K Kaouel

La Rabta Hospital Tunis, Tunis-Ville, Tūnis, Tunisia

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Publications (25)3.71 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Migration of an aortic stent is one of the most serious complications that can occur during follow-up after endovascular repair of an abdominal aortic aneurysm. We report the case of a 75-year-old man who underwent endovascular treatment for an infra-renal aortic aneurysm using an aorto-mono-iliac stent associated to a femoro-femoral bypass. The angiography performed at the end of procedure showed complete exclusion of the aneurysm. The postoperative course was uneventful. CT scans at 1, 6 and 12 months were normal. The CT scan at the 18th month showed a proximal migration of the stent, which was complicated by a type 1 endoleak and a stent disjunction with a type 3 endoleak. Revision surgery was indicated but the patient died from aneurismal rupture pending treatment. The migration of an aortic stent is a rare but serious complication of endovascular aneurysmal repair. Prevention requires a precise anatomical selection and adequate deployment of the stent graft.
    Journal des Maladies Vasculaires 04/2014; · 0.24 Impact Factor
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    ABSTRACT: Migration of an aortic stent is one of the most serious complications that can occur during follow-up after endovascular repair of an abdominal aortic aneurysm. We report the case of a 75-year-old man who underwent endovascular treatment for an infra-renal aortic aneurysm using an aorto-mono-iliac stent associated to a femoro-femoral bypass. The angiography performed at the end of procedure showed complete exclusion of the aneurysm. The postoperative course was uneventful. CT scans at 1, 6 and 12 months were normal. The CT scan at the 18th month showed a proximal migration of the stent, which was complicated by a type 1 endoleak and a stent disjunction with a type 3 endoleak. Revision surgery was indicated but the patient died from aneurismal rupture pending treatment. The migration of an aortic stent is a rare but serious complication of endovascular aneurysmal repair. Prevention requires a precise anatomical selection and adequate deployment of the stent graft.
    Journal des Maladies Vasculaires 01/2014; · 0.24 Impact Factor
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    ABSTRACT: Lesions affecting the supra-aortic arterial trunks often occur in a contest of severe chest trauma. They are rarely isolated and can be life-threatening. We report a case of surgery for an isolated traumatic dissection of the innominate artery. A 48-year-old patient had a road accident causing head injury, trauma of the left lower limb and blunt chest trauma. At the physical exam, the pulse at the upper right limb was weak compared to the contralateral member. A pressure gradient of 50mm Hg was recorded between the two upper limbs. A whole body scan revealed a dissection of the innominate artery sparing its origin and bifurcation. Cervicotomy and sternotomy was necessary to achieve control. After heparinization and clamping, a prosthetic bypass was inserted to replace the innominate artery. The postoperative course was uneventful and the pressure gradient between the two upper limbs disappeared. Lesions of the brachiocephalic arterial trunk are not frequent but they are serious. A careful physical exam at admission helps detect them. Prognosis is directly linked to early diagnosis and management. Conventional surgery provides good results and remains the standard treatment for these lesions.
    Journal des Maladies Vasculaires 12/2013; · 0.24 Impact Factor
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    ABSTRACT: Arterial aneurysms are most commonly (60% of cases) located in the infrarenal abdominal aorta. An inflammatory mechanism is involved in only 10% of cases. Infrarenal abdominal aortic aneurysms revealing Takayasu's disease is unusual. Takayasu's disease is a rare vasculitis affecting large arteries in young people. It is 10 times more common in women. We report the case of an acute rupture of an abdominal aortic aneurysm revealing Takayasu arteritis in a 39-year-old man with an uneventful medical history.
    Journal des Maladies Vasculaires 11/2013; · 0.24 Impact Factor
  • La Tunisie médicale 07/2013; 91(7):478-9.
  • La Tunisie médicale 06/2013; 91(6):423-4.
  • La Tunisie médicale 03/2013; 91(3):224-5.
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    Journal des Maladies Vasculaires 03/2013; 38(2):135. · 0.24 Impact Factor
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    ABSTRACT: Objectives The aim of this study was to review our experience in the management of traumatic rupture of the aortic isthmus, to evaluate the results of surgery and endovascular exclusion and to develop an adequate therapeutic strategy based on the existence and severity of associated injuries. Material A series of 37 patients presenting posttraumatic aortic rupture associated with other severe lesions was collected from 2000 to 2012. There were 33 males and four females, mean age 38 years. In this series, 25 patients underwent surgical treatment and 12 endovascular exclusion. Results Six patients died during or after surgery. Overall mortality was 16% (24% in the surgery group). The postoperative period was uneventful in all patients treated with the endovascular procedure. Postoperative computed tomography controls at one week, 1 month and 12 months showed good positioning of the stent without endoleakage. Conclusion Traumatic aortic rupture is often the result of a severe high-energy chest trauma. Other serious injuries are often associated. Results of immediate surgical repair are associated with high morbidity and mortality. The advent of endovascular treatment has revolutionized the treatment of traumatic aortic rupture, especially in patients with a high surgical risk.
