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Stumpo V, Latour K, Trevisi G, Valente I, D'Arrigo S, Mangiola A, Olivi A, Sturiale CL. Retrospective Application of UIATS Recommendations to a Multicenter Cohort of Ruptured Intracranial Aneurysms: How It Would Have Oriented the Treatment Choices? World Neurosurg 2020; 147:e262-e271. [PMID: 33326858 DOI: 10.1016/j.wneu.2020.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/07/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Decisions to treat unruptured intracranial aneurysms remain challenging, as the risk of rupture needs to be balanced with risk of intervention. In 2015, the Unruptured Intracranial Aneurysm Treatment Score (UIATS) was introduced to assist physicians in the decision making process. As its reliability is still debated, we retrospectively applied UIATS to a multicenter cohort of aneurysmal subarachnoid hemorrhage patients to test its performance in suggesting treatment in patients with known natural history. METHODS Demographical, clinical, and radiological data of subarachnoid patients admitted in 2 referral cerebrovascular centers were collected. UIATS was individually calculated for each patient, and resulting recommendations were pooled in 3 groups (favor treatment, favor conservative management, unclear indication). RESULTS One-hundred and forty-six patients were included in this study. In the event of aneurysm discovery previous to their rupture, UIATS calculation revealed that 40 (27.4%) patients would have received an indication-to-treat advice (mean score: 4.58 ± 1.32), 46 (31.5%) would have been suggested a conservative management (mean score: -7.07 ± 4.15), and 60 (41.1%) would have been included in an unclear recommendation group (mean score: 0.07 ± 1.42). UIATS sensitivity ranged between 27% and 68% depending on the inclusion of patients with unclear indication within the conservative or intervention group. CONCLUSIONS In our study, UIATS would have failed to provide a clear recommendation to treat in up to 72.6% of patients whose aneurysm eventually ruptured. In agreement with previous reports, we provide additional evidence that some unruptured intracranial aneurysms may elude UIATS sensitivity. Further long-term prospective studies are necessary to assess UIATS reliability in real-world clinical practice.
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Affiliation(s)
- Vittorio Stumpo
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Kristy Latour
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Gianluca Trevisi
- Department of Neurosurgery, Santo Spirito Hospital, University of Chieti-Pescara, Chieti, Italy
| | - Iacopo Valente
- Department of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sonia D'Arrigo
- Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annunziato Mangiola
- Department of Neurosurgery, Santo Spirito Hospital, University of Chieti-Pescara, Chieti, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy; Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Pagiola I, Mihalea C, Caroff J, Ikka L, Chalumeau V, Iacobucci M, Ozanne A, Gallas S, Marques M, Nalli D, Carrete H, Caldas JG, Frudit ME, Moret J, Spelle L. The PHASES score: To treat or not to treat? Retrospective evaluation of the risk of rupture of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage. J Neuroradiol 2019; 47:349-352. [PMID: 31400432 DOI: 10.1016/j.neurad.2019.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The PHASES score was formulated to predict the 5-year risk of rupture for intracranial aneurysms. We retrospectively analyzed all patients treated in our institution for aneurysmal SAH and applied the PHASES score to estimate the probable predicted risk of bleeding in this group of patients. METHODS Between February 2015 and August 2018, all patients with aneurysmal SAH were retrospectively analyzed and the PHASES score was applied. A total of 155 patients were included with a mean age of 53.8years, including 60 males and 95 females. RESULTS Of our patients 110 (70.9%) had a PHASES score of below or equal to 5, with a hemorrhagic risk of up to 1.3% over 5years. If we analyze the patients with a risk of below 2% this figure increases to 122 patients (78.7%). Of these 99.3% were European and 0.6% were Japanese (1 patient). In 86 patients (55.4%), the aneurysm was smaller than 5mm and in 10 patients (6.4%) the aneurysm was located in the posterior circulation. CONCLUSION Of our patients 78.7% had less than a 2% 5-year rupture risk based on their PHASES score, highlighting the discrepancy of the rupture risk calculated with the PHASES score when hypothetically applied to this group of patients. In the hypothetical scenario that our patients had unruptured aneurysms, our retrospective analysis shows that the PHASES score may only provide a weak tool for clinicians to use in the decision-making process as to whether or not to treat these aneurysms.
