Publications by authors named "R Denguir"

57 Publications

[Telemedicine and social Media in the management of ECMOs in the era of COVID-19: The Tunisian experience].

Ann Cardiol Angeiol (Paris) 2021 Apr 5;70(2):125-128. Epub 2021 Jan 5.

University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Jabbari street 1007, Tunis, Tunisia.

Introduction: In Tunisia, as elsewhere in the world, severe forms of acute respiratory distress syndrome (ARDS) related to SARS-Covid19 have been observed. When the usual means of resuscitation were no longer sufficient, the implementation of the Extracorporeal membrane oxygenation or ECMO was needed.

Aim: The whole problem of the management of these patients in this pandemic period has been to manage the operation of the ECMO machine, usually reserved for expert and specialized centers in the field.

Methods: The cardio-vascular surgery department of La Rabta teaching hospital of Tunis has tried the experience of management of ECMO implanted in the different reanimations of Tunis, remotely, using telemedicine and social networks. Thus, a Facebook-Messenger discussion group was created and enabled the management of patients under ECMO via video conferencing in real time involving all stakeholders.

Results: A call was made whenever the physician needed it. The video provided an opportunity to discuss with surgeons and perfusionists in real time the complications or problems of these patients. Their clinical status was continuously shared on the focus group. Following the instructions of the expert surgeons and the exchanges made on the group, the reanimator could then intervene on this or that parameter.

Conclusion: Social media have invaded everyone's daily lives and health professionals are not exception to this trend. The Covid-19 pandemic has only strengthened this digital alternative with the goal of efficiency and patient interest. While their use in a professional setting offers many advantages, it must nevertheless be done in compliance with the rules of ethics and bring real added value.
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http://dx.doi.org/10.1016/j.ancard.2020.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785278PMC
April 2021

Tuberculosis lymphadenopathy: A rare etiology of the superior vena cava syndrome.

J Med Vasc 2021 Feb 2;46(1):9-12. Epub 2020 Dec 2.

Cardiovascular surgery department, La Rabta Teaching Hospital, Faculty of medicine of Tunis, University of Tunis El Manar, Jabbari Street, 1007 Tunis, Tunisia.

Superior vena cava syndrome is the clinical expression of the obstruction of the superior vena cava reducing the blood flow. Malignant etiologies are the most common. Its management is multidisciplinary and despite the progress of endovascular procedures, conventional surgery retains its place in certain indications. Mediastinal fibrosis secondary to tuberculosis lymphadenopathy may be associated with superior vena cava syndrome. In the presence of symptomatic SVCS associated with extensive mediastinal fibrosis compressing the superior vena cava with sub occlusive thrombosis, conventional surgery remains a treatment option, with cavo-venous derivation by prosthetic bypass.
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http://dx.doi.org/10.1016/j.jdmv.2020.11.001DOI Listing
February 2021

Endovascular repair of traumatic aortic isthmic rupture: Early and mid-term results.

J Med Vasc 2020 Sep 9;45(5):254-259. Epub 2020 Jul 9.

Cardiovascular department La Rabta, faculty of medicine of Tunis, university of Tunis El Manar, Tunis, Tunisia.

Introduction: Conventional open repair of a traumatic aortic isthmic rupture is associated with a significantly high mortality and morbidity rates. Thoracic endovascular aortic repair (TEVAR) is currently often performed because it is a less invasive treatment than surgery. The aim of this study was to evaluate short and mid-term results of TEVAR in traumatic aortic isthmic rupture.

Methods: This is a retrospective study conducted between 2010 and 2018 including patients who underwent TEVAR for traumatic aortic isthmic rupture.

Results: Thirty-six consecutive patients were included. All patients had sustained a violent blunt chest trauma after a sudden deceleration with associated injuries. The injury severity score (ISS) was 40 (14-66). All patients were hemodynamically stable at admission. We deployed thoracic aorta stent grafts with a mean diameter of 26mm (18-36). The procedural success rate was 100%. We reported one intra-operative complication which was a distal migration of the graft, managed by an implantation of an aortic extension graft. On the first postoperative day, one patient presented an acute lower limb ischemia, probably due to the surgical femoral access, treated with an embolectomy with a Fogarty catheter with satisfactory results. The mean follow-up was 40.41 months (6.5-96). The mortality and paraplegia rates were 0% at one month and during the follow-up period. We reported a case of kinking of the graft that occurred at 6 months. No cases of endoleak neither re-intervention were reported.

Conclusion: TEVAR is a safe and a reliable method for the treatment of sub-acute traumatic thoracic aortic injuries.
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http://dx.doi.org/10.1016/j.jdmv.2020.06.007DOI Listing
September 2020

[Arterial trauma of the upper limbs: Particularities of the population in Tunisia and risk factors for amputation].

Ann Cardiol Angeiol (Paris) 2021 Feb 25;70(1):41-46. Epub 2020 Aug 25.

Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie.

Aim Of The Study: The purpose of our study was to review the population at risk of upper limb arterial injury, to determinate the rate of upper limb salvage and the predictive factors of limb loss.

Methods: This was a retrospective study, involving 128 patients with upper extremity arterial trauma operated between January first, 2006 and June 30, 2017. Exclusion criteria were arterial ligation, primary limb amputation and arterial iatrogenic injuries. End points were immediate technical success, primary patency and limb salvage rate.

Results: The average age was 27.7 years with a sex ratio M/F=41, causes of trauma were self-inflicted wounds (51%), assaults (23%), road traffic accidents (10%), work accidents (9%) and domestic accidents (7%). Injured arteries were brachial (66.5%) usually because of self-inflicted injuries; arteries of the forearm (31%) and axillery arteries (2.5%). The techniques of arterial repair were vein graft interposition in 52% of cases, end-to-end anastomosis in 23%, primary arterial repair in 21% and venous patch in 4%. Eight reconstructions occluded during the first week (6.25%). Four patients required secondary amputation and limb salvage rate was 96.8%. After a median follow-up time of 62 days, only 21% were followed at 3 months. Mechanism of injury, soft tissue loss and arterial reconstruction thromboses were selected as factors influencing the rate of limb salvage. One death occurred at day 14 secondary to multi-component poly-trauma.

Conclusion: Prompt diagnosis, appropriate multidisciplinary management of the upper extremity arterial trauma and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage. Associated soft tissue injury is a poor limb salvage factor.
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http://dx.doi.org/10.1016/j.ancard.2020.03.015DOI Listing
February 2021

Late diagnosed post traumatic femoral arteriovenous fistula revealed by leg ulcer.

J Med Vasc 2020 Jul 5;45(4):224-227. Epub 2020 May 5.

Cardiovascular department, La Rabta, Faculty of Medicine of Tunis, Tunis, Tunisia.

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http://dx.doi.org/10.1016/j.jdmv.2020.04.006DOI Listing
July 2020