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Introduction Advanced Practice Registered Nurses (APRNs) treat and diagnose diseases, counsel the public about health problems, manage chronic diseases, and participate in continuing education. In the cardiovascular field, Peripheral Arterial Disease (PAD), one of the manifestations of atherosclerotic cardiovascular disease, is archetypal in combining multiple cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus smoking). Vascular medicine faces the challenge of improving their care and quality of life, but some goals cannot be achieved with all patients. Patients with PAD should benefit from APRN care, but to date there is little published on the place of APRN in vascular medicine worldwide, and none in France. Objective It appeared important to us to assess the perception of their role by physicians and nurses in vascular medicine. As the status of APRN in France has only been enacted by law in 2018, we aim to investigate physicians and nurses working with patients suffering from PAD, to gather their opinions and draw the cooperation outlines these practitioners could have with an APRN. Methods Multicentre exploratory qualitative study by semi-directive interview conducted until data saturation and thematic analysis carried out with healthcare practitioners taking care of patients with PAD: 10 physicians working either in private practice setting or hospital setting or both, and 8 nurses in a vascular unit for hopsitalised patients. Results Three main themes emerged from responders' verbatims: a specific organization of vascular medicine with its inherent challenges, particularly regarding patients with PAD (specific psychosocial profile of patients, lack of therapeutic education, time, knowledge of non-specialist physicians, tedious follow-up outside hospitals, complex care trajectory, and lack of medical-surgical collaboration). Second, a role for APRN, particularly in consultation as part of patient follow-up, with expected benefits for the patient and the care team. The APRN is wanted to fill part of this gap. The expected benefits include a smoother care pathway and increased capacity for cardiovascular education and prevention, especially during consultations. Third, there are certain pitfalls that need to be clarified to integrate these new practitioners into the vascular teams already in place. In particular, the need to inform the vascular medicine teams about this new profession, and the indispensable presence of the conditions necessary for the development of a relationship of trust. Conclusion APRN could be the missing link in a Vascular team by creating a continuum in the care of patients with PAD, ensuring clinical assessment, nursing supervision, adverse event screening, and renewing drug prescriptions with the necessary adjustments, while ensuring an essential part of therapeutic education personalized to each PAD patient. Funding Acknowledgement Type of funding sources: None.

Background Vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited connective tissue disorder, leading to mainly arterial complications, caused by COL3A1 pathogenic variations. Ong et al. (Lancet 2010) showed that the introduction of celiprolol significantly reduced arterial events in a predominantly symptomatic population on arterial level. We reported the benefit of full dose of Celiprolol in longitudinal study to prevent arterial events in Frank et al. (JACC 2019). To our knowledge, there is no data regarding the benefit of celiprolol in patients without any arterial event. Purpose The aim of this study was to assess the occurrence of arterial events during follow-up in vEDS patients without arterial event. Methods All patients – probands and relatives – with a pathogenic variation in COL3A1 diagnosed at the Referral Centre for Rare Vascular Diseases since 2001 and at least one arterial tree assessment were included. We then focused on vEDS patients without any arterial event. We retrospectively analyzed the duration of follow-up, the occurrence of arterial events during follow-up, and the introduction and dose of celiprolol, especially at the time of occurrence of an arterial event. Results Among the 230 patients included, 144 (63%) had at least one symptomatic arterial event, 44 (19%) had only silent arterial event and 67 (29%) had no arterial event at the first arterial tree assessment event. Patients with no arterial event were significantly younger at this visit compared with the two other groups with a median age of 23 vs. 38 and 39 years (silent and symptomatic) (p Conclusions Genetic testing of the relatives of probands with vEDS remains of utmost importance as one quarter presented with symptomatic arterial event and one fifth had silent arterial event at initial arterial tree assessment. For patients with no arterial event, those without celiprolol have a similar incidence of arterial events than those with celiprolol, however their follow-up duration was twice shorter suggesting a higher incidence rate or arterial event in the absence of celiprolol. Funding Acknowledgement Type of funding sources: None.