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Affiliation(s)
- Igor Pagiola
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France; Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil.
| | - Cristian Mihalea
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Leon Ikka
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Marta Iacobucci
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Marcio Marques
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Darcio Nalli
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Henrique Carrete
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - José Guilherme Caldas
- Department of Interventional Neuroradiology, Universidade de São Paulo, São Paulo SP, Brazil
| | - Michel Eli Frudit
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Jacques Moret
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
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Hallikainen J, Lindgren A, Savolainen J, Selander T, Jula A, Närhi M, Koivisto T, Kellokoski J, Ylöstalo P, Suominen AL, Frösen J. Periodontitis and gingival bleeding associate with intracranial aneurysms and risk of aneurysmal subarachnoid hemorrhage. Neurosurg Rev 2019; 43:669-679. [PMID: 30972514 PMCID: PMC7186244 DOI: 10.1007/s10143-019-01097-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 12/20/2022]
Abstract
Oral bacteria DNA has been found in intracranial aneurysms (IA) and a high prevalence of periodontitis was reported in IA patients. We investigated whether periodontitis associates with IA formation and aneurysmal subarachnoid hemorrhage (aSAH). First, we compared in a case-control setting the prevalence of periodontal disease in IA patients (42 unruptured IA, 34 ruptured IA) and in age- and gender-matched controls (n = 70) from the same geographical area (Health 2000 Survey, BRIF8901). Next, we investigated whether periodontitis at baseline associated with aSAH in a 13-year follow-up study of 5170 Health 2000 Survey participants. Follow-up data was obtained from national hospital discharge and cause of death registries. Univariate analysis, logistic regression, and Cox-regression were used. Periodontitis (≥ 4mm gingival pocket) and severe periodontitis (≥ 6mm gingival pocket) were found in 92% and 49% of IA patients respectively and associated with IAs (OR 5.3, 95%CI 1.1–25.9, p < 0.000 and OR 6.3, 95%CI 1.3–31.4, p < 0.001, respectively). Gingival bleeding had an even stronger association, especially if detected in 4–6 teeth sextants (OR 34.4, 95%CI 4.2–281.3). Severe periodontitis in ≥ 3 teeth or gingival bleeding in 4–6 teeth sextants at baseline increased the risk of aSAH during follow-up (HR 22.5, 95%CI 3.6–139.5, p = 0.001 and HR 8.3, 95%CI 1.5–46.1, p = 0.015, respectively). Association of periodontitis and gingival bleeding with risk of IA development and aSAH was independent of gender, smoking status, hypertension, or alcohol abuse. Periodontitis and gingival bleeding associate with increased risk for IA formation and eventual aSAH. Further epidemiological and mechanistic studies are indicated.
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Affiliation(s)
- Joona Hallikainen
- Department of Dentistry, University of Eastern Finland, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
| | - Antti Lindgren
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Jarno Savolainen
- Department of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, Finland
| | - Matti Närhi
- Department of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Jari Kellokoski
- Department of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Ylöstalo
- Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Anna Liisa Suominen
- Department of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland. .,Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.
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Neyazi B, Sandalcioglu IE, Maslehaty H. Evaluation of the risk of rupture of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage according to the PHASES score. Neurosurg Rev 2019; 42:489-92. [PMID: 29948496 DOI: 10.1007/s10143-018-0989-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/16/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
The PHASES score was developed to determine the risk of rupture of un-ruptured intracranial aneurysms (UIAs). The purposes of the current study were to apply this score on patients with actually ruptured intracranial aneurysms and to analyze the hypothetically prediction of the risk in this particularly patient group. We extracted the data of 100 recently treated patients (23 male, 77 female, mean age 56.4 years, range 17-93 years) with ruptured saccular intracranial aneurysms from our prospectively maintained neurovascular database according to the parameters used in the PHASES score (population, hypertension, age, earlier SAH, size and site of the aneurysm). Descriptive statistical analysis was performed using SPSS for Windows version 18.0 (SPSS Inc., Chicago, Illinois, USA). Ninety-nine percent of the patients were European and 1% Japanese in our series. Pre-existing arterial hypertension was found in 59%. Fifteen percent of the patients were > 75 years. Earlier SAH was found in 1%. The site of the aneurysms were the internal carotid artery (ICA) in 10%, the middle cerebral artery (MCA) in 14%, and arteries of the anterior and posterior circulation (PC) including the posterior communicating artery (PCOM) in 76%. Sixty-six percent of the aneurysms were smaller than 7 mm, 18% ranged between 7 and 9.9 mm, 14% were between 10 and 19.9 mm, and 2% were larger than 20 mm. European population, aneurysm size < 7 mm, and age < 75 years scored with 0 point in the PHASES study occurred most frequently in our series. The distribution of the aneurysm site to the anterior and posterior circulation scored with 4 points occurred most frequently. Considering the 5-year risk of rupture, 70% of our patient collective would have an estimated risk of < 2%. Interestingly, 70% of the patients with aneurysmal SAH had a low risk profile and would have a low risk of rupture according to the PHASES score in our series. This observation underlines the discrepancy of the estimated low risk of rupture for UIAs in young and healthy patients and the obvious fact the majority of the SAH patients are actually young with low risk factors. Parameters beyond the features of the PHASES score are needed to determine the risk of rupture of intracranial aneurysms.
