolues, le total précipité et la précipitation maximale en vingt-quatre heures, relevés pour chaque mois, pendant dix ans, dans dix-huit stations représentatives. En dépit d'une continentalité dominante, marquée par de fortes amplitudes thermiques, cinq régions climatiques se distinguent assez bien, selon l'influence, pourtant souvent limitée, de l'humidité des masses d'air maritimes (Méditerranée, golfe Persique, mer Rouge), de l'altitude, ou encore de l'humidité provoquée par des précipitations convectives. L'effet des moussons sur le Sud-Ouest est particulièrement bien marqué.
Un vignoble méditerranéen français : l'exemple du Var
Authors: de Reparaz André
Published: May 2011

By its diversity and importance within the departmental and regional agricultural space, the Var vineyard represents a good dynamic structural example of the French Mediterranean vineyards in full transformation. With its 43 .000 hectares in 1980, this vineyard used to occupy the two-thirds of the Varois agricultural spaces, virtually a monoculture in much of the department. But between 1959 and 1980 this vineyard lost 30% of its area. The vineyards yielding ordinary table-wines were the first concerned in the decline whereas a considerable effort was made (choice of varieties). The turning of the «V.D.Q.S.» into «A.O.C.», the diminution of the number of vine-growers and the increasing value of the estates compared to the number of «village farming concerns» of the wine-cooperatives are characteristic features. The output keeps up in spite of the dwindling area while a cooperative effort and technical gathering is producing to a second generation of «intercommunal» cooperatives with a concentration parallel to that of the wine merchants.
Évolution récente et dynamique spatiale du vignoble espagnol
Authors: Piqueras Juan
Published: May 2011

En los últimos veinte años el viñedo español ha modificado su localización espacial notablemente, concentrándose su cultivo en la región de la Mancha. La producción de vino ha aumentado de 25 a 35 milliones de hectolitros, mientras que la exportación sólo lo ha hecho de 1"5 a 6 milliones, habiendo permanecido estancado el consumo interior, por lo que los excedentes son cada vez may or es y representan y a casi la cuarta parte de toda la producción.
L'évapotranspiration potentielle et réelle dans le Midi méditerranéen. Son originalité par rapport au reste de le France
Authors: Carrega Pierre
Published: May 2011

L'unité climatique du littoral méditerranéen français est, grâce au régime des précipitations, évidente en ce qui concerne l'évapotranspiration réelle. Elle est beaucoup moins nette pour la composante énergétique du bilan hydrique (évapotranspiration potentielle) : certaines stations du sud-ouest et de la côte méditerranéenne se ressemblant très fortement.
La typologie fonctionnelle de l'implantation touristique; l'exemple des villages de Wysowa et Rytro, dans les Carpates polonaises..
Authors: Liszewski Stanislas
Published: May 2011

L'Auteur propose une typologie des stations de tourisme, qui s' appuie essentiellement sur les divers aspects de la fonction touristique. Pour cela, une étude théorique retient cinq critères: la dimension du mouvement touristique, son caractère saisonnier, sa structure démographique, les motivations des touristes et l'étendue de la zone d' influence: un grand tableau synthétise les détails de la typologie. L' étude théorique est ensuite appliquée à deux localités touristiques, Wysowa (Basses-Beskides) et Rytro (Beskides de Sacz).
Le mouvement touristique dans les Carpates polonaises
Authors: Matczak Andrzej
Published: May 2011

Malgré l'insuffisance des statistiques, l'Auteur tente une synthèse sur les flux touristiques dans les Carpates polonaises, très fréquentées depuis le XIXème siècle: sans doute 10 millions de touristes, dont 8% d'étrangers; surtout dans les Beskides occidentales et les Tatry, ainsi qu'à Cracovie; tourisme d'excursion et de randonnée principalement (70%), pour une durée moyenne de 7 jours, mais réparti sur toute l'année, malgré les pointes d'été et d'hiver (Zakopane); si la fréquentation a un caractère national, ce sont surtout les grandes villes du pays et les voïvodies méridionales qui envoient des touristes.
Murettes et terrasses de culture dans les régions karstiques méditerranéennes
Authors: Nicod Jean
Published: May 2011

Stone-walls and land-terraces in the mediterranean karst areas.