Objectives Use of sulphur hexafluoride microbubbles (MB) with ultrasound can provide arterial wall enhancement. The use of ultrafast imaging with MB super-localization offers the possibility of ultrasound localization microscopy (ULM) and thus a visualization of in vivo carotid vasa vasorum. We aim to perform in vivo Vasa vasorum imaging in the carotid wall in Takayasu's arteritis and to provide a correlation with the disease's activity. Methods Patients with Takayasu arteritis were consecutively included in the national referral centre. Assessment of activity was performed by NIH activity index, with measurement of biological inflammation, morphological evaluation by computed tomography (CT) angiography, and 18-fluorodeoxyglucose CT scan. Ultrafast ultrasound imaging was performed with a 7 MHz central frequency linear probe. A dedicated contrast imaging sequence (plane waves with 8 angles, frame rate 500 Hz, voltage 8 V, duration of 8 s), coupled with the intravenous injection of sulphur hexafluoride MB allow us to store the raw radio frequency data of the MB passage. After a pre-processing step to accumulate frames properly including a frames selection and a movement correction, the MB were localized then tracked, allowing reconstruction of the vasa vasorum. The inflammation was quantified through MB tracked and normalized for inter acquisition comparison. Results 16 patients were included. 5 patients (median age 35.8 [24.5–46.0] years, 3 women) had active disease and 11 patients (37.2 [31.7–47.3] years, 9 women) had quiescent disease. The passage of MB allowed the visualisation of microvessels within the arterial wall for active cases. The number of MB detected per second in the wall was 118 [80–169] for active cases vs. 13 [10–15] for quiescent cases (p=0.0005). Conclusion ULM allows visualization of microvessels within the carotid wall, with significantly greater MB passage in active Takayasu arteritis. ULM provides for the first time a precise visualization in vivo of the vasa vasorum and gives access to quantification of the vascularity of the arterial wall. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Société française de cardiologie

Background High lipoprotein(a) levels are involved in the development of cardiovascular events, as particularly in myocardial infarction, stroke, and peripheral artery disease. Studies assessing prognostic values of lipoprotein(a) levels on the lower limbs are lacking. Purpose The aim of our study was to look after a relationship between the lipoprotein(a) level and the incidence of major adverse limb events (MALE) defined as major amputation, peripheral artery endovascular revascularization or peripheral artery bypass. Methods We included 16,513 patients with lipoprotein(a) measurements from our clinical information system. Normal lipoprotein(a) level was under 50 mg/dL and we defined: high lipoprotein(a) level as a lipoprotein(a) level between 50 mg/dL and 134 mg/dL and very high lipoprotein(a) level as a lipoprotein(a) levels over 134 mg/dL, i.e the 95th percentile in this cohort. Accelerated Failure Time models were used to assess the relationship between the lipoprotein(a) level and the incidence of MALE retrieved from the patient's electronic record during a median (interquartile range) follow-up of 3.74 (1.07; 7.30) years after the lipoprotein(a) measurement. MALE was defined as the occurrence of one of the following during follow-up: aortofemoral bypass surgery, limb bypass surgery, percutaneous transluminal angioplasty revascularization of the iliac, or infrainguinal arteries; or major amputation above the forefoot. Secondary outcomes included individual components of the primary Results Median lipoprotein(a) level was 24 mg/dL (10; 60), with 70.3%; 24.7%; and 5.0% within normal; high and very high lipoprotein(a) level respectively. The 1-year MALE incidence was 2.2% [95% CI: 1.96; 2.51]; 2.60% [95% CI: 2.09; 3.10] and 4.54% [95% CI: 3.08; 5.98] among the normal, high and very high lipoprotein(a) level patients respectively. High and very high lipoprotein(a) levels were independently associated with an increased risk of MALE (adjusted Accelerated Failure Time Exponential Estimate) 0.43 [95% CI: 0.24; 0.78], p=0.01 and 0.17 [95% CI: 0.07; 0.40], p Conclusion In this large cohort of unselected real-world hospital inpatients, higher lipoprotein(a) levels were independently associated with an increased risk of MALE. Though, lipoprotein(a) measurement shall be taken into account not only to refine the cardiovascular risk but also the lower limb risk of revascularization or amputation. Funding Acknowledgement Type of funding sources: None.