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Mocchegiani F, Vincenzi P, Coletta M, Agostini A, Marzioni M, Baroni GS, Giovagnoni A, Guerrieri M, Marmorale C, Risaliti A, Vivarelli M. Prevalence and clinical outcome of hepatic haemangioma with specific reference to the risk of rupture: A large retrospective cross-sectional study. Dig Liver Dis 2016; 48:309-14. [PMID: 26514738 DOI: 10.1016/j.dld.2015.09.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/15/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prevalence and incidence of hepatic haemangioma are estimated from autopsy series only. Although benign and generally asymptomatic, hepatic haemangioma can cause serious complications. AIMS The aim of the study was to assess the prevalence of hepatic haemangioma and to attempt to quantify the risk of major complications such as spontaneous rupture. METHODS We retrospectively analyzed the radiology database of a Regional University Hospital over a 7-year period: the radiological records of 83,181 patients who had an abdominal computed tomography or magnetic resonance scan were reviewed. Diagnoses made at imaging were reviewed and related to clinical course. RESULTS Hepatic haemangioma was diagnosed in 2071 patients (2.5% prevalence). In 226 patients (10.9%), haemangioma had diameter of 4 cm or more (giant haemangioma). The risk of bleeding was assessed on patients without concomitant malignancies. Spontaneous bleeding occurred in 5/1067 patients (0.47%). All 5 patients had giant haemangioma: 4 had exophytic lesions and presented with haemoperitoneum; 1 with centrally located tumour experienced intrahepatic bleeding. CONCLUSION Giant haemangiomas have a low but relevant risk of rupture (3.2% in this series), particularly when peripherally located and exophytic. Surgery might be considered in these cases.
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Affiliation(s)
- Federico Mocchegiani
- Hepatobiliary and Transplantation Surgery, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
| | - Paolo Vincenzi
- Hepatobiliary and Transplantation Surgery, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
| | - Martina Coletta
- Hepatobiliary and Transplantation Surgery, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
| | - Andrea Agostini
- Radiology, Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, Italy.
| | - Marco Marzioni
- Clinic of Gastroenterology, Department of Clinic and Molecular Sciences, Polytechnic University of Marche, Italy.
| | - Gianluca Svegliati Baroni
- Clinic of Gastroenterology, Department of Clinic and Molecular Sciences, Polytechnic University of Marche, Italy.
| | - Andrea Giovagnoni
- Radiology, Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, Italy.
| | - Mario Guerrieri
- Clinic of Surgery, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
| | - Cristina Marmorale
- Clinic of Surgical Training, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
| | - Andrea Risaliti
- Clinic of Surgery, Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Marco Vivarelli
- Hepatobiliary and Transplantation Surgery, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
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Georg Y, Delay C, Schwein A, Lejay A, Thaveau F, Gaertner S, Stephan D, Heim F, Chakfe N. [Contribution of mathematical models and biomechanical properties in predicting the risk of abdominal aortic aneurysm rupture]. ACTA ACUST UNITED AC 2015; 41:63-8. [PMID: 26318549 DOI: 10.1016/j.jmv.2015.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/17/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Rupture is the worst outcome of abdominal aortic aneurysm (AAA). The decision to operate should include counterbalancing the risk of aneurysm rupture against the risk of aneurysm repair, within the context of a patient's overall life expectancy. Current surgical guidelines are based on population studies, and important variables are missed in predicting individual risk of rupture. METHODS In this literature review, we focused on the contribution of biomechanical and mathematical models in predicting risk of AAA rupture. RESULTS Anatomical features as diameter asymmetry and lack of tortuosity are shown to be anatomical risk factors of rupture. Wall stiffness (due to modifications of elastin and collagen composition) and increased inflammatory response are also factors that affect the structural integrity of the AAA wall. Biomechanical studies showed that wall strength is lower in ruptured than non-ruptured AAA. Intra-luminal thrombus also has a big role to play in the occurrence of rupture. Current mathematical models allow more variables to be included in predicting individual risk of rupture. CONCLUSION Moving away from using maximal transverse diameter of the AAA as a unique predictive factor and instead including biological, structural and biomechanical variables in predicting individual risk of rupture will be essential in the future and will help gain precision and accuracy in surgical indications.
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Affiliation(s)
- Y Georg
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - C Delay
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - A Schwein
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - A Lejay
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - F Thaveau
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - S Gaertner
- Service des maladies vasculaires, hypertension artérielle et pharmacologie clinique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - D Stephan
- Service des maladies vasculaires, hypertension artérielle et pharmacologie clinique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - F Heim
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Laboratoire de physique et mécanique textile, ENSISA, 11, rue Alfred-Werner, 68093 Mulhouse cedex, France
| | - N Chakfe
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France.
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