Surgical treatment of cardiovascular complications in patients with Marfan syndrome: a report of two cases and literature review.

in Acta Chirurgica Belgica (2012), 112(3), 213-8

Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. The most life threatening complication is aortic root aneurysms leading to aortic dissection or ... [more ▼]

Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. The most life threatening complication is aortic root aneurysms leading to aortic dissection or rupture. It can be prevented by regular aortic follow-up and prophylactic aortic surgery. Modern aortic surgery has led to a substantial increase in the life expectancy of these patients. We report two cases of Marfan syndrome with cardiovascular complications. Their management is discussed according to the most recent literature. [less ▲]

Timing of Carotid Endarterectomy : a Comprehensive Review

in Acta Chirurgica Belgica (2012), 212

ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC).

in European Heart Journal (2011), 32(22), 2851-906

Do we need a new carotid artery stenting trial?

in Acta Chirurgica Belgica (2010), 110(4), 432-44

Four well-conducted carotid artery trials comparing carotid artery stenting with carotid artery endarterectomy (EVA-3S, SPACE, ICSS and CREST) could not demonstrate the superiority of carotid artery ... [more ▼]

Four well-conducted carotid artery trials comparing carotid artery stenting with carotid artery endarterectomy (EVA-3S, SPACE, ICSS and CREST) could not demonstrate the superiority of carotid artery stenting (CAS) over carotid artery endarterectomy (CEA). There is at the moment no level-I evidence to support widespread use of endovascular management of carotid artery disease in routine practice. In order to shead some light on the continuing debate on the role of carotid artery stenting, the authors conducted a search in contemporary published literature concerning carotid artery stenting. This extensive literature review reveals a higher peri-procedural stroke-death rate after CAS and a higher cost. Two other events hamper the value of CAS: a higher late restenosis rate and a higher risk of micro-embolisation during the procedure, compared with CEA. The authors conclude that the prevailing overenthusiasm of interventionalists (vascular surgeons, radiologists, cardiologists) for carotid artery stenting is not justified. [less ▲]

Antiplatelet therapy in the perioperative period.

in Acta Anaesthesiologica Belgica (2010), 61

antiplatelet drugs are the cornerstone treatment in the secondary prevention of arterial thrombosis. Until recently, their intake was interrupted in the perioperative period because of fear for bleeding ... [more ▼]

antiplatelet drugs are the cornerstone treatment in the secondary prevention of arterial thrombosis. Until recently, their intake was interrupted in the perioperative period because of fear for bleeding, but new insights have challenged this old habit. in patients at high risk for atherothrombotic events who need to undergo surgery or an invasive procedure, the risk for bleeding complications because of a treatment with low-dose acetylsalicylic acid (lD aSa) needs to be balanced against the risk of atherothrombotic events after treatment discontinuation. for patients at high risk of atherothrombotic complications recent guidelines do no longer advocate to interrupt lD aSa routinely. However, the likelihood of bleeding versus atherothrombotic complications should be considered on a case-by-case basis. when continued perioperatively, the bleeding risk associated with thienopyridines (ticlopidine, clopidogrel and prasugrel) is higher than that of lD aSa. it is recommended to stop their intake 1 week before the surgical intervention, except in patients with (recent) coronary stenting [less ▲]

Endovascular aneurysm repair (EVAR): does it fulfil all its promises?

in Acta Chirurgica Belgica (2009), 109(4), 436-43

In the trend of the endovascular revolution for occlusive arterial disease, management of aneurysmal disease has known an analogous change in the nineties. Elective endo-aneurysmal stentgrafting (EVAR or ... [more ▼]

In the trend of the endovascular revolution for occlusive arterial disease, management of aneurysmal disease has known an analogous change in the nineties. Elective endo-aneurysmal stentgrafting (EVAR or endovascular aneurysm repair) is nowadays of widespread application in contemporary practice all over the world, sometimes by over-enthusiast proponents. There is a burden of recent publications on that topic. Critical analysis of relevant data reveal compelling evidence that elective EVAR is a safe procedure with a threefold reduced 30-day morbidity-mortality, when compared to conventional open aneurysm repair. EVAR also deemed efficace in terms of AAA rupture prevention. At the other hand, mid-term follow-up revealed that EVAR does not endure at the long-term in any late survival benefit, compared to open AAA repair. The major concern and drawback of EVAR is its higher cost and the need for indefinite, life-long surveillance, with a 20% reintervention rate (almost catheter-based endovascularly) at 5-year follow-up. In this review-paper, short-term gains of EVAR are balanced against the inherent disadvantages and long-term losses. According best available evidence, EVAR should not longer be the first choice for high-risk patients, judged unfit for open aneurysm repair. There also exist doubt on the use of EVAR in young fit patients with an anticipated long life expectancy. In approximately half of the AAA patients, EVAR can be considered as the appropriate treatment option. [less ▲]

Pseudo-anévrysme de l'isthme aortique après correction chirurgicale de la coarctation aortique

in Revue Médicale de Liège (2008), 63(11), 666-70

Aortic pseudo-aneurysm is a well-known late complication after surgical repair of aortic coarctation. We report two cases of pseudo-aneurysm of the aortic isthmus evidenced after previous surgical repair ... [more ▼]

Aortic pseudo-aneurysm is a well-known late complication after surgical repair of aortic coarctation. We report two cases of pseudo-aneurysm of the aortic isthmus evidenced after previous surgical repair of congenital aortic coarctation. These clinical observations give us the opportunity to underline the importance of a specific lifelong medical follow-up for patients who have undergone such surgery. [less ▲]

Health care cost containment.

in Acta Chirurgica Belgica (2008), 108(1), 2-3

Association of abdominal aortic aneurysm, horseshoe kidneys, and left-sided inferior vena cava: report of two cases.

in Journal of Vascular Surgery (2008), 47(3), 645-8

Surgery for abdominal aortic aneurysm may be challenging when rare renal or venous anomalies are present. This article reports two similar cases of aortic abdominal aneurysm associated with horseshoe ... [more ▼]

Surgery for abdominal aortic aneurysm may be challenging when rare renal or venous anomalies are present. This article reports two similar cases of aortic abdominal aneurysm associated with horseshoe kidney and left-sided inferior vena cava treated with a transperitoneal approach. Preoperative knowledge of the anatomic situation enabled appropriate aneurysm repair. Operative strategy is discussed. This report describes an uncommon venous vascular malformation complex and stresses the importance of computed tomography imaging not only in assessing the characteristics of the aneurysmal disease but also in detecting variations in pertinent vascular or parenchymal anatomy. [less ▲]

Diagnosis and treatment of peripheral arterial disease: recommendations for the medical practice in Belgium.

in Acta Chirurgica Belgica (2007), 107(6), 595-604