After analysis on the functions of stone-walls and terraces, the paper show many types of agrarian arrangement in limestone slopes and table-land, in rapport with the quality of soils, and in little karst depressions. They make up «agro-karstic landscapes». In the dolines and uvalas particularly, the contouring and removal of blocks give «anthropo-geomorphological forms». This researches are continued in the outline of I.G.U. Study Group on «Man's impact in Karst», now «Environmental Changes in Karst Areas».
Les industries de l'aire métropolitaine marseillaise en 1989 et leur avenir
Authors: Wolkowitsch Maurice
Published: May 2011

La distinction entre industries de biens intermédiaires, de biens d' équipements et de biens de consommation ne correspond pas à la logique de notre exposé. Nous étudions d'abord des industries héritées du passé (construction et réparation navales; produits alimentaires, houille, alumine, ciment) dont les perspectives sont très diverses, pour beaucoup inquiétantes. Le traitement des hydrocarbures retient notre attention, conduisant à opposer le secteur du raffinage en déclin à celui de la pétrochimie en plein essor. Les industries récentes ou en progrès révèlent l'importance de la sidérurgie et du traitement des métaux non ferreux, de la construction aéronautique, des nouvelles industries de la mer sans rapport avec les navires, du matériel électronique. Il convient enfin de souligner la multiplication et l'extension des zones industrielles qui ont accueilli de nombreux établissements venus de Marseille: des milliers d'emplois ont été diffusés au sein de l'Aire métropolitaine marseillaise: la désindustrialisation touche la ville mais non l'Aire. Des aspects positifs caractérisent aussi l'industrie marseillaise: le tissu solide de petites et moyennes entreprises, le développement de filières vers l'aval, et de la recherche et développement en entreprise.
Innovation et développement économique dans les Bouches-du-Rhône. La politique régionale face à la réalité des entreprises
Authors: Francissen Paul , Wijbenga Gerben
Published: May 2011

Le rôle de l'innovation dans le processus de production devient de plus en plus important. Pour arriver à un développement économique régional plus approfondi, il est essentiel d'anticiper sur cette tendance dans les entreprises. Malgré l'existence de certaines conditions favorables au développement de la région Provence- Alpes-Côte d'Azur et du département des Bouches-du-Rhône, il existe également quelques points chauds. Il est important d'arriver à une coopération structurelle, dans la région comme dans le département, entre les différents partenaires, sans divergence interne. Si quelques conditions sont remplies, Provence-Alpes-Côte d'Azur et les Bouches-du-Rhône pourraient atteindre une position éminente dans la structure économique européenne.
Matériaux relatifs à la sismicité de l'Algérie occidentale au cours de la deuxième moitié du XIXe et au début du XXe siècle
Authors: Vogt Jean , Ambraseys Nicholas Nicholas
Published: May 2011

In the frame of research work on moghrebian historical seismology, first results from archives and press are given for western Algeria. Some quakes escaped catalogues (1871, 1878), bette knowledge is available for several events poorly dealt with by catalogues : sequences, epicenters, macroseismic areas, with sometimes draconic reintepretations (1851, 1854, 1871, 1872, 1887, 1889, 1900, 1904). The intensity of most of them has been overestimated. With other results, this new knowledge suggests a possibility of a deeper-digging seismo-tectonic discussion of the area.
La morphogenèse sur la montagne Sainte-Victoire après l'incendie : l'exemple du ruissellement (1989-1992)
Authors: Ballais Jean-Louis , Bosc Marie-Chritine , Sandoz Alain
Published: May 2011

L'incendie d'août 1989 a provoqué une accélération considérable de la dynamique des ruisseaux intermittents, d'abord par une forte accumulation en 1989-1990, puis par une incision en 1990-1991. Il était alors possible de perser à une stabilisation précoce de la morphogenèse grâce à la recolonisation végétale rapide. Cependant, la crue exceptionnelle de septembre 1991 montre que cette stabilisation reste imparfaite.
La permanence du problème du Mezzogiorno italien
Authors: Lieutaud Jacqueline
Published: May 2011

