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Durieux R, Sakalihasan N, Defraigne JO. [Opportunistic screening for abdominal aortic aneurysm during echocardiography in patients with coronary artery disease: Utility or futility?]. Ann Cardiol Angeiol (Paris) 2021; 71:53-58. [PMID: 33640149 DOI: 10.1016/j.ancard.2020.12.003] [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: 12/12/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Abdominal aortic aneurysm is a chronic degenerative disease that is usually silent until rupture occurs and this complication is still associated in contemporary era with a high rate of mortality. Screening programmes for abdominal aortic aneurysm have been shown to be effective in reducing global mortality in the screened population but these programmes are poorly implemented in the Western countries. As coronary artery disease and abdominal aorta aneurysmal disease share many risk factors, the cardiologist is centrally positioned in the screening strategy, not only to identify patients with higher risk of developing abdominal aortic aneurysm, but also to perform an opportunistic screening during echocardiography. This paper summarises evidence about the feasibility, indications, modalities, benefits and risks related to the opportunistic screening for abdominal aortic aneurysm during echocardiography with a particular emphasis on the population of patients with coronary artery disease.
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Affiliation(s)
- R Durieux
- Service de chirurgie cardio-vasculaire, CHU de Liège, domaine universitaire du Sart-Tilman, B35, 4000 Liège, Belgique.
| | - N Sakalihasan
- Service de chirurgie cardio-vasculaire, CHU de Liège, domaine universitaire du Sart-Tilman, B35, 4000 Liège, Belgique
| | - J O Defraigne
- Service de chirurgie cardio-vasculaire, CHU de Liège, domaine universitaire du Sart-Tilman, B35, 4000 Liège, Belgique
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2
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Affiliation(s)
- R. Limet
- Department of Cardiovascular Surgery, CHU du Sart-Tilman, Liège, Belgium
| | - B. Nusgens
- Laboratory of Connective Tissues Biology, CHU du Sart-Tilman, Liège, Belgium
| | - A. Verloes
- Department of Genetics, CHU du Sart-Tilman, Liège, Belgium
| | - N. Sakalihasan
- Department of Cardiovascular Surgery, CHU du Sart-Tilman, Liège, Belgium
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3
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Affiliation(s)
- H. Van Damme
- Department of Cardiovascular, CHU Liège, Belgium
| | | | - C. Vazquez
- Department of Cardiovascular, CHU Liège, Belgium
| | - Q. Desiron
- Department of Cardiovascular, CHU Liège, Belgium
| | - R. Limet
- Department of Cardiovascular, CHU Liège, Belgium
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4
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Damme HV, Sakalihasan N, Limet R. Fibromuscular Dysplasia of the Internal Carotid Artery. Personal Experience with 13 Cases and Literature Review. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1999.12098470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- H. Van Damme
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | - N. Sakalihasan
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | - R. Limet
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
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5
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Bru Ls S, Kerzmann A, Durieux R, Quaniers J, Tchana-Sato V, Lavigne JP, Sakalihasan N, Radermecker MA, Desiron Q, Szecel D, Holemans C, Boesmans E, Defraigne JO. [The opportunities of the minimally invasive approach for the cardiovascular and thoracic surgery]. Rev Med Liege 2020; 75:292-299. [PMID: 32496669] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There is a continuous growth in the incidence of cardiovascular and thoracic diseases, especially related to the increased life expectancy. Moreover, the quality and efficacy of care for these pathologies are progressing constantly. The evolution of surgery prompts us to develop less aggressive (minimally invasive), although technically more complex, treatment or diagnostic techniques. Pathologies, which until now required heavy surgeries, are managed today in a less invasive way and become therefore accessible to patients even if they are older or in a poor general condition. In this article, we present our experience in the development of the minimal invasive procedures in cardiovascular and thoracic surgery.
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Affiliation(s)
- S Bru Ls
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - A Kerzmann
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - R Durieux
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - J Quaniers
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - V Tchana-Sato
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - J P Lavigne
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - M A Radermecker
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - Q Desiron
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - D Szecel
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - C Holemans
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - E Boesmans
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
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6
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Brüls S, Tchana-Sato V, Lavigne JP, Durieux R, Sakalihasan N, Radermecker MA, Désiron Q, Creemers E, D'Orio V, Nelessen E, D'Orio V, Ancion A, Lancellotti P, Hans G, Lagny M, Blaffart F, Defraigne JO. [Heart transplantation, indications and results at the University Hospital of Liege]. Rev Med Liege 2020; 75:29-36. [PMID: 31920041] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Heart transplantation remains undoubtedly the most effective treatment for end-stage heart failure, whatever its cause. Last decade has witnessed significant improvements in terms of morbidity and mortality following heart transplant. The 5-year survival rate is now beyond 70 %. However, the shortage of potential donors limits its use and requires strict criteria before listing a candidate for heart transplantation. Herein, we present a review of current indications and results of the heart transplantation program at the University hospital of Liège.