Resume La maladie de Takayasu est une vascularite inflammatoire chronique d’origine inconnue qui affecte les vaisseaux de gros calibre, principalement l’aorte et ses branches principales. L’inflammation de la paroi arterielle conduit a l’epaississement de la paroi, sa fibrose et a une stenose. Souvent asymptomatiques a la phase initiale, les lesions arterielles peuvent se manifester par le retentissement de ces stenoses : claudication de membre, accident cerebral ischemique transitoire, accident cerebral ischemique constitue, hypertension arterielle renovasculaire. Ces symptomes etant peu specifiques, quelle place a l’imagerie dans le diagnostic de la maladie, et au-dela de son concours au diagnostic, quelle place prend-elle dans le suivi et la caracterisation de l’activite de cette arterite ? Une facon d’evaluer la place de l’imagerie dans l’exploration de l’arterite de Takayasu est de se poser la question de faire sans. Enfin, qu’elle est la place des interventions basees sur l’evaluation de l’arterite de Takayasu ?

En medicina vascular, varias patologias reciben tratamiento farmacologico. Los tratamientos utilizados en esta especialidad tambien tienen su propia iatrogenia. El sindrome de Raynaud esta asociado a diversas quimioterapias contra el cancer, betabloqueantes, derivados de la ergotamina, tratamientos del trastorno por deficit de atencion, reboxetina, fentermina. La hidroxiurea y el nicorandil son causas de ulceras en las piernas. La necrosis cutanea y la isquemia venosa de los miembros pueden ocurrir con antivitaminas K (AVK), en particular en caso de cancer o de trombocitopenia inmunoalergica inducida por heparina. El estrogeno, la testosterona, la quimioterapia contra el cancer y los neurolepticos son factores de riesgo de accidentes tromboembolicos venosos. La corticoterapia, la terapia antirretroviral, los antiangiogenicos, los inhibidores de la tirosina cinasa (ITK) y de mTOR (blanco mecanicista de la rapamicina) exponen al riesgo de trombosis arterial, a veces por dislipidemia, hipertension arterial o diabetes. Los antitromboticos exponen a un riesgo hemorragico, variable segun el tratamiento, que aumenta en caso de asociacion: antiplaquetario (aspirina, dipiridamol, clopidogrel, prasugrel, ticlopidina, ticagrelor, antagonistas de los receptores de la glucoproteina [GP] IIb/IIIa), heparinas no fraccionadas y de bajo peso molecular (HBPM), AVK, anticoagulantes orales directos (AOD) (dabigatran, rivaroxaban, apixaban, edoxaban). Su conocimiento orienta la eleccion y duracion del tratamiento.

To report our initial experience of fully percutaneous deep venous arterialization (pDVA) for the treatment of chronic critical limb ischemia (cCLI) after failed distal angioplasty.pDVA was performed in five consecutive patients by creating an arteriovenous fistula (AVF) between a below the knee artery and its satellite deep vein. In this early experience, only patients with failed prior interventional attempts at establishing flow with no distal targets for an arterial bypass were selected. Early technical success was defined as successful AVF creation and retrograde venous perfusion of the wound site. Patient demographics, procedural details, morbidity/mortality and wound healing outcomes were assessed prospectively. Patients were followed up in wound care centers, and graft patency was documented on duplex ultrasound.All five consecutive patients (mean age 58 years) underwent successful pDVA without any procedural complications. There were neither 30-day major adverse limb events nor major cardiovascular complications. Three out of the five patients (60%) had clinical improvement as observed by resolution of rest pain and complete wound healing. At the 1-month FU, one patient died and one patient received a major amputation. The median wound healing time was 39 weeks.pDVA is a safe and feasible vascularization alternative in patients with end-stage/no-option CLI. The early experience highlights the need for a multidisciplinary approach including a dedicated wound care service.

Resume La maladie de Takayasu est une vascularite inflammatoire chronique d’origine inconnue qui affecte les vaisseaux de gros calibre, principalement l’aorte et ses branches principales. L’inflammation des vaisseaux conduit a epaississement de la paroi, la fibrose et a une stenose. Les lesions sont souvent asymptomatiques menant a claudication des membres, accident ischemique transitoire, accident cardiovasculaire et hypertension renovasculaire. Le traitement repose sur les corticoides, immunosuppresseurs et biotherapies si besoin. Le traitement endovasculaire et la chirurgie peuvent etre utiles pour soulager l’ischemie d’organes.

