Limb Arteriopathy Research Articles

Fièvre Q chronique. Revue de la littérature à propos d’un cas de spondylodicite à hémocultures négatives

IntroductionFever is a cosmopolit zoonosis due to Coxiella burnetii. The diagnosis of chronic Q fever can be really misleading. The growth of this bacterium is difficult and blood cultures are often negatives. Case presentationWe rapport here the case of a 69-year-old man presenting with an alteration of his general condition and low back pain. He suffered from a well-controlled HIV infection and lower limb arteriopathy treated with a cross-femoral bypass. A computed tomography scan revealed a L3–L4 abscessed spondylodiscitis but multiple blood cultures remained sterile, and the transthoracic echocardiography was normal. PET scan showed a hypermetabolism on L3–L4 vertebrae but also indicated an intense uptake of the cross-femoral bypass. C. burnetii serology was in favour of a chronic Q fever. The management of this chronic Q fever needed a multidisciplinary discussion. Three months after the treatment initiation, C. burnetii serology was reduced by a titer and has stabilized 6months to a year. ConclusionChronic Q fever and mostly osteoarticular diseases are difficult to diagnose. We have to evoke the diagnosis of osteoarticular chronic Q fever in case of insidious inflammatory syndrome, negatives blood cultures spondylodiscitis especially when associated to endocarditis or vascular infection, and in case of spondylodiscitis with a granulomatous histology without Mycobacterium tuberculosis. Although there are many complementary tests (PET scanner, PCR), serology remains the cornerstone of diagnosis.

P298 TRANS–AXILLARY ACCESS AS AN ALTERNATIVE ROUTE IN TRANSCATHETER AORTIC VALVE IMPLANTATION

Abstract Background Transcatheter aortic valve replacement (TAVR) is the main procedure for treating severe aortic stenosis in patients considered at high surgical risk. Generally, this procedure is performed through percutaneous femoral arterial access. The presence of anatomical variants or peripheral atherosclerotic pathology sometimes necessitates the use of alternative vascular accesses, including access through the axillary artery. Data from a meta–analysis involving 1793 patients who underwent TAVR through trans axillary or transapical access showed a statistically significant reduction in 30–day mortality in the former group. We wait for future randomized trials to confirm the consistency of these data. Clinical case 71–year–old man, smoker, hypertensive and dyslipidaemic. In 2018, he underwent bilateral aorta–iliac–femoral bypass surgery for severe lower limb arteriopathy. Due to the onset of angina and dyspnea at rest, he went to the ER where a diagnosis of NSTEMI was made. On echocardiogram, there was evidence of severe high–gradient aortic stenosis while coronary angiography showed 80% RCA stenosis in the middle tract. Because of the high surgical risk (EUROSCORE II: 12%) and the evidence of bilateral femoral artery occlusion on CT–angiography, the Heart Team concluded to perform TAVR through percutaneous left trans–axillary access with concomitant percutaneous coronary revascularization. Obtained the backup access on the left radial artery, PTCA+DES was performed on RCA through the right radial access with subsequent placement of a pigtail catheter in the non–coronary sinus of Valsalva. Once the temporary pacemaker had been placed through the right femoral vein, an angio–guided puncture of the left axillary artery was performed with placement of the 14 Fr introducer for implantation of the Medtronic Evolut R 26 mm aortic biological prosthesis. Post–procedure ultrasound examination showed a residual mean aortic valve gradient of 17 mmHg with evidence of a small periprosthetic leak. Seven days after the procedure, the patient was discharged, asymptomatic and in good hemodynamic compensation without vascular complications. Conclusions Trans–axillary arterial access should be considered a viable alternative to transfemoral access for the performance of TAVR.

Evaluation of Post-Surgical Complications of Lower Limb Arteriopathy in the Elderly in a Geriatric Short-Stay Unit in Senegal

Evaluation of Post-Surgical Complications of Lower Limb Arteriopathy in the Elderly in a Geriatric Short-Stay Unit in Senegal

Lower Limb Arteriopathy in Diabetics at the Oueme-Plateau Provincial Hospital in Porto-Novo: Frequency and Associated Factors

Lower Limb Arteriopathy in Diabetics at the Oueme-Plateau Provincial Hospital in Porto-Novo: Frequency and Associated Factors

Actual impact of screening for myocardial ischemia with single-photon emission tomography among patients undergoing peripheral vascular interventions.