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Affiliation(s)
- S Brüls
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - V Tchana-Sato
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - J P Lavigne
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - R Durieux
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - M A Radermecker
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - Q Désiron
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - E Creemers
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Belgique
| | - V D'Orio
- Service de Cardiologie, CHU Liège, Belgique
| | - E Nelessen
- Service de Cardiologie CHPLT, Verviers, Belgique
| | - V D'Orio
- Service de Cardiologie, CHU Liège, Belgique
| | - A Ancion
- Service de Cardiologie, CHU Liège, Belgique
| | | | - G Hans
- Service d'Anesthésie-Réanimation, CHU Liège, Belgique
| | - M Lagny
- Secteur perfusion, CHU Liège, Belgique
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7
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Radermecker A, Stiennon L, Leroux A, Sooknunden M, Duysinx B, Guiot J, Davin L, Sakalihasan N, Radermecker MA, Defraigne JO. [Giant pulmonary artery aneurysms. Case report and proposal of management algorithm]. Rev Med Liege 2019; 74:90-94. [PMID: 30793562] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Pulmonary artery aneurysm is a rare and multiform pathology related to multiple etiologies and therefore different pathophysiological mechanisms. Delineating homogenous sub-groups is a pre-requisite to refine medico-surgical management. The case of a giant PAA without pulmonary hypertension but associated to a dysplastic pulmonary valve is reported. This association could be in some instances the result of a congenital anomaly in the development of both the pulmonary valve and the root creating the conditions for further development of a pulmonary artery aneurysm. Whilst minor forms are usually asymptomatic, they can lead to lethal complications in huge sizes and are frequently associated via pulmonary valve insufficiency to right ventricular dysfunction. This specific association is discussed and a diagnostic algorithm for nosologic classification and management is proposed.
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Affiliation(s)
- A Radermecker
- Service de Chirurgie cardio-vasculaire et thoracique, CHU Liège, Belgique
| | - L Stiennon
- Service de Chirurgie cardio-vasculaire et thoracique, CHU Liège, Belgique
| | - A Leroux
- Service de Chirurgie, UCL Mont-Godinne, Belgique
| | - M Sooknunden
- Service de Chirurgie cardio-vasculaire et thoracique, CHU Liège, Belgique
| | - B Duysinx
- Service de Pneumologie, CHU Liège, Belgique
| | - J Guiot
- Service de Pneumologie Allergologie, CHU Liège, Belgique
| | - L Davin
- Service de Cardiologie, CHU Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie cardio-vasculaire et thoracique, CHU Liège, Belgique
| | - M A Radermecker
- Service de Chirurgie cardiovasculaire et Département d'Anatomie humaine, CHU-Uliège, Belgique
| | - J O Defraigne
- Service de Chirurgie cardio-vasculaire et thoracique, CHU Liège, Belgique
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8
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Tchana-Sato V, Sakalihasan N, Defraigne JO. [Ruptured abdominal aortic aneurysm]. Rev Med Liege 2018; 73:296-299. [PMID: 29926569] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ruptured abdominal aortic aneurysm is a cardiovascular emergency associated with a 30 day mortality as high as 70 %. However, recent progresses in the management of these patients have improved the results. From a surgical point of view, endovascular methods such as balloon occlusion and endovascular repair (EVAR) in patients with suitable anatomy are recommended in order to reduce mortality.
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Affiliation(s)
- V Tchana-Sato
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
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9
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Tchana-Sato V, Sakalihasan N, Defraigne JO. [Aortic dissection]. Rev Med Liege 2018; 73:290-295. [PMID: 29926568] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aortic dissection is a life-threatening condition due to a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of the different layers of the aortic wall. Among the risk factors, age, hypertension, dyslipidemia and genetic disorders of the connective tissue have been identified. A prompt diagnosis and an adequate treatment are important in the management of affected patients. The type of treatment depends on the location and extension of the dissection. Open surgical repair is most commonly used for dissections involving the ascending aorta and the aortic arch, whereas endovascular intervention is indicated for descending aorta dissections that are complicated. In this paper, we will review the epidemiology, and physiopathology of aortic dissection and describe the appropriate management for each type of dissection (open surgery, endovascular or medical treatment).
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Affiliation(s)
- V Tchana-Sato
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - J O Defraigne
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Site Sart Tilman, Liège, Belgique
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10
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Léonard M, Courtois A, Defraigne JO, Sakalihasan N. [Isolated spontaneous dissection of the superior mesenteric artery]. Rev Med Liege 2017; 72:175-180. [PMID: 28471548] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report the case of a 57-year old man suffering from acute abdominal cramps. Abdominal computed tomography (CT) scanner revealed an isolated dissection of the superior mesenteric artery. The pain decreased within a few days under conservative treatment and monitoring by angioscans showed a stabilization of the dissection. This clinical case report is accompanied by a literature review on this rare pathology.
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Affiliation(s)
| | - A Courtois
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Site Sart Tilman, Liège, Belgique
| | - J-O Defraigne
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Site Sart Tilman, Liège, Belgique
| | - N Sakalihasan
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Liège, Site Sart Tilman, Liège, Belgique
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11
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Magotteaux S, Bulk S, Farhat N, Sakalihasan N, Defraigne JO, Seghaye MC. [Marfan syndrome in childhood and adolescence]. Rev Med Liege 2016; 71:342-348. [PMID: 28383843] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Marfan syndrome is a systemic connective tissue disorder with autosomal dominant inheritance. A mutation of the fibrillin-1 gene, a glycoprotein which is the main constituent of the extracellular matrix, is the cause of the disease. The cardinal features involve the skeletal, ocular and cardiovascular systems. The expression of the Marfan syndrome varies from the severe neonatal presentation to the classical manifestations of the child and young adult, but also comprises isolated features. In children, phenotypical manifestations are age dependent. For these reasons, the diagnosis of Marfan syndrome might be lately revealed by its cardiovascular complications. We report the case of 2 siblings: it illustrates the phenotypic variability that might be observed in a same family, the phenotype evolution with age and the diagnosis challenge in childhood.