Les fluoroquinolones sont parmi les antibiotiques les plus frequemment prescrits apres les betalactamines. Elles sont utilisees pour traiter les infections courantes comme les pneumonies et les infections urinaires, mais egalement les infections osseuses et les infections nosocomiales en etablissement de sante. En 2016, la prescription de fluoroquinolones en France representait 4,7 % des antibiotiques prescrits en ville et 11 % des antibiotiques prescrits en etablissement de sante. Les effets indesirables bien connus des fluoroquinolones sont une augmentation du risque de tendinopathie : tendinite et rupture tendineuse. Plus recemment, un lien entre l’utilisation des fluoroquinolones et une atteinte de l’aorte a ete soulevee, comprenant anevrisme aortique et dissection, des conditions pouvant necessiter une intervention urgente. L’apparition d’un anevrisme de l’aorte ou d’une dissection a ete significativement associee dans les 60 jours suivant l’utilisation des fluoroquinolones avec un risque multiplie entre 1,8 et 3,2 par comparaison a l’utilisation d’amoxicilline dans une etude sur donnees de sante en Suede. Dans une etude canadienne, ce risque etait entre 2,02 et 2,49 dans les 37 jours suivant la prise de fluoroquinolones. C’est plus le risque d’anevrisme de l’aorte abdominale que de dissection qui est augmente, et surtout dans les 10 premiers jours. Pas de difference selon le sexe ou l’âge n’etait retrouvee. Une possible explication de cet effet provient de l’observation de l’augmentation des metalloproteases de la matrices (MMP) et de la degradation du collagene de type I dans le tendon avec la ciprofloxacine. L’augmentation d’activite des MMP 2 et 9 induit un anevrisme de l’aorte chez la souris et favorise le developpement d’un anevrisme de l’aorte chez l’homme. L’evolution de la prescription entre 2007 et 2017 est en baisse de 37,3 % en ville et 54,5 % en etablissement de sante. Neanmoins, en raison d’effets indesirables potentiellement graves, une vigilance est donc recommandee lors de leur prescription. Ainsi, l’utilisation des donnees de pharmacovigilance a permis de faire emerger un effet indesirable des fluoroquinolones insoupconne jusqu’alors. Les mecanismes physiopathologiques sous-jacents necessitent des explorations complementaires afin de confirmer ou non les hypotheses avancees.

Les betabloquants dans l’arterite obliterante des membres inferieurs (AOMI) sont craints sur des arguments bases sur la pharmacodynamie de cette classe medicamenteuse, et la vasoconstriction engendree par le blocage des recepteurs β2 adrenergiques au niveau arteriel peripherique. D’ailleurs, ce raisonnement pharmacologique a conduit au developpement de molecules selectives des recepteurs β1 comme le Metoprolol, ou bloquant a la fois les recepteurs β et α1 adrenergiques, ces derniers etant responsables d’une vasoconstriction arterielle en cas de stimulation, comme le Labetalol, ou bloquant selectivement les recepteurs β1 et les recepteurs α2, et stimulant les recepteurs β2 amplifiant l’effet vasodilatateur peripherique, comme le Celectol, ou enfin bloquant les recepteurs β1 et stimulant les recepteurs β3 responsables d’une vasodilatation monoxyde d’azote dependante, comme le Nebivolol. Toutes ces molecules ont ete testees dans l’AOMI avec des benefices evalues par l’augmentation du flux sanguin arteriel des membres inferieurs et de la distance de marche chez le patient claudicant, la reduction de la mortalite globale dans une etude de cohorte de patients atteints d’AOMI et de la mortalite a 30 jours de patients en ischemie chronique menacant les membres inferieurs. Par ailleurs, la securite d’usage a egalement ete retrouvee dans des etudes retrospectives que cela soit chez le patient claudicant ou meme dans une situation d’ischemie chronique menacant le membre inferieur, sans augmentation du risque d’amputation. Ainsi, les craintes d’aggravation de l’AOMI en cas d’utilisation des betabloquants dans l’AOMI ne sont pas fondees sur les donnees de la litterature. Par ailleurs, la mortalite cardiovasculaire, notamment par infarctus du myocarde, est elevee en presence d’AOMI (8–9 % a 5 ans), s’expliquant par une prevalence de la maladie coronaire chez ces patients entre 40 et 60 %. Mais les preuves formelles du benefice des betabloquants en prevention des complications de la maladie coronaire stable sont minces. Enfin, il n’existe pas d’etude controlee, randomisee, en double aveugle des betabloquants dans l’AOMI. Ainsi, bien qu’intuitivement, le benefice des betabloquants dans cette population a tres haut risque de mortalite cardiovasculaire semble en faveur de leur utilisation, et que par ailleurs, leur securite d’emploi ne soit pas mise en doute, il n’y a pas de preuves formelles permettant de recommander leur prescription systematique chez le patient arteritique.