The present study provides actual data with regard to the prevalence of myocardial ischemia among patients under contemporary cardiovascular prevention strategies undergoing peripheral vascular interventions. We included a total of 200 consecutive patients who underwent gated single-photon emission computed tomography myocardial perfusion study between January 2012 and January 2014 as preoperative evaluation for peripheral vascular interventions at our institution. The baseline medical treatment comprised aspirin (81%), statins (79%), and β-blockers (54%). Thirty-two (16%) patients underwent carotid revascularization; 69 (34.5%) patients underwent lower limb revascularization, and 99 patients underwent aortic interventions. Twenty-six (13%) patients showed evidence of myocardial ischemia, with an extensive ischemic burden identified in seven (3.5%) patients. Within the group of patients with peripheral vasculopathy, those with lower limb arteriopathy had a higher prevalence of ischemia. According to the results of the myocardial perfusion study, the cardiology in charge indicated invasive coronary angiography in 11/26 (42%) patients with evidence of myocardial ischemia. Seven of the 11 (64%) patients who had coronary angiography were revascularized. After a mean follow-up of 24 months, no cardiovascular adverse events were detected.

Factors Associated with Death in Subjects Admitted for a Diabetological Emergency: Experience of the Medical Clinic II of the Abass Ndao Hospital Center in Dakar (Senegal) —Death in Diabetic Emergencies

Introduction: Metabolic and vascular emergencies constitute a risk of lethality in diabetic subjects admitted to hospital. The objective was to evaluate the factors associated with death in subjects admitted for a diabetological emergency to improve management. Materials and Methods: It was a 12-month retrospective, descriptive and analytical study at Dakar’s Marc Sankale Diabetes Center. The study concerned any type of diabetics subjects admitted for a diabetological emergency. We evaluated the profile of diabetes, the pathologies found and factors associated with death. Results: We identified 697 cases of diabetic emergencies with a prevalence of 13.8%. The sex ratio (M/F) was 0.82, the mean age was 49.6 years, and the mean duration of diabetes was 7.1 years. The metabolic profile was hypoglycemia (11.3%), ketoacidosis (34.6%), and hyperosmolar hyperglycemia syndrome (5%). The associated pathologies were vascular (51.1%), infectious (65.3%), kidney function impairment (7.6%), anaemia (13.8%). During the follow-up, 94 patients died, as an annual frequency of 13.5% among diabetological emergencies. In univariate analysis, the factors significantly associated with death were age > 60 years [OR = 4.09 (2.6 - 6.41)], hyperglycemia [OR = 2.58 (1.50 - 4.4)], hyperosmolar hyperglycemia syndrome [OR = 10.5 (5.19 - 21.5)], septic diabetic foot [OR = 3.57 (2.24 - 5.66)]. Vascular pathologies that significantly associated with death were stroke [OR = 4.06 (2.10 - 7.81)], lower limb arteriopathy [OR = 3.25 (1.84 - 5.73)], cardiovascular collapse [OR = 6.85 (2.34 - 20)]. In addition to diabetes, the deceased patients had one (18%), two (34%) and at least three (45.7%) known factors of poor prognosis. Conclusion: Emergencies in diabetology remain frequent in our practice. The comorbidity (vascular and infectious) constitutes a risk of abnormally high death rate. A particular attention must concern on old diabetics subjects with several pathologies.