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Affiliation(s)
| | - S Bulk
- Service de Génétique, CHU de Liège, Belgique
| | - N Farhat
- Service de Pédiatrie, CHU de Liège, Site NDB, Chênée, Belgique
| | - N Sakalihasan
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Belgique
| | - J-O Defraigne
- Service de Chirurgie Cardiovasculaire, CHU de Liège, Belgique
| | - M-Ch Seghaye
- Service de Pédiatrie, CHU de Liège, Site NDB, Chênée, Belgique
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12
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Affiliation(s)
- H. Van Damme
- Service de Chirurgie Cardio-Vasculaire et Thoracique, Hôpital Universitaire de Liège, CHU du Sart Tilman, Liège, Belgique
| | - N. Sakalihasan
- Service de Chirurgie Cardio-Vasculaire et Thoracique, Hôpital Universitaire de Liège, CHU du Sart Tilman, Liège, Belgique
| | - R. Limet
- Service de Chirurgie Cardio-Vasculaire et Thoracique, Hôpital Universitaire de Liège, CHU du Sart Tilman, Liège, Belgique
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13
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Brüls S, Goffin P, Sakalihasan N, Bonnet P, Defraigne JO. [TRAUMATIC RUPTURE OF THE AORTIC ISTHMUS: MODERN PERSPECTIVES]. Rev Med Liege 2015; 70:415-422. [PMID: 26638441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Traumatic aortic rupture of the thoracic aorta (usually at the isthmus) is frequently associated with concomitant life-threatening injuries. Historically, the conventional care consisted of surgical repair of the lesion performed as soon as possible. However, in spite of constant technical improvements the morbi-mortality remains high because of these associated lesions. In addition, their management can have priority and delay aortic surgery. The endovascular approach has been shown to be a feasible and efficient technique and currently represents a valuable alternative to open surgery for patients with multiple traumas. We report a patient presenting with a traumatic aortic rupture of the aortic isthmus, which was successfully treated by delayed combined endovascular (thoracic aortic stentgrafting) and open approach (hemiaortic arch debranching).
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Gasser T, Nchimi A, Swedenborg J, Roy J, Sakalihasan N, Böckler D, Hyhlik-Dürr A. A Novel Strategy to Translate the Biomechanical Rupture Risk of Abdominal Aortic Aneurysms to Their Equivalent Diameter Risk: Method and Retrospective Validation. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Durieux R, Van Damme H, Labropoulos N, Yazici A, Legrand V, Albert A, Defraigne JO, Sakalihasan N. High prevalence of abdominal aortic aneurysm in patients with three-vessel coronary artery disease. Eur J Vasc Endovasc Surg 2014; 47:273-8. [PMID: 24456737 DOI: 10.1016/j.ejvs.2013.12.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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: 08/23/2013] [Accepted: 12/02/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Currently, the prevalence of abdominal aortic aneurysm (AAA) in patients with coronary artery disease (CAD) and the correlation between CAD severity and AAA prevalence are not clearly known. We conducted a prospective study to determine the prevalence of AAA in patients undergoing coronary angiography and to determine the risk factors and a coronary profile associated with AAA. METHODS Over an 18-month period, abdominal aortic ultrasound was performed on 1,000 patients undergoing coronary angiography for suspected or known CAD, or prior to valve surgery. Clinical characteristics and coronary profile were collected from the patients. RESULTS The overall number of previously repaired, already diagnosed, and new cases of AAA in the study population was 42, yielding a prevalence of 4.2%. Among the patients with newly detected AAAs, only two had an AAA diameter of >54 mm and were therefore treated surgically. In men aged ≥ 65 years, the prevalence reached 8.6%, while in men with three-vessel CAD it was 14.4%. Multivariate analysis showed that age ≥ 65 years (p = .003), male gender (p = .003), family history of AAA (p = .01), current smoking (p = .002), and three-vessel CAD (p < .001) were significantly associated with a higher prevalence of AAA. CONCLUSION The prevalence of AAA was high in men aged ≥ 65 years and in those with three-vessel CAD regardless of age. While our findings do not prove the cost-effectiveness of screening for AAA in these high risk patients, they do support the usefulness of a quick ultrasound examination of the abdominal aorta during routine transthoracic echocardiography in such patients.