Common femoral vein occlusion (CFVO) is frequently found in patients with chronic venous insufficiency. The iatrogenic form, secondary to either central catheter or surgery, is very rare but highly symptomatic. Classical compression therapy barely improves the clinical status of these patients, making them suitable candidates for an interventional procedure for venous recanalization.We report here three consecutive cases of iatrogenic CFVO referred to our outpatient clinic because the disease had an impact on daily life activities. We detail the recanalization procedure, the Doppler control and the short-term outcome.In each case, endovascular recanalization required rigid material (rigid guide or Colapinto needle) to cross the fibrous adhesions before angioplasty could be performed with stenting. The procedure required two attempts in each case, underlining its complexity, but eventually enabled effective recanalization. No major complication occurred per- or post-procedure. One month later, a duplex Doppler control confirmed the permeability of the common femoral vein. The patients had experienced rapid and significant symptom improvement.Patients suffering from severe chronic venous insufficiency caused by iatrogenic CFVO can benefit from endovascular recanalization. Although these procedures may be complex due to the extensive fibrosis at the Scarpa and require specialized equipment, no major complications were observed. Patency of the recanalization persisted at least one month after the procedure. Symptom relief was good.

Cas clinique Madame Christine M, 75 ans, consulte pour douleurs, œdemes et hypodermite des membres inferieurs. A l’examen, il existe des lesions multiples, godet, Stemmer positif, classe C5s. Dans ses antecedents, on note une HTA traitee par diuretique thiazidique, et des antecedents familiaux d’insuffisance veineuse. L’echographie Doppler arterio-veineuse met en evidence une incontinence ostio-tronculaire des grandes saphenes. Une sclerotherapie echo-guidee a la mousse est alors associee a une compressotherapie inamovible par bande inamovible a l’oxyde de Zn. Nous avons obtenu une disparition de l’hypodermite et des lesions cutanees. Mais les œdemes persistent… Bilan cardiologique HVG moderee sans signe de decompensation. Scanner thoraco-abdomino-pelvien RAS. Sur le plan clinique, la marche devient de plus en plus difficile, elle porte sa compression qui ne la soulage pas. Le bilan biologique montre une hypereosinophilie d’intensite croissante (depuis 2014), un syndrome inflammatoire avec une CRP a 25 puis 50. Un test de Coombs positif de type Ig G sans argument en faveur d’une hemolyse. La fonction renale est normale. Une hypoprotidemie a 53 g/L et hypoalbuminemie a 23 g/L. Une hypergammaglobulinemie d’allure polyclonale sans pic d’IgM. Une corticotherapie a 60 mg/j est alors instauree. Epidemiologie Il s’agit d’une maladie rare, que l’on trouve essentiellement chez l’homme entre 20 et 60 ans, avec des formes pediatriques et geriatriques. La maladie se declare en general en automne ou en hiver (saison froide). Clinique Deux phases essentiellement, une inaugurale avec apparition d’œdemes douloureux des membres symetriques epargnant les extremites et le visage, une seconde avec disparition de ces phenomenes et instauration d’une induration et retraction des articulations limitant leur mobilite. L’etiologie reste inconnue. Diagnostic differentiel Essentiellement avec les sclerodermies : absence d’acrosyndrome, de sclerodactylie et de phenomene de Raynaud. La capillaroscopie est normale en cas de FAE. Traitement et pronostic Le traitement de reference est la corticotherapie : 0,5 a 1 mg/kg/j. Le pronostic est favorable en cas de diagnostic rapide (avant la fibrose) en quelques semaines. Le pronostic est tres favorable s’il n’est pas associe a une hemopathie severe.

Takayasu arteritis is a chronic inflammatory vasculitis of unknown origin affecting large vessels, predominantly the aorta and its main branches. Vessel inflammation leads to wall thickening, fibrosis, and stenosis. The lesions are often asymptomatic leading to limb numbness, transient ischemic attack, cardiovascular event and renovascular hypertension. Treatment is based on corticosteroids, immunosuppressant and biologics if necessary. Endovascular treatment and open-surgery can be useful for end-organ ischemia relief.