    Journal des Maladies Vasculaires 02/2013; 38(1):13–21. · 0.24 Impact Factor
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    ABSTRACT: OBJECTIVES: The aim of this study was to review our experience in the management of traumatic rupture of the aortic isthmus, to evaluate the results of surgery and endovascular exclusion and to develop an adequate therapeutic strategy based on the existence and severity of associated injuries. MATERIAL: A series of 37 patients presenting posttraumatic aortic rupture associated with other severe lesions was collected from 2000 to 2012. There were 33 males and four females, mean age 38 years. In this series, 25 patients underwent surgical treatment and 12 endovascular exclusion. RESULTS: Six patients died during or after surgery. Overall mortality was 16% (24% in the surgery group). The postoperative period was uneventful in all patients treated with the endovascular procedure. Postoperative computed tomography controls at one week, 1 month and 12 months showed good positioning of the stent without endoleakage. CONCLUSION: Traumatic aortic rupture is often the result of a severe high-energy chest trauma. Other serious injuries are often associated. Results of immediate surgical repair are associated with high morbidity and mortality. The advent of endovascular treatment has revolutionized the treatment of traumatic aortic rupture, especially in patients with a high surgical risk.
    Journal des Maladies Vasculaires 01/2013; · 0.24 Impact Factor
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    ABSTRACT: Arterial aneurysms are most commonly (60% of cases) located in the infrarenal abdominal aorta. An inflammatory mechanism is involved in only 10% of cases. Infrarenal abdominal aortic aneurysms revealing Takayasu's disease is unusual. Takayasu's disease is a rare vasculitis affecting large arteries in young people. It is 10 times more common in women. We report the case of an acute rupture of an abdominal aortic aneurysm revealing Takayasu arteritis in a 39-year-old man with an uneventful medical history.
    Journal des Maladies Vasculaires 01/2013; 38(6):373–376. · 0.24 Impact Factor
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    ABSTRACT: Introduction Lesions affecting the supra-aortic arterial trunks often occur in a contest of severe chest trauma. They are rarely isolated and can be life-threatening. We report a case of surgery for an isolated traumatic dissection of the innominate artery. Case report A 48-year-old patient had a road accident causing head injury, trauma of the left lower limb and blunt chest trauma. At the physical exam, the pulse at the upper right limb was weak compared to the contralateral member. A pressure gradient of 50 mm Hg was recorded between the two upper limbs. A whole body scan revealed a dissection of the innominate artery sparing its origin and bifurcation. Cervicotomy and sternotomy was necessary to achieve control. After heparinization and clamping, a prosthetic bypass was inserted to replace the innominate artery. The postoperative course was uneventful and the pressure gradient between the two upper limbs disappeared. Conclusion Lesions of the brachiocephalic arterial trunk are not frequent but they are serious. A careful physical exam at admission helps detect them. Prognosis is directly linked to early diagnosis and management. Conventional surgery provides good results and remains the standard treatment for these lesions.
    Journal des Maladies Vasculaires 01/2013; · 0.24 Impact Factor
  • La Tunisie médicale 11/2012; 90(11):831-2.
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    ABSTRACT: Objective Aneurysm of the extracranial carotid artery is rare. The embolic risk mandates prompt intervention once diagnosed. The aim of this study was to determine therapeutic techniques, their indications and outcomes. Patients and methods We report a series of ten patients who underwent surgery for extracranial carotid artery aneurysm in the cardiovascular surgery department of La Rabta hospital. Results There were six men and four women, mean age 43 years. All patients were symptomatic (swelling and pulsatile cervical mass). Two patients had dysphonia and one patient underwent an emergency procedure because of aneurismal rupture. Aneurismal excision was performed in most patients. The arterial reconstruction was performed by end-to-end anastomosis in four cases, interposition of an autologous venous graft in four, interposition of a prosthetic graft in one and suture of a small rent in the artery in one. There was no postoperative mortality. Early postoperative morbidity included one recurrent laryngeal nerve injury, one hypoglossal nerve injury, one stroke and one infection with thrombosis of a prosthetic graft. The follow-up was uneventful. Conclusion Surgical treatment of extracranial carotid aneurysms is required, in most cases with good results. Endovascular treatment may be an effective therapy in selected cases.
    Journal des Maladies Vasculaires 07/2012; 37(4):201–206. · 0.24 Impact Factor
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    ABSTRACT: Aneurysm of the extracranial carotid artery is rare. The embolic risk mandates prompt intervention once diagnosed. The aim of this study was to determine therapeutic techniques, their indications and outcomes. We report a series of ten patients who underwent surgery for extracranial carotid artery aneurysm in the cardiovascular surgery department of La Rabta hospital. There were six men and four women, mean age 43 years. All patients were symptomatic (swelling and pulsatile cervical mass). Two patients had dysphonia and one patient underwent an emergency procedure because of aneurismal rupture. Aneurismal excision was performed in most patients. The arterial reconstruction was performed by end-to-end anastomosis in four cases, interposition of an autologous venous graft in four, interposition of a prosthetic graft in one and suture of a small rent in the artery in one. There was no postoperative mortality. Early postoperative morbidity included one recurrent laryngeal nerve injury, one hypoglossal nerve injury, one stroke and one infection with thrombosis of a prosthetic graft. The follow-up was uneventful. Surgical treatment of extracranial carotid aneurysms is required, in most cases with good results. Endovascular treatment may be an effective therapy in selected cases.