Risk factors and outcomes for nosocomial infection after prosthetic vascular grafts

ObjectiveThe objective of this study was to determine risk factors for nosocomial infections (NIs) and predictors of mortality in patients with prosthetic vascular grafts (PVGs). MethodsThis was a prospective cohort study of all consecutive patients who underwent PVG of the abdominal aorta with or without iliac-femoral involvement and peripheral PVG from April 2008 to August 2009 at a university hospital. Patients younger than 15 years and those with severe immunodeficiency were excluded. The follow-up period was until 3 years after surgery or until death. ResultsThere were 261 patients included; 230 (88.12%) were male, and the mean age was 67.57 (standard deviation, 10.82) years. The reason for operation was aortic aneurysm in 49 (18.77%) patients or lower limb arteriopathy in 212 (81.23%) patients. NIs occurred in 71 (27.20%) patients. Of these, 42 were surgical site infections (SSIs), of which 61.9% occurred in the lower extremities (14 superficial, 10 deep, and 2 PVG infections) and 38.1% in the abdomen (7 superficial, 7 deep, and 2 PVG infections); 15 were respiratory tract infections; and 15 were urinary tract infections. Active lower extremity skin and soft tissue infection (SSTI) at the time of surgery was a significant predictor of NI for both types of PVG (abdominal aortic PVG: adjusted odds ratio [OR], 12.6; 95% confidence interval [CI], 1.15-138.19; peripheral PVG: adjusted OR, 2.43; 95% CI, 1.08-5.47). Other independent predictors of NI were mechanical ventilation (adjusted OR, 55.96; 95% CI, 3.9-802.39) for abdominal aortic PVG and low hemoglobin levels on admission (adjusted OR, 0.84; 95% CI, 0.71-0.99) and emergent surgery (adjusted OR, 4.39; 95% CI, 1.51-12.74) for peripheral PVG. The in-hospital mortality rate was 1.92%. The probability of surviving the first month was 0.96, and significant predictors of mortality were active lower extremity SSTI (adjusted risk ratio [RR], 12.07; 95% CI, 1.04-154.75), high postsurgical glucose levels (adjusted RR, 1.02; 95% CI, 1.00-1.04), and noninfectious surgical complications (adjusted RR, 19.38; 95% CI, 2.25-167.29). The long-term mortality rate was 11.88%. The probability of surviving at 12, 24, and 36 months was 0.94, 0.92, and 0.87, respectively. Variables significantly associated with long-term death were older age (adjusted RR, 1.08; 95% CI, 1.01-1.15), high values of creatinine on discharge (adjusted RR, 1.91; 95% CI, 1.08-3.38), and an SSI with the highest adjusted RR (6.35; 95% CI, 1.87-21.53). ConclusionsSSI was the primary NI. The risk of NI depended primarily on the presence of a lower extremity SSTI at the time of surgery, whereas mortality was determined by age, surgical complications during the operation, and SSI. These findings suggest that in those cases in which surgery is reasonably delayed, surgery should be deferred until the lower extremity SSTIs are resolved.

Benefits of intralesional injections of sodium thiosulfate in the treatment of calciphylaxis.

Calciphylaxis (CPX) is a rare calcifying thrombotic vasculopathy responsible for painful necrotic ulcers, with a high mortality rate, and its management is often difficult. Recently, intravenous infusions of sodium thiosulfate (STS) have shown efficacy. The aim of this study was to assess the efficacy of intralesional STS (IL STS) in four patients. Our aim was to assess the efficacy of IL STS in a prospective mono-centric open study that included four patients with a biopsy-proven cutaneous CPX. Four women (55-84 years old, mean age: 71·2 years) with a uremic (n = 1) or non-uremic CPX (n = 3) and primary hyperparathyroidism induced by teriparatide or after the initiation of oral anti-vitamin K were treated by IL STS (250 mg/ml). The injections were performed around the ulcers, on the active borders, once or twice a week and then at 1-2 weeks intervals. The injected quantity varied from 1·5 to 15 ml. Pain usually improved after two series of injections. Clinical response was visible after 2 weeks. Three patients (75%) healed completely or almost completely. A failure was observed in the last patient who also had lower limb arteriopathy. The main side effect was the pain during injections. IL STS is an interesting alternative therapeutic option in the management of CPX necrotic ulcers with limited side effects. Larger studies are warranted to precisely define its place, its administration procedure and the patients who could benefit from it.