To assess the relationship between Takayasu arteritis (TAK) and pregnancy outcome.This study included 240 pregnancies in 96 patients fulfilling the American College of Rheumatology 1990 criteria for the classification of TAK and/or the 1994 Chapel Hill Consensus Conference nomenclature/criteria for vasculitis. We analyzed obstetric and maternal outcomes in women who were pregnant before and/or at the same time as or after TAK diagnosis. We assessed factors associated with complicated pregnancy.One hundred forty-two pregnancies occurred in 52 patients before TAK diagnosis (median age at pregnancy 26 years [interquartile range 23-30 years]), and 98 pregnancies occurred in 52 patients concomitant with or after TAK diagnosis (median age at pregnancy 28 years [interquartile range 26-31 years]). Pregnancies concomitant with or after TAK diagnosis had a 13-fold higher rate of obstetric complications compared to pregnancies before TAK diagnosis (odds ratio 13 [95% confidence interval 5-33], P0.0001). TAK was associated with a 40% frequency of obstetric complications, including preeclampsia/eclampsia (24 pregnancies [24%]), premature delivery (8 pregnancies [8%]), and intrauterine fetal growth restriction or death (5 pregnancies [5%]). Maternal complications of TAK occurred during 39% of pregnancies and included mainly new-onset or worsening hypertension (26 pregnancies [27%]). In multivariate analysis, smoking (odds ratio 6.15 [95% confidence interval 1.31-28.8]) and disease activity of TAK (a National Institutes of Health score of1) (odds ratio 28.7 [95% confidence interval 7.89-104.7]) were independently associated with obstetric and maternal complications.TAK negatively affects pregnancy outcomes. Disease activity increases the risk of obstetric and maternal complications, mainly due to arterial hypertension.

The development of tyrosine kinase inhibitors (TKI) has revolutionized management of patients with chronic myeloid leukemia (CML), transforming this fatal disease into a chronic disease with nearly normal life expectancy. Nilotinib is a second generation TKI targeting the oncoprotein BCR-ABL used in patients in the chronic phase of CML. Several research teams have suggested over recent years that nilotinib might be the causal agent in the development or aggravation of vascular disease, particularly in patients with cardiovascular risk factors or an established cardiovascular disease. We report here the case of a patient who developed severe peripheral arterial disease of the lower limbs that worsened despite optimal medical and surgical care, presenting recurrent re-stenoses after different revascularization techniques (bypass, angioplasty…) associated with aggravation of severe trophic disorders to the point of potentially requiring amputation. Discontinuation of nilotinib enabled a stabilization of the arterial lesions and complete healing of the trophic lesions. This case illustrates the importance of recognizing co-morbid conditions in patients with severe vascular disease and to examine the possibility of drug interactions leading to rapid aggravation of arterial disease with no other cause. Studying the pathophysiological impact of TKIs on the vascular system may open new avenues of research for the investigation of factors triggering arteriosclerosis.

Diabetes mellitus is an independent risk factor for peripheral artery disease. Life expectancy is 41 months for diabetic patients with an ischemic ulcer. The characteristics of diabetic arteriopathy make its treatment more difficult than in non-diabetic patients. Few data are available about the surgical treatment of arteriopathy in diabetic patients (including angioplasty or bypass), especially in case of distal arteriopathy. The choice of the procedure depends on multiple factors such as the disease localization, its extent, distal blood flow and vascular disease-related surgical risk. The principal aim of revascularisation is to restore direct flow to the foot in order to ensure wound healing and limb salvage. With percutaneous endoluminal angioplasty, limb salvage can be achieved in more than 80% of patients at 1-3 years. The percutaneous procedure is less invasive than open surgery, there are fewer complications, and morbidity and mortality rates are reduced; moreover, a second procedure remains possible in the future. With bypass surgery, the rate of limb salvage exceeds 80% at five years. Nevertheless, peri-operative mortality reaches 3% and arterial anatomy, patient-related risks factors or venous graft availability may be limitations. New endovascular techniques especially designed for the distal arteries of the lower limbs enable very distal revascularization with morbidity and mortality rates lower than with surgery.