    Journal des Maladies Vasculaires 05/2012; 37(4):201-6. · 0.24 Impact Factor
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    ABSTRACT: Total anomalous pulmonary venous return (TAPVR) has a rather low incidence (1-3%) of all congenital heart disease. Intracardiac TAPVR represent 25-30% of all TAPVR. Aim: To report our results and long-term follow-up of surgical management of intracardiac TAPVR. Retrospective study of 7 patients with intra cardiac TAPVR treated surgically between Mai 1992 and July 2007. The surgical technique has been an intra atrial procedure in all cases. We didn't report any early post-operative death. Early postoperative complications were principally pulmonary infections. We report one death at three months of follow-up caused by laryngeal stenosis. Late follow-up was good for all patients. Good result of surgical treatment of intracardiac TAPVR depends on early diagnosis and adequate surgical technique.
    La Tunisie médicale 06/2011; 89(6):561-4.
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    ABSTRACT: Prosthetic valve endocarditis (PVE) is a serious complication of valve surgery. The aim of this study is to determine the diagnostic and therapeutic management for PVE. It's a retrospective study about 14 cases of PVE operated in the department of cardiovascular surgery of la Rabta hospital between January 1996 and December 2006. In two cases, surgery was performed emergent, in the remnant cases surgery was elective. The coagulase-negative staphylococcus (CNS) is the predominant cause of these PVE.Surgery consisted on seven mitral prosthesis replacements and seven aortic prosthesis replacements.Hospital mortality was 50%. In conclusion attention should be made to prevent endocarditis when possible. In case of PVE, an early diagnosis a leads to earlier application of appropriate therapies and improved outcome.
    La Tunisie médicale 12/2008; 86(11):978-82.
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    ABSTRACT: The beating heart coronary artery bypass technique is becoming more popular in many cardiac units throughout the world. This relativity new technique has prompted surgeons and anaesthetists to review and analysed the routine approach to coronary surgery. In this study we reviewed 26 patients operated off pump technique group I (50 %) and the group II (50 %) operated on pump coronary artery bypass. The patients in the group II were more symptomatic with more heart function, than group I. The postoperative cause of the two groups was similar. This retrospective analysis shows that beating heart technique for coronary surgery can be offered to many patients with good out come and on pump technique can be more safety specially in case of poor myocardial function.
    La Tunisie médicale 01/2007; 84(12):782-5.
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    ABSTRACT: The purpose of our study is to determine the causes and the management of anastomotic aneurysms. We report the cases of 25 patients with a mean age of 64 years at the time of initial surgical revascularisation. The mean interval between the first operation and the occurrence of anastomotic aneurysm is 5 years (range 2 months-11 years). The treatment consists on the interposition of a graft in 8 patients, anastomotic angioplasty in 9 patients and the reconstruction of the anastomosis in 8 patients. Hospital mortality was 20%. Late death occurs 3 patients and the long-term morbidity was evaluated at 22%. A recurrence of anastomotic false aneurysm occurred in 4 patients (16%) (Range 7 months-1 year). In conclusion anastomotic false aneurysm is one of the major complications of vascular reconstruction; careful follow-up can detect the rare instances of anastomotic aneurysm and reoperation can be accomplished with a low-rate of adverse outcome.
    Annales de Cardiologie et d Angéiologie 11/2006; 55(5):294-9. · 0.30 Impact Factor
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    ABSTRACT: The purpose of our study is to determine the causes and the management of anastomotic aneurysms. We report the cases of 25 patients with a mean age of 64 years at the time of initial surgical revascularisation. The mean interval between the first operation and the occurrence of anastomotic aneurysm is 5 years (range 2 months–11 years). The treatment consists on the interposition of a graft in 8 patients, anastomotic angioplasty in 9 patients and the reconstruction of the anastomosis in 8 patients. Hospital mortality was 20%. Late death occurs 3 patients and the long-term morbidity was evaluated at 22%. A recurrence of anastomotic false aneurysm occurred in 4 patients (16%) (Range 7 months–1 year). In conclusion anastomotic false aneurysm is one of the major complications of vascular reconstruction; careful follow-up can detect the rare instances of anastomotic aneurysm and reoperation can be accomplished with a low-rate of adverse outcome.
    Annales De Cardiologie Et D Angeiologie - ANN CARDIOL ANGEIOL. 01/2006; 55(5):294-299.

Publication Stats

6 Citations
3.71 Total Impact Points

Institutions

  • 2003–2014
    • La Rabta Hospital Tunis
      Tunis-Ville, Tūnis, Tunisia
  • 2013
    • University of Tunis El Manar
      Tunis-Ville, Tūnis, Tunisia
    • Faculty of Medecine of Tunis
      Tunis-Ville, Tūnis, Tunisia