DIABSAT Telemedicine Itinerant Screening of Chronic Complications of Diabetes Using a Satellite.

Health authorities recommend regular screening for the chronic complications of diabetes. The ENTRED * survey results show that insufficient screening is undertaken. The DIABSAT † program aims to improve care for diabetes patients in rural areas of the Midi-Pyrénées region, telemonitoring complications of diabetes through an itinerant screening service. A vehicle was equipped with a satellite dish and medical equipment for screening ophthalmological, renal, vascular, and neuropathic damage and assessing the level of risk of diabetic foot ulceration. Onboard, a nurse performs some or all of the tests on patients who have had no diabetes review for over a year. The data are entered into a computer and transmitted by satellite for interpretation by designated specialists. The results are sent to patients, general practitioners (GPs), and diabetologists. Two hundred twenty-eight screening days were held in six departments of the Midi-Pyrénées between 2010 and 2013. 1,545 patients were screened: mean age 70.7 years, 55.8% men. 93.4% diagnosed with type 2 diabetes, mean duration 11.7 years. Recruitment was chiefly by health professionals (55%). 17-32% of tests detected pathologies: 18.7% diabetic retinopathy, 31.9% microalbuminuria, 17.2% lower limb arteriopathy, 28.3% peripheral neuropathy, and 28.2% high risk of foot ulceration (grade 2: 20.6% and grade 3: 7.6%). The large number of patients screened and the high rate of pathological results found, confirm telemonitoring viability and relevance. DIABSAT, a primary resource for healthcare professionals, improves healthcare access through its innovative organization and use of satellite technology.

Ulcères de jambe : une expertise hospitalière est-elle souhaitable ?

Determine whether general practitioners have sufficient expertise in the field of leg ulcers. A cross-sectional survey was conducted among 179 general practitioners working in the region Île-de-France to evaluate the implementation of leg ulcer guidelines issued by the Superior Health Authority (HAS) in 2006. Participating physicians were either internship supervisors or practitioners in Paris' 14th district. The first hundred usable answers (response rate 65%) came from 71 internship supervisors and 29 practitioners of Paris' 14th district. Only 40% of the physicians were aware of the guidelines, with no significant difference noted between the two groups. 9/10 practitioners examined less than 10 patients with leg ulcers per year. Physical examinations were done according to the guidelines and a venous Doppler was prescribed in two thirds of the cases. The ankle-brachial pressure index (ABPI) essential to diagnose lower limb arteriopathy was measured for only 10% of the patients. In accordance with the guidelines, compression was by far (73%) considered as the main treatment as compared to dressing (37%), but compression therapy was well prescribed in only one-third of the cases. Despite poor prognosis criteria (characteristic and time course), referral for a specialized opinion was rare. Even if they were not always aware of the detailed guidelines, the practitioners applied the main recommendations. Nevertheless, practices could be improved by measuring the ABPI, searching for a diagnosis of arteriopathy, and better prescription of compression therapy. General practitioners should refer patients with leg ulcers to a specialized hospital unit.

CO-35: ALPHA-1 Antitrypsin deficiency : a novel cause of isolated systolic resistant hypertension?