New antithrombotic agents with the potential to prevent atherothrombotic complications are being developed to target receptors on platelets and other cells involved in plaque growth. The aim of this study was to investigate the antiplatelet effects of F 16618, a new non-peptidic PAR1 (thrombin receptor) antagonist.We investigated the inhibitory effect of F 16618 on human platelet aggregation ex vivo, in whole blood and washed platelets, by using a multiple-electrode platelet aggregometer based on impedance and an optical aggregometer, respectively. Its effects on whole-blood haemostasis (clot parameters) were analysed with the ROTEM thromboelastometry device and the platelet function analyser PFA-100. A guinea-pig model of arterial thrombosis was used to investigate its effects on thrombus formation in vivo.F 16618 inhibited PAR1 agonist peptide (SFLLR-peptide)-induced washed platelet aggregation ex vivo. This effect was concentration-dependent and exhibited a competitive inhibition profile. Washed platelet aggregation, as well as P-selectin expression induced by thrombin, were significantly inhibited by 10 µM F 16618. In whole-blood experiments, 20 µM F 16618 inhibited SFLLR-induced platelet aggregation by 49%. In contrast, it had no effect on whole-blood haemostasis. In the guinea-pig model of carotid thrombosis, 0.32 mg·kg(-1) F 16618 doubled the occlusion time.F 16618 was shown to have strong antithrombotic activity in vivo and moderate antiplatelet effects ex vivo. As these effects were not associated with major effects on physiological haemostasis, this molecule is a good antiplatelet drug candidate for use either alone or in combination with current treatments.

Valvular incompetence with reflux and postthrombotic syndrome are the most common features of varicose veins, a common disease. More rare etiologies must be evoked when these two main causes have been ruled out. We report herein the case of a 47-year-old man who has been suffering from varicosis and complained with left leg pain since 15 years. He had already been managed by standard stripping, saphenous ligations, phlebectomies but was not completely relieved. X-ray findings of the tibia, doppler ultrasonography and magnetic resonance imaging led us to the diagnosis of tibial intraosseous venous drainage anomaly. We then report diagnosis and therapeutic decisional approach.

Recurrent venous thromboembolism (VTE) is frequent and can be fatal. Long-term antithrombotic treatment reduces the risk of recurrent VTE but increases the risk of bleeding and, therefore, cannot be proposed for all patients. Predicting the probability of recurrence in an individual patient is of utmost importance for assessing the risk-benefit ratio of long-term anticoagulation. Multiple clinical risk factors for recurrent VTE have been identified which include: unprovoked first episode, anatomical proximal location, male gender, residual venous thrombosis, cancer and antiphospholipid syndrome. d-dimer level after discontinuation of oral anticoagulation can help to predict the risk of recurrence with a good negative predictive value. Finally, genetic polymorphisms and rare inherited deficiencies of natural anticoagulant proteins do not seem to be strongly associated to recurrence. New antithrombotic drugs may, in the near future, improve the safety and of long-term anticoagulation treatment.

Introduction La maladie de Takayasu (MT) est une arterite inflammatoire entrainant une stenose progressive des arteres de gros et moyen calibre, notamment les arteres renales. La prevalence de l’insuffisance renale chronique (IRC) dans cette maladie n’a jamais ete etudiee. Patients et methodes Etude retrospective multicentrique conduite dans 3 centres de reference pour la MT. Les dossiers medicaux des patients avec une MT, definie par les criteres de l’ACR, ont ete analyses a la recherche d’une IRC, definie par la presence d’un DFG (MDRD) 2 a deux reprises, a plus de 3 mois d’intervalle. Resultats Sur les 240 patients atteints de MT, 16 patients presentaient une IRC (soit 6,7 %). Le sex-ratio (H/F) etait de 2/14 et l’âge moyen au diagnostic de la MT egal a 49 ± 17 ans. Tous etaient hypertendus et dans les antecedents on notait un AVC dans 3 cas, une coronaropathie dans 3. Une corticotherapie avait ete donnee a 11 patients, des immunosuppresseurs dans 9 cas. Une atteinte des arteres renales par la MT a ete retrouvee chez 10 patients, unilaterale dans 4 cas, bilaterale dans 6. L’arteriographie objectivait une stenose dans 13 cas, une occlusion dans 3. Dans 15 cas, l’IRC etait objectivee apres le diagnostic de la MT, avec un delai median de 12 ans (2 a 31). Une glomerulonephrite etait diagnostiquee dans 2 cas (GNMP et amylose AA), mais l’IRC a ete le plus souvent attribuee a une nephropathie vasculaire. Au dernier suivi, 3 patients etaient en dialyse et les 13 patients non dialyses avaient un DFG median de 39 mL/min/1,73 m 2 . Discussion et conclusion Dans la MT, l’IRC reste rare, souvent modeste, et secondaire essentiellement a une nephropathie vasculaire. Le pronostic fonctionnel renal semble plus dependant de l’HTA que de l’atteinte frequente des arteres renales.