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Affiliation(s)
- R Durieux
- Department Cardiovascular and Thoracic Surgery, University Hospital of Liège, Liège, Belgium.
| | - H Van Damme
- Department Cardiovascular and Thoracic Surgery, University Hospital of Liège, Liège, Belgium
| | - N Labropoulos
- Department of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - A Yazici
- Department Cardiovascular and Thoracic Surgery, University Hospital of Liège, Liège, Belgium
| | - V Legrand
- Department of Cardiology, University Hospital of Liège, Liège, Belgium
| | - A Albert
- Department of Medical Informatics and Biostatistics, University Hospital of Liège, Liège, Belgium
| | - J-O Defraigne
- Department Cardiovascular and Thoracic Surgery, University Hospital of Liège, Liège, Belgium
| | - N Sakalihasan
- Department Cardiovascular and Thoracic Surgery, University Hospital of Liège, Liège, Belgium
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16
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Courtois A, Nusgens B, Hustinx R, Gomez P, Defraigne JO, Colige A, Sakalihasan N. [Benefits of positron emission tomography in the management and prognosis of abdominal aortic aneurysms]. Rev Med Liege 2014; 69 Spec No:12-18. [PMID: 25796792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Rupture of abdominal aortic aneurysm (AAA) remains a major cause of death in the elderly. Its prediction is a serious challenge for public health. Despite its regular use to identify patients requiring surgical treatment, the diameter of AAA is not a sufficiently precise and reliable parameter for discriminating aneurysms at high risk of rupture. A better targeting of high risk patients needs understanding in deep the processes and mechanisms directing wall rupture. Inflammation is a significant element in the progression ofAAA and can be visualized using medical imaging techniques such as positron emission tomography (PET) using a glucose derivative (FDG) as radiotracer. Studies conducted in our department have established a relationship between PET positivity and the presence of symptoms such as accelerated growth of the aneurysm or pain, signs generally considered as predictive of rupture. Moreover, activation of leukocytes coupled to cellular and molecular alterations of the aneurysmal wall in the sites of FDG uptake may lead to its instability and incompetence to resist blood pressure and rupture. PET therefore represents a new original exploration method to characterize the severity of AAA progression allowing to assess the need for a surgical treatment much better than does the AAA diameter.
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17
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Bruls S, Van Damme H, Sakalihasan N, Defraigne JO. [Endovascular treatment of descending aortic dissection (type B)]. Rev Med Liege 2012; 67:468-474. [PMID: 23115848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aortic dissection is one of the most serious aortic diseases by its potential for rupture, but also for other complications, such as cerebral or splanchnic ischemia, which may be fatal. If open surgery is the rule for lesions of the ascending aorta (type A), type B (not concerning the ascending aorta) is first a matter of medical treatment except when complications are present. In this case the placement of a stentgraft is a valuable alternative to open surgery. We report a patient presenting with a type B aortic dissection, characterized by rapid expansion and complicated by peri-aortic leakage, who was successfully treated by thoracic aortic stentgraft placement. This was done in a hybrid operating room associating the characteristics of a classical operating room for cardio-vascular surgery with those of an interventional radiology suite.
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Affiliation(s)
- S Bruls
- Service de Chirurgie cardio-vasculaire et thoracique, CHU de Liège, Belgique.
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18
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Pincemail J, Defraigne JO, Cheramy-Bien JP, Dardenne N, Donneau AF, Albert A, Labropoulos N, Sakalihasan N. On the potential increase of the oxidative stress status in patients with abdominal aortic aneurysm. Redox Rep 2012; 17:139-44. [PMID: 22732574 DOI: 10.1179/1351000212y.0000000012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a major cause of preventable deaths in older patients. Oxidative stress has been suggested to play a key role in the pathogenesis of AAA. However, only few studies have been conducted to evaluate the blood oxidative stress status of AAA patients. METHODS AND RESULTS Twenty seven AAA patients (mean age of 70 years) divided into two groups according to AAA size (≤ 50 or > 50 mm) were compared with an age-matched group of 18 healthy subjects. Antioxidants (vitamins C and E, β-carotene, glutathione, thiols, and ubiquinone), trace elements (selenium, copper, zinc, and copper/zinc ratio) and markers of oxidative damage to lipids (lipid peroxides, antibodies against oxidized patients, and isoprostanes) were measured in each subject. The comparison of the three groups by ordinal logistic regression showed a significant decrease of the plasma levels of vitamin C (P = 0.011), α-tocopherol (P = 0.016) but not when corrected for cholesterol values, β-carotene (P = 0.0096), ubiquinone (P = 0.014), zinc (P = 0.0035), and of selenium (P = 0.0038), as AAA size increased. By contrast, specific markers of lipid peroxidation such as the Cu/Zn ratio (P = 0.046) and to a lesser extent isoprostanes (P = 0.052) increased. CONCLUSION The present study emphasizes the potential role of the oxidative stress in AAA disease and suggests that an antioxidant therapy could be of interest to delay AAA progression.
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Affiliation(s)
- J Pincemail
- Department of Cardiovascular Surgery, University of Liège, CHU Sart Tilman, Liège, Belgium.