Background Alpha-1 Antitrypsin (AAT), a serine protease of the SERPIN superfamily inhibits various tissue proteases such as neutrophil elastase and proteinase 3. Mutations in the corresponding gene, SERPINA1, are at the origin of AAT deficiency (AATD). The most frequent manifestations of AATD are panacinar emphysema and chronic liver disease. AATD has been occasionally associated with aneurysms and dissection of large vessels. Compared to matched controls, AATD patients homozygous for the common Z variant have larger ascending aortas with abnormal elastic properties (Vizzardi et al. Heart 2012 ; 98: 1354–58). However, so far, increased arterial stiffness and isolated systolic hypertension have not been documented in AATD patients. We describe the case of a young patient with isolated systolic refractory hypertension associated with a mild, atypical form of AATD, and discuss the potential link between both entities. Methods A 43-year-old non-smoker man was referred at the hypertension consultation for severe, early-onset resistant hypertension with very high pulse pressure, despite intake of eight antihypertensive drugs. He reported a history of eosinophilic esophagitis and left popliteal stent for lower limb arteriopathy. Results In a context of moderate increase in ALAT ( Genetic testing confirmed the presence of the frequent Z variant of SERPINA1 at the heterozygous state, in the absence of AAT-related liver or pulmonary disease. Sitting office blood pressure was 160/50mmHg. Body mass index was 31.3kg/m 2 . Clinical examination was otherwise unremarkable. Mean day – and night-time ambulatory blood pressre were 142/58 and 115/43mmHg, respectively. Blood and urine analysis, urinary metanephrines and abdominal CT-angiography were normal. Echocardiography showed mild concentric left ventricular hypertrophy (LVMI : 134g/m 2 ). Carotid-femoral pulse wave velocity (SphygmoCor ® ) was markedly increased (14.2 m/s; age-adjusted reference values : 4.6–9.8 m/s). By contrast, detailed assessment of retinal and sublingual capillaries showed no evidence of microvascular dysfunction. Conclusions This case report suggests that increased arterial stiffness and isolated systolic hypertension are an integral part of the spectrum of AATD-related vascular abnormalities. Conversely, AATD may be considered in the differential diagnosis of resistant hypertension, especially in the presence of increased pulse pressure in a young patient. Future perspectives include indepth blood pressure and vascular characterization of a cohort of patients with both heterozygous and homozygous AATD.

Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access

Major vascular complications (VC) remain frequent after transcatheter aortic valve implantation (TAVI) and may be associated with unfavorable clinical outcomes. The objective of this study was to evaluate the rate of VC after transfemoral TAVI performed using an exclusive open surgical access strategy. From 2010 to 2014, we included in a monocentric registry all consecutive patients who underwent transfemoral TAVI. The procedures were performed with 16Fr to 20Fr sheath systems. VC were evaluated within 30days and classified as major or minor according to the Valve Academic Research Consortium 2definition. The study included 396 patients, 218 were women (55%), median age was 85years (81 to 88), and the median logistic Euroscore was 15.2% (11 to 23). The balloon-expandable SAPIEN XT and the self-expandable Medtronic Core Valve prosthesis were used in 288 (72.7%) and 108 patients (27.3%), respectively. The total length of the procedure was 68±15minutes including 13±5minutes for the open surgical access. Major and minor VC were observed in 9 (2.3%) and 16 patients (4%), respectively, whereas life-threatening and major bleeding concerned 18 patients (4.6%). The median duration of hospitalization was 5days (interquartile range 2 to 7), significantly higher in patients with VC (7days [5 to 15], p <0.001). Mortality at 1-month and 1-year follow-up (n= 26, 6.6%; and n= 67, 17.2%, respectively) was not related to major or minor VC (p= 0.6). In multivariable analysis, only diabetes (odds ratio 2.5, 95% confidence interval 1.1 to 6.1, p=0.034) and chronic kidney failure (odds ratio 3.0, 95% confidence interval 1.0 to 9.0, p= 0.046) were predictive of VC, whereas body mass index, gender, Euroscore, and lower limb arteriopathy were not. In conclusion, minimal rate of VC and bleeding can be obtained after transfemoral TAVI performed using an exclusive surgical strategy, with a particular advantage observed in high-risk bleeding patients.

FRI0076 Need for Statins in Rheumatoid Arthritis Patients with High Cardiovascular Risk: Differences According to European and American Recommendations. the Comedra Study

BackgroundCardiovascular risk (CVR) is increased in RA and should be evaluated annually. EULAR recommends using the SCORE equation to calculate risk, after applying a multiplier of 1.5 in patients with...

Evidences of +896 A/G TLR4 polymorphism as an indicative of prevalence of complications in T2DM patients.