Objectives The aim of this registry is to determine: (1) the real-life use of various biologics in Takayasu arteritis in France; (2) to compare the efficacy of different biologics among them; (3) to evaluate the tolerance; (4) to describe the long term outcome. Methods All French practionners from the departments of internal medicine, of vascular medicine and rheumatology will be regularly contacted to declare the patients with TA under biologics. The clinical, biological and radiological data are collected in standardized fill at the baseline, at 6, 12, 24 months and the last visit. All radiological exams will be reviewed by two radiologists blinded to the clinical and biological data. The response to the biologics will be assessed using NIH score, and the outcome will be compared at the least visit to the baseline. The disease activity was determined using the NIH score. Results Forty two patients with TA (age 42±15 years, 36 women) were included. At the initiation of biologics, 91% of patients were treated with steroids (prednisone mean amount 27±20 mg/day). Another immunosuppressive agent was associated in 88%: methotrexate (56%), azathioprine (34%) and mycophenolate mofetil (3%). Steroid dependence was noted in 41% of patients. At the time of the biologics initiation the clinical symptoms were upper limb claudication (35%), carotidynia (32%), arterial hypertension (21%), headaches (24%), fever (9%), arthromyalgias (35%), and arterial vascular stroke (12%). Associated disease was noted in 24% of cases: spondyloarthritis (15%), Crohn disease (6%) and sarcoidosis (1%). The various biologics were used in 48 cases for 42 patients. Among them, the biologics was infliximab (52%), etanercept (14%), adalimumab (10%), tocilizumab (31%), anakinra (2%) and rituximab (5%). The biologics duration was 1.8±1.1 year, with the mean follow-up of 3±1.5 years. Two infusion related reactions were noted, one myocardial infarction and 4 severe infections. One patient under tocilizumab experienced adverse effect which was severe neutropenia (

Background Takayasu arteritis (TA) is a chronic inflammatory disease that primarily affects large vessels, such as the aorta and its main branches. Objectives To report clinical features, morphologic findings, treatment and long-term outcome of a large cohort of patients with TA. Methods We performed a retrospective multicenter study of characteristics and outcome of 122 patients with TA fulfilling the American College of Rheumatology criteria. Results The median age [Q1; Q3] at onset of symptoms was 35.4 [24.4; 46.3] years and with a predominance of females (n=103, 84.4%). The median delay of diagnosis was 10 [0; 46.25] months. The most common clinical findings were vascular bruits (n=66, 54.1%), upper extremity blood pressure discrepancy >10 mm Hg (n=57, 46.7%), and unequal or absent pulses (n=55, 45.1%). Major complications at diagnosis were hypertension (n=41, 33.6%), aortic regurgitation (n=24, 19.7%), aneuvrysm (n=30, 24.6%) and retinopathy (n=3, 2.1%). Fifty five (45%) patients had extensive disease at diagnosis according to Numano type V. Twenty four (19.7%) patients had another inflammatory or auto-immune disease associated to TA. Stenotic lesions were 3.1-fold more common than were aneuvrysms (77.9% versus 24.6%, respectively). Revascularization procedure was required for 53 (43.4%) patients. The median delay between diagnosis and first surgery or endovascular intervention was 5 [0; 17.5] months. Medical therapy (i.e. corticosteroids) was prescribed in 107 (87.7%) patients. The median delay in initiation of corticosteroids was 1 [0; 5] months. Eighty one (66.4%) patients required additional immunosuppressive agent. The median delay in initiation of the first immunosuppressor was 11 [2; 29.5] months. Fifty four (44.3%) patients relapsed after a median follow-up of 64.5 [24.9; 124.5] months. The median relapse-free survival was 16 [7; 62.25] months. Conclusions Most patients with TA require prolonged and intensive medical therapy. However, relapse and revascularization are frequents, occurring in nearly half of patients. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5926