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19
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Xu XY, Borghi A, Nchimi A, Leung J, Gomez P, Cheng Z, Defraigne JO, Sakalihasan N. High levels of 18F-FDG uptake in aortic aneurysm wall are associated with high wall stress. Eur J Vasc Endovasc Surg 2009; 39:295-301. [PMID: 19926315 DOI: 10.1016/j.ejvs.2009.10.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Functional imaging using positron emission tomography (PET) showed increased metabolic activities in the aneurysm wall prior to rupture, whereas separate studies using finite element analysis techniques found the presence of high wall stresses in aneurysms that subsequently ruptured. This case series aimed to evaluate the association between wall stress and levels of metabolic activities in aneurysms of the descending thoracic and abdominal aorta. METHODS Five patients with aneurysms in the descending thoracic aorta or abdominal aorta were examined using positron emission tomography-computed tomography (PET-CT). Patient-specific models of the aortic aneurysms were reconstructed from CT scans, and wall tensile stresses at peak blood pressure were calculated using the finite element method. Predicted wall stresses were qualitatively compared with measured levels of 18F-fluoro-2-deoxy-glucose (18F-FDG) uptakes in the aneurysm wall. RESULTS The distribution of wall stress in the aneurysm wall was highly non-uniform depending on the individual geometry. Predicted high wall stress regions co-localised with areas of positive 18F-FDG uptake in all five patients examined. In the two ruptured cases, the locations of rupture corresponded well with regions of elevated metabolic activity and high wall stress. CONCLUSIONS These preliminary observations point to a potential link between high wall stress and accelerated metabolism in aortic aneurysm wall and warrant further large population-based studies.
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Affiliation(s)
- X Y Xu
- Department of Chemical Engineering, Imperial College London, UK
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20
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Sakalihasan N, Michel J. Functional Imaging of Atherosclerosis to Advance Vascular Biology. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Sakalihasan N, Michel J. Functional Imaging of Atherosclerosis to Advance Vascular Biology. Eur J Vasc Endovasc Surg 2009; 37:728-34. [DOI: 10.1016/j.ejvs.2008.12.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 12/30/2008] [Indexed: 12/20/2022]
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22
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Limet R, Sakalihasan N. [Modern look at a pathology of the millenium: abdominal aortic aneurysms]. Bull Mem Acad R Med Belg 2008; 163:205-212. [PMID: 19245100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- R Limet
- Prosesseur de Clinique, Service de Chirurgie Cardio-VAsculaire, CHU-Tilman, Liège
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23
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Verscheure S, Sakalihasan N, Limet R. [Image of the month. Coronary artery to pulmonary artery fistula]. Rev Med Liege 2007; 62:479. [PMID: 17853666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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24
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Defawe OD, Thiry A, Lapiere CM, Limet R, Sakalihasan N. Primary sarcoma of an abdominal aortic aneurysm. ACTA ACUST UNITED AC 2005; 31:117-9. [PMID: 16314988 DOI: 10.1007/s00261-005-0366-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Accepted: 04/13/2005] [Indexed: 10/25/2022]
Abstract
Primary tumors of the aorta are extremely rare and the diagnosis is made most often after surgery or autopsy. Because clinical symptoms of abdominal sarcoma are similar to those of occlusive or aneurysmal disease, aortic sarcomas are frequently mistaken for these lesions. The imaging findings are frequently nonspecific and therefore do not allow a definitive preoperative diagnosis. We report a case of an epithelioid angiosarcoma in the vessel wall of an abdominal aortic aneurysm.
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Affiliation(s)
- O D Defawe
- Department of Cardiovascular Surgery, University of Liege, CHU Sart-Tilman, Sart-Tilman, Liege, B-4000, Belgium
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25
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Sakalihasan N, Radermacher V, Chevolet C, Limet R. [Clinical case of the month. Twiddler's syndrome: report of a case]. Rev Med Liege 2005; 60:647-8. [PMID: 16184739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The Twiddler's syndrome is characterized by the migration of pacemaker's leads due to rotation of the pulse generator. In our case, ventricular leads coiled in the upper side of the right atrium with stimulation of pectoralis major muscle during left decubitus lateralis position.
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Affiliation(s)
- N Sakalihasan
- Service de Chirurgie Cardio-Vasculaire et Thoracique, Hôpital Universitaire de Liège, CHU du Sart-Tilman, 4000 Liège.
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26
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Melon P, Sakalihasan N, Waleffe A, Lancellotti P, Pirard L. 621 Impact of biventricular pacing on QT interval and QT dispersion. Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.141-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - N. Sakalihasan
- University Hospital of Liege, Cardiology, Liege, Belgium
| | - A. Waleffe
- University Hospital of Liege, Cardiology, Liege, Belgium
| | - P. Lancellotti
- University Hospital of Liege, Cardiology, Liege, Belgium
| | - L.A. Pirard
- University Hospital of Liege, Cardiology, Liege, Belgium
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27
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Abstract
Abdominal aortic aneurysms cause 1.3% of all deaths among men aged 65-85 years in developed countries. These aneurysms are typically asymptomatic until the catastrophic event of rupture. Repair of large or symptomatic aneurysms by open surgery or endovascular repair is recommended, whereas repair of small abdominal aortic aneurysms does not provide a significant benefit. Abdominal aortic aneurysm is linked to the degradation of the elastic media of the atheromatous aorta. An inflammatory cell infiltrate, neovascularisation, and production and activation of various proteases and cytokines contribute to the development of this disorder, although the underlying mechanisms are unknown. In this Seminar, we aim to provide an updated review of the pathophysiology, current and new diagnostic procedures, assessment, and treatment of abdominal aortic aneurysm to provide family practitioners with a working knowledge of this disorder.