T2DM is today considered as world-wide health problem, with complications responsible of an enhanced mortality and morbidity. Thus, new strategies for its prevention and therapy are necessary. For this reason, the research interest has focused its attention on TLR4 and its polymorphisms, particularly the rs4986790. However, no conclusive findings have been reported until now about the role of this polymorphism in development of T2DM and its complications, even if a recent meta-analysis showed its T2DM association in Caucasians. In this study, we sought to evaluate the weight of rs4986790 polymorphism in the risk of the major T2DM complications, including 367 T2DM patients complicated for the 55.6%. Patients with A/A and A/G TLR4 genotypes showed significant differences in complication's prevalence. In particular, AG carriers had higher risk prevalence for neuropathy (P = 0.026), lower limb arteriopathy (P = 0.013), and the major cardiovascular pathologies (P = 0.017). Their cumulative risk was significant (P = 0.01), with a threefold risk to develop neuropathy, lower limb arteriopathy, and major cardiovascular events in AG cases compared to AA cases. The adjusted OR for the confounding variables was 3.788 (95% CI: 1.642–8.741). Thus, the rs4986790 polymorphism may be an indicative of prevalence of complications in T2DM patients.

Aorta thrombosis diagnosed due to acute myocardial infarct

A 54-year-old man was admitted for acute weakness in both legs. His past medical history was limited to a likely lower limb arteriopathy. His cardiovascular risk factors were heavy smoking habit and hypertension. The electrocardiogram was typical of inferior semi-recent myocardial infarct, with a Q-wave and ST-segment elevation. Transthoracic echocardiography showed an inferior hypokinesia, low left ventricular ejection fraction evaluated to 40%, normal valves, normal right cavities. An aortic computed tomography scan was then performed to rule out aortic dissection, or other aortic disorders. This scan showed an aortic thrombosis, just after the ostia of the renal arteries. Arteries were calcified, supporting the arteriopathy. This confirmed the total occlusion of the right coronary artery, without any other significant lesions. Ventricular angiography confirmed the inferior hypokinesia. The patient then suffered from an asymptomatic inferior acute myocardial infarct leading to acute aortic thrombosis, because of likely low outflow acutely worsening severe lower limb arteriopathy. The clinical presentation was surprising, as the patient had never complained of any strong pain, neither chest pain, nor lower limb pain.

Atteinte des artères des membres et maladie de Horton : à propos de cinq cas

Giant cell arteritis of the limbs is rarely reported. It may be underestimated because it is usually asymptomatic. The aim of this study was to describe the distinctive features of this involvement. Retrospective study of 50 patients with giant cell arteritis diagnosed from January 1985 to December 2007, satisfying the American college of rheumatology (ACR) classification criteria. All five patients had typical lesion at examination of temporal artery biopsy. Among these patients, those with ischemic manifestations of the limbs were selected. All patients disclosed elevated acute phase reactants and typical radiological findings. Temporal artery histopathology was made necessary to select patients. Five female (mean age: 66.8 years) out of 50 patients (10%) with temporal arteritis presented with symptomatic limb arteriopathy. Limb arteritis was the presenting feature in four patients. Clinical presentation was similar to other non-inflammatory arteritis. One patient presented with involvement of her four limbs. Typical arteriographic abnormalities were presents in all patients (occlusion or moniliform stenosis without atheromatous lesions). Despite therapy with corticosteroids associated to anticoagulants or antiplatelet drugs, four amputations were necessary. Specific limb involvement may be the presenting feature of temporal arteritis. It can mimic arteriosclerosis vascular disease, particularly prevalent in this age group.

Étude de la variabilité de réponse à l’aspirine et au clopidogrel : résistance clinique et/ou biologique ?

Millions of people in France are taking long-term treatments with the two main antiplatelet drugs, aspirin and/or clopidogrel. Most of these people are on a secondary preventive regimen after arterial thrombotic events such as myocardial infarction, stroke, or ischemic complications of lower limb arteriopathy. The term resistance is often a source of confusion. When used, its definition should be explicit. It would be probably be wiser to use a term such as "variable response" which is more widely accepted by specialists and researchers. It would be better to use the term variable platelet response since true pharmacological resistance is rare. The distinction may have clinical pertinence in terms of prognosis. An abundant amount of biological and clinical work in the literature has improved our understanding of the topic. Diverse tests for exploring platelet functions can be used to evaluate the biological impact of treatment. They should, in the near future, contribute to the implementation of guidelines or suggestions for optimal therapeutic modalities. Upcoming results of ongoing large-scale prospective studies will be needed before confirming the potential usefulness and clinical pertinence of these tests.

Evaluación de la arteriopatía de los miembros inferiores por tomografía computarizada multidetector comparada con la angiografía por sustracción digital

To evaluate the diagnostic efficacy of multidetector computed tomography angiography (MDCTA) in lower limb arteriopathy (LLA) by comparing it with digital subtraction angiography (DSA). Twenty-four patients with LLA were studied. All patients underwent MDCTA (four detectors) and DSA, with double reading between the two techniques. Vascular territories were divided to facilitate analysis. Sensitivity (S), specificity (Sp), prevalence, positive and negative predictive values (PPV, PNV), and concordance (Kappa test) were evaluated. In third-portion arteries, the diagnostic performance of MDCTA was evaluated using an ROC curve. MDCTA study to evaluate arterial pathology showed: Lower sensitivity in the study of the internal iliac artery (S: 0.65 and 0.71) with Sp 0.94 and 1. In the other vascular territories, S approached 1, with a slight decrease in Sp. Concordance with DSA was very high (kappa between 0.62 and 1) in all of the territories studied. MDCTA showed greater vessel longitude than DSA. In the third portion, the best diagnostic performance (ROC) was obtained in the reading of pathological vessels. MDCTA was highly reliable in the study of LLA, with high concordance with DSA. In tortuous vessels, MDCTA depicted the lesions poorly; however, in straight vessels and third-portion vessels, MDCTA showed more vascular segments.

OP10. INCIDENCE OF CARDIOVASCULAR EVENTS IN BIOPSY-PROVEN AND BIOPSY-NEGATIVE GIANT CELL ARTERITIS: THE PROSPECTIVE, MULTICENTRIC DOUBLE COHORT GRACG STUDY

Background: Pre-existing atheromatous disease may be a risk factor for Giant Cell Arteritis (GCA). Also, coronary vasculitis, cerebro-vascular disease, and upper or lower limb arteritis may be related to GCA in some patients. Increased rates of cardiovascular events as compared with expected rates have been reported in Scandinavian populations. Our objective was to assess in a prospective, double cohort study, the relative risk of cardiovascular events in GCA patients compared with randomly selected, population based, sex- and age-matched controls included at the time of diagnosis of the cases. Methods: 396 GCA patients (288 females, 108 males, 271 biopsy proven, and 125 biopsy negative cases) have been included on pre-defined criteria at the time of diagnosis, along with 290 controls. A follow-up questionnaire has been sent every 6 months to their physician, over a 5-year period. The 5-year relative risk has been adjusted according to Mantel-Haenszel, and interval confidence computed according to Greenland-Robins. Results are given in the table. Cumulative incidence of stroke is significantly increased in cases, but remains always lower than 3%/6 months. Incidence of angina pectoris is lower than 5% per year. There are no differences between cases and controls as regard myocardial infarction, transient cerebral attack, or lower limb arteriopathy. Conclusion: Although overall mortality is similar in GCA patients and controls, incidence of stroke and angina pectoris is slightly increased in the former, and long-term anti-platelet therapy needs to be assessed.

Thermalisme et médecine vasculaire

The therapeutic utilisation of mineral waters is very ancient. The physiological effects of immersion are now well known. Immersion results in a significant increase of diuresis, cardiac output and haemodilution. The subsequent improved tissue perfusion and decreased oedema are beneficial, in case of occlusive lower limb arteriopathy and in case of chronic venous insufficiency. Fourteen French spas are specialized in the management of arteriopathies, and 11 other centres in that of chronic venous insufficiency. Thermatology is a complementary therapy; it should be combined with a kinesitherapy and the management of risk factors. During the thermal procedure, health education should be undertaken. Main indications are ischemic lower limb arteriopathies, and chronic venous insufficiency whichever the posture.