La permanence du «fossé» entre le nord et le sud de l'Italie montre une sous-estimation par les aménageurs des causes structurelles de ce décollage. Elle traduit aussi le laxisme des experts qui ont fait d'une législation d'harmonisation régionale une politique nationale de développement qui a profité aux régions septentrionales plus qu'au Mezzogiorno.
Pression socio-démographique et construction abusive dans l'agglomération napolitaine
Authors: Vallat Colette
Published: May 2011

Naples possède les caractères communs aux grandes villes européennes, cependant, elle garde des traits particuliers. Le délestage démographique du centre est tardif, impulsé de façon conjoncturelle par le séisme de 1980, il s'accompagne du développement d'une périphérie mal organisée.
Un port de plaisance sur un littoral deltaïque : le cas de Port-Gardian en Camargue
Authors: Richez Gérard
Published: May 2011

Le développement du tourisme et des loisirs tient une place majeure dans les mutations que connaît actuellement le delta du Rhône. La réalisation d'un port de plaisance aux Saintes-Maries-de-la-Mer, certes de taille modeste, au centre d'un littoral deltaïque, est une exception au moins en Méditerranée. Il complète un large éventail d'activités récréatives et touristiques en ouvrant vers le large l'espace camarguais, longtemps répulsif. Cette petite cité touristique surprend par son dynamisme, par la variété de ses équipements touristiques et de loisir, par l'ampleur de sa fréquentation et par la grande maîtrise de son développement.
Los espacios periurbanos en el área de Alicante-Elche (España)
Authors: Gozálvez Pérez Vicente , Ponce Herrero Gabino , Costa Mas José , Canales G. , Navarro J.R.
Published: May 2011

Les espaces périurbains dans l'aire d'Alicante-Elche (Espagne)

Les processus de périurbanisation autour d'Alicante (ville tertiaire) et de Elche (ville industrielle) ont commencé avec les années soixante, et depuis ont connu une expansion continue et accélérée; en outre, au début des années 1990 on envisage un renouvellement de leur dynamisme. Ces processus ont trouvé leurs fondements économiques dans l'industrialisation et dans le développement tertiaire locaux, auxquels s'est mêlée une fièvre de constructions touristico-résidentielles sur la frange côtière, destinée en partie à une clientèle extérieure à la province. La périurbanisation autour des deux villes peut être résumée en trois types d'occupation du sol, selon les formes de construction et d'usage :

1) Sur la frange côtière, la forme touristique et résidentielle concerne soit les extensions de noyaux urbains préexistants, soit des «urbanisations» créées ex nihilo: les immeubles d'appartements prédominent le long des plages, tandis que les «chalets unifamiliaux» sont la majorité sur les portions de côtes rocheuses.

2) A l'écart du littoral, la périurbanisation est le fait de logements unifamiliaux, d'abord dispersés, puis groupés en lotissements et plus récemment en lotissements de pavillonnaire jointif. Elle a occupé de vastes espaces agricoles, aux détriments d'exploitants minifundiaires et de cultures arbustives peu rentables dans des périmètres d' irrigation déficitaires en eau. Il s'agit alors de résidences principales ou secondaires très liées à l'emploi ou à la clientèle des deux villes principales, tandis que sur la côte le poids des propriétaires extérieurs à la région est grand.

3) Autour d'Alicante les espaces périurbains industriels et tertiaires s'organisent en fonction des routes principales qui rayonnent depuis la ville; Elche reste entouré par une couronne industrielle, qui se prolonge largement en suivant la route N-340.

Les vastes espaces encore inoccupés entre Alicante et Elche sont actuellement l'objet de projets d' urbanisme privé ou publique, où s' affrontent la logique de la croissance économique d'une part, et celle de l'équilibre entre l'occupation humaine et le milieu physique d'autre part. Les nouveaux cadres institutionnels et législatifs seront- ils capables de les concilier?
Les espaces flous des franges périurbaines de la Basse Provence
Authors: Durbiano Claudine , de Reparaz André
Published: May 2011