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Affiliation(s)
- N Sakalihasan
- Department of Cardiovascular and Thoracic Surgery, University of Liège, Sart-Tilman 4000 Liège, Belgium
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28
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Van Damme H, Sakalihasan N, Limet R. Factors promoting rupture of abdominal aortic aneurysms. Acta Chir Belg 2005; 105:1-11. [PMID: 15790196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The risk for rupture of an abdominal aortic aneurysm is widely believed to be related to its maximum diameter. Rupture occurs at the site of maximum wall stress, when it exceeds the tensile strength of the aortic wall. Basic research confirmed that peak wall stress and aortic wall biodegradation contribute to the mechanism of aneurysm rupture. In order to highlight the role of loss in wall strength and increase in focal peak stress, the authors reviewed recent literature. The clinical relevance of these recent insights in the etiopathogenesis of aneurysm rupture is analysed.
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Affiliation(s)
- H Van Damme
- Service de Chirurgie Cardio-Vasculaire et Thoracique, Hôpital Universitaire de Liège, CHU du Sart Tilman, Liège, Belgique.
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29
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Defawe OD, Colige A, Lambert CA, Delvenne P, Lapière CM, Limet R, Nusgens BV, Sakalihasan N. Gradient of proteolytic enzymes, their inhibitors and matrix proteins expression in a ruptured abdominal aortic aneurysm. Eur J Clin Invest 2004; 34:513-4. [PMID: 15255789 DOI: 10.1111/j.1365-2362.2004.01371.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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30
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Sakalihasan N, Limet R. [Role of open repair of abdominal aortic aneurysm in the prevention of mortality due to rupture]. Rev Med Liege 2003; 58:404-8. [PMID: 12945240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Open repair of AAA effectively prevents the death by rupture. Surgery is indicated if operative mortality is low (< 2%) and AAA at high risk of rupture, i.e. large transverse diameter. Higher risk subgroups can be identified. The role of open repair is justified in these conditions.
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Affiliation(s)
- N Sakalihasan
- Service de Chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, Liège
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31
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Abstract
Vascular injuries secondary to isolated shoulder dislocation are rare. Unawareness for closed axillary artery trauma by many physicians treating shoulder dislocations, counts often for missed or delayed diagnosis. The authors describe two cases that presented with an anterior shoulder dislocation, complicated by a disruption of the axillary artery with subsequent thrombosis. The various pathogenic mechanisms are discussed. The pathognomic triad consists of anterior shoulder dislocation, absent or diminished distal pulse and an axillary protruding hematoma. Prompt surgical arterial repair is mandatory.
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Affiliation(s)
- S Maweja
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Liège, CHU du Sart-Tilman, Liège, Belgium
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32
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Sakalihasan N, Van Damme H, Gomez P, Rigo P, Lapiere CM, Nusgens B, Limet R. Positron emission tomography (PET) evaluation of abdominal aortic aneurysm (AAA). Eur J Vasc Endovasc Surg 2002; 23:431-6. [PMID: 12027471 DOI: 10.1053/ejvs.2002.1646] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND aneurysmal disease is associated with an inflammatory cell infiltrate and enzymatic degradation of the vessel wall. AIM OF THE STUDY to detect increased metabolic activity in abdominal aortic aneurysms (AAA) by means of positron emission tomography (PET-imaging). STUDY DESIGN twenty-six patients with AAA underwent PET-imaging. RESULTS in ten patients, PET-imaging revealed increased fluoro-deoxy-glucose (18-FDG) uptake at the level of the aneurysm. Patients with positive PET-imaging had one or more of the following elements in their clinical history: history of recent non-aortic surgery (n = 4), a painful inflammatory aortic aneurysm (n = 2), moderate low back pain (n = 2), rapid (> 2;5 mm in 6 months) expansion (n = 4), discovery by PET-scan of a previously undiagnosed lung cancer (n = 3) or parotid tumour (n = 1). Five patients with a positive PET scan required urgent surgery within two to 30 days. Among the 16 patients with negative PET-imaging of their aneurysm, only one had recent non-aortic surgery, none of them required urgent surgery, only two had a rapidly expanding AAA, and in only one patient, PET-imaging revealed an unknown lung cancer. CONCLUSION these data suggest a possible association between increased 18-FDG uptake and AAA expansion and rupture.
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Affiliation(s)
- N Sakalihasan
- Department of Cardiovascular Surgery, University Hospital of Liège, CHU Sart-Tilman, 4000 Liege, Belgium.
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33
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Abstract
Chronic rupture of abdominal aortic aneurysm (AAA) resulting in unusual clinical manifestations can occur if the resistance of structures surrounding the aorta is sufficient to contain hemorrhage. In this report, we describe five cases of chronic ruptured AAA in which the presenting feature was crural neuropathy. All patients were male with a mean age of 74 +/- 1.8 years. At the time of presentation, crural neuropathy had been ongoing for 3 to 9 weeks. In three cases, AAA was not initially suspected because an inadequate clinical examination was performed (not in the vascular surgery department) and because of the small diameter of the aorta in relation to the patient's morphology. Two patients had one episode of hypotension that was wrongly attributed to vagal attack. Abdominal CT scanning was always diagnostic of chronic rupture. In two cases, rupture was associated with erosion of the body of one or more vertebrae and laboratory evidence of inflammation, i.e., increase in sedimentation rate and fibrinogen level. The mean diameter of the AAA was 7.1 +/- 0.9 cm (range 5-10 cm). All patients underwent midline laparotomy, which was performed under emergency conditions in two cases, under semi-emergency conditions in one case, and electively in two cases. Perforation was consistently located on the posterolateral wall of the aorta and varied from 1 to 3 cm in length. Repair was performed using an aortobifemoral prosthesis in four cases, and a straight tube in one case. The patient who underwent emergency surgery died 4 days after the procedure. The remaining four patients recovered uneventfully and were discharged after 10 days. In the elderly, ruptured AAA should be included in the differential diagnosis of crural neuropathy. An episode of hypotension, regardless of its duration, in an elderly patient should be given serious consideration as a possible sign of ruptured AAA with ongoing retroperitoneal hemorrhage.
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Affiliation(s)
- J O Defraigne
- Cardiovascular Surgery Department, University Hospital, Liège, Belgium
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34
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Schils F, Sakalihasan N, Sente JM, Limet R. [Clinical case of the month. Rupture of Salmonella mycotic aneurysm of the infrarenal abdominal aorta]. Rev Med Liege 1999; 54:786-8. [PMID: 10605311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Mycotic aneurysms are uncommon but remain one of the most challenging clinical problems for the vascular surgeon. They are associated with high morbidity and mortality, and the clinical signs and symptoms are non specific. We report here the case of an abdominal aorta mycotic aneurysm due to salmonellosis treated by insertion of an arterial homograft.
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Affiliation(s)
- F Schils
- Université de Liège, Service de Chirurgie cardio-vasculaire
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35
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Van Damme H, Sakalihasan N, Limet R. Fibromuscular dysplasia of the internal carotid artery. Personal experience with 13 cases and literature review. Acta Chir Belg 1999; 99:163-8. [PMID: 10499386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
From January 1990 to December 1997, the authors observed 13 cases of fibromuscular dysplasia of the internal carotid artery. Four patients presented transient ischemic attacks, one amaurosis fugax, two suffered from a minor stroke, four had non-focalized ischemic cerebral symptoms and two were asymptomatic. At angiography, all patients showed a typical image of "string of beads". Seven patients were operated on. Six had endoluminal graduated dilatation, with rigid dilators up to 4.5 mm, associated with thrombendarterectomy of the bifurcation in three and to correction of a kink in one case. In one case a venous interposition graft was done to exclude a saccular microaneurysm of the dysplasic internal carotid artery. In another case, backflow was insufficient after endoluminal dilatation, and a long venous patch allowed to restitute a normal vascular lumen. There was neither postoperative mortality nor stroke. Six patients, asymptomatic or with non focalized symptoms, were treated medically. During a mean follow-up of 47 months, only one of the 13 patients developed a transient ischemic attack; the patient had not been operated on and received only medical treatment. Prevalence, etiopathology, diagnosis and management of fibromuscular dysplasia of the internal carotid artery are discussed. Fibromuscular dysplasia is a rare cause of cerebral ischemia. For asymptomatic lesions, a conservative approach seems appropriate. Surgery is only to be considered for symptomatic lesions. Surgical graduated endoluminal dilatation, where necessary combined with standard endarterectomy of the carotid bifurcation, is a safe, efficient and durable operation. Some complex cases of fibromuscular dysplasia may necessitate patch insertion or excision and graft interposition.
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Affiliation(s)
- H Van Damme
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
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36
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Zeaiter R, Sakalihasan N, Van Damme H, Limet R. [Clinical case of the month. Diagnosis and treatment of a popliteal artery adventitial cyst]. Rev Med Liege 1999; 54:514-6. [PMID: 10446519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The authors report the case of a 66-year-old patient with unilateral intermittent claudication, in whom no evidence of intravascular occlusive disease was found. Surgical approach revealed an intraparietal cystic adventitial disease of the popliteal artery. An excision of the affected segment and bypass grafting with the internal saphenous vein was done.
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Affiliation(s)
- R Zeaiter
- Service de Chirurgie cardiovasculaire, Université de Liège
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37
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Wang X, Tromp G, Cole CW, Verloes A, Sakalihasan N, Yoon S, Kuivaniemi H. Analysis of coding sequences for tissue inhibitor of metalloproteinases 1 (TIMP1) and 2 (TIMP2) in patients with aneurysms. Matrix Biol 1999; 18:121-4. [PMID: 10372551 DOI: 10.1016/s0945-053x(99)00008-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aneurysms are characterized by dilation, i.e. expansion and thinning of all the arterial wall layers, which is accompanied by remodeling of the connective tissue. Genes involved in the regulation of tissue remodeling are therefore candidate genes. We analyzed TIMP1 and TIMP2 coding sequences in 12 individuals with abdominal aortic aneurysms (AAA), one individual with AAA and intracranial aneurysms (IA), four individuals with IA and two clinically unaffected individuals. We identified two nucleotide variants in both the TIMP1 and the TIMP2 coding sequences. All differences occurred in the third base positions of codons and were neutral polymorphisms. A significant difference was observed in the frequency of TIMP2 nt 573 polymorphism between 168 alleles from AAA patients and 102 control alleles.
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Affiliation(s)
- X Wang
- Center for Molecular Medicine and Genetics, and Department of Surgery, Wayne State University, School of Medicine, Detroit, MI 48201, USA
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38
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Vazquez C, Sakalihasan N, D'Harcour JB, Limet R. Routine ultrasound screening for abdominal aortic aneurysm among 65- and 75-year-old men in a city of 200,000 inhabitants. Ann Vasc Surg 1998; 12:544-9. [PMID: 9841684 DOI: 10.1007/s100169900198] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Unruptured abdominal aortic aneurysm (AAA) is seldom recognized. Thus it is difficult to know whether the incidence of AAA in the general population is high enough to warrant routine screening at least in men after a certain age. Ultrasound screening studies to evaluate the incidence of AAA have been carried out in several English-speaking and Scandinavian countries. The purpose of this report is to describe the results of a study carried out in Belgium. All 65- and 75-year-old men living in the city of Liege, Belgium, were given the opportunity to undergo a free ultrasound examination. Only 41% of the target population was examined. AAA defined as abdominal aortic diameter of >30 mm was observed in 28 subjects (incidence: 3.8%). Mean abdominal aortic diameter was 34.7 mm. A diameter >29 mm was observed in 33 subjects (incidence 4.5%). Mean abdominal aortic diameter was 30.4 mm. On the basis of epidemiological data collected, a high-risk population for AAA was identified. Arterial hypertension (p < 0.05), previous coronary artery surgery (p < 0.05), and smoking (p < 0.06) were more common in subjects with than without AAA. The overall cost of screening was $18.175. The cost per AAA diagnosed was $551.00.
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Affiliation(s)
- C Vazquez
- Departments of Cardiovascular Surgery and Medical Imaging, Sart-Tilman University Hospital Center, Liege, Belgium
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39
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Limet R, Nusgens B, Verloes A, Sakalihasan N. Pathogenesis of abdominal aortic aneurysm (AAA) formation. Acta Chir Belg 1998; 98:195-8. [PMID: 9830543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- R Limet
- Department of Cardiovascular Surgery, CHU du Sart-Tilman, Liège, Belgium
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40
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Limet R, Sakalihasan N, Lapière CM. [Mechanism of the growth and rupture of abdominal aortic aneurysm]. Bull Mem Acad R Med Belg 1998; 152:295-302; discussion 302-3. [PMID: 9622940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The relationship between atherosclerosis and abdominal aortic aneurysm development is well known. Atherosclerosis cannot explain the whole mechanism. Genetic characters of mechanisms leading to abdominal aortic development is obvious from this study and others. Our study evidences an increased metalloproteases activity in aortic wall proportionally to the size of the abdominal aortic aneurysm. A decrease of aortic wall elastin is evidenced proportionally to the AAA size. Extractable collagen is significantly increased in the aortic wall of patients operated on for aortic rupture.
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Affiliation(s)
- R Limet
- C.H.U. du Sart-Tilman, Université de Liège
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41
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Van Damme H, Sakalihasan N, Vazquez C, Desiron Q, Limet R. Abdominal aortic aneurysms in octogenarians. Acta Chir Belg 1998; 98:76-84. [PMID: 9615162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The decision on whether to operate or not abdominal aortic aneurysms (AAA) in elderly depends on the relative risk of the operation versus the natural course of the unoperated AAA. From January 1984 to December 996, 138 patients, aged 80 years and older, were referred to our department for an aneurysm of 40 mm or more (transverse diameter) of the infrarenal abdominal aorta (95 asymptomatic, 15 painful, and 28 ruptured AAA). For 58 patients with asymptomatic AAA, operation was denied at referral because of transverse diameter less than 50 mm (n = 21), patient refusal (n = 10) or unacceptable operative risk or poor general condition (n = 27). Thirty-four of these observed AAA were ultimately operated after a mean delay of 41 months because of aneurysm enlargement (n = 15), aneurysm tenderness (n = 6) or rupture (n = 13). Overall, 52 patients had immediate (n = 37) or delayed (n = 15) elective repair of their AAA, with an in-hospital mortality of 5.7%. Urgent operation was done for 21 patients with a painful AAA. Six patients died at hospital (28% mortality rate). Emergent surgery was applied to 41 patients with ruptured AAA (including 13 AAA who ruptured during surveillance). The operative mortality in this subgroup attained 68%. Follow-up for the 77 survivors and the 24 non-operative patients averaged 43 months. The 5-year survival (operative mortality included) is 47% for electively operated patients, 30% for urgently and 20% for emergently operated patients. For comparison, the 5-year survival of an age and sex matched Belgian population is 63%. For the 24 medically followed AAA, the 5-year survival was 33%. In six cases, the cause of death was rupture of the AAA. Of the 58 patients for whom operation was initially not considered, 19 (33%) presented AAA rupture (13 operated in emergency and 6 who never came to surgery). The operative outcome of AAA repair in octogenarians is less favourable than in the younger age group (3.6% mortality after elective repair, 44% after operation for AAA rupture, according to our institution data). The authors conclude that AAA surgery should not be denied to octogenarians on the basis of advanced age alone. They recommend a straightforward surgery for otherwise healthy octogenarians with AAA of 50 mm diameter, surveillance up to 60 mm for high-risk patients and no surgery for unfit, bedridden or demented patients