Les «espaces flous» périurbains de basse Provence sont, aux périphéries des communes urbaines, des zones très étendues caractérisées par des densités humaines presque nulles, la nature difficile de leurs reliefs marqués et des écosystèmes très dégradés. Espaces aux affectations incertaines, zones de rejet, voire de délinquance, ils sont aussi marqués par des pratiques originales : chasse très organisatrice du territoire, tourisme «naturel»... et loisirs bruyants. Leur avenir est fonction d'une politique de gestion où l'action des associations, le renforcement de la propriété publique et les objectifs des collectivités territoriales vont vers de nouvelles affectations : espaces naturels protégés, installations de technopoles et urbanisation limitée, renforcement des pratiques de loisirs.
Aux marges du système urbain : les espaces «flous» et leur évolution
Authors: Prost Brigitte
Published: May 2011

The «fuzzy spaces» express a territorial marginalism in which urban and rural systems are in confrontation. The rural system is on unequal terms in front of the conquering urban system. The new territorial organization is a sign of the town's winning.
Frange rurali e crescita urbana : la resistenza all'urbanizzazione nel periurbano di Cagliari (Sardegna)
Authors: Gentileschi Maria Luisa
Published: May 2011

Resistance to suburbanization by a rural community in the metropolitan area of Cagliari, Parteolla, is described. Here the population refused the installation of council houses fearing that the presence of extraneous families of a low social level might worsen the standard of living in the village. In fact, the presence of an agricultural residue, of food producing industries (cheese factories, oil mills, wineries) and even the arrival of shepherds families from inland contribute to maintaining alive the rural element, and with this some environmental values such as the traditional landscape and the absence of congestion.
La función de ocio en el área metropolitana de Valencia
Authors: Miranda Montero María Jesús
Published: May 2011

This report analizes the leisure function in the AMV accross the location of three kinds of essential equipment : second homes, campings and hotels that shape the residential equipment; restaurants and coffee houses that constitute the relation equipment; and finally the sports facilities. There are a veritable leisure function integrated in the AMV, that depends on potential abundant clientele; its essential parts are the residential leisure settlements that have three notable locations : the seaboard and the areas north-west and south-west.
La pêche aux engins, moyens d'approche de la richesse halieutique du bassin du Rhône. Données récentes
Authors: Changeux Thomas
Published: May 2011

Between 1988 and 1989, on the navigable waters of the Rhône and the Saône, the fishing gear fishery comprised around 37 commercial fishermen (professionals) and 708 recreational fishermen (amateurs). Their voluntary declarations allow an estimation of their capture at 256 tonslyr. of which 72% was due to the professionals. The study of the declared fishing gear allows the characterization of the different types of fishing which follow a seasonal cycle with a peak from June to november. The downstream reaches of the Saône appears to be a zone of national importance for the strictly riverine fishery, with catches of small fry, American crayfish, and carnivorous fishes. On the other hand, the estuary is not as exploited as its atlantic coast counterparts, given the absence or the rarity of migratory fish species of economic importance such as sturgeon, salmon, or shad.
À la recherche d'un arc méditerranéen
Authors: Voiron-Caniccio Christine
Published: May 2011

The persistence of differences in the level of development between the centre and the extremities of the northwestern Mediterranean seaboard inevitably calls for an examination of the spatial and functional structures that characterize this seaboard. Diachronous analyses also highlight divergent evolutionary patterns. In order to understand these complex regional behavioural trends, what, in the observed evolutions, reflected a spatial trend was first distinguished from that reflecting a local trend. The next step consisted in finding out whether the differences in regional behaviours corresponded to different stages of a single model or were related to various different models of evolution. These various spatio-temporal analyses highlight the existence of an «arc» effect.
Pour une «pré-histoire» de l'arc méditerranéen
Authors: Caty Roland , Richard Éliane
Published: May 2011

À défaut d'un véritable arc méditerranéen, il est possible de discerner au XIXe siècle, du point de vue marseillais, quelques éléments constitutifs d'ordre économique et humain : établissements de réseaux commerciaux, convergence des entrepreneurs, structuration des espaces, mouvements migratoires, etc. Le système, qui fonctionne au milieu des rivalités et des concurrences, prend toute sa valeur en période de difficultés, soit qu'il permette à la place de reconstituer son économie à la sortie de crises, soit qu'il serve de position de repli en cas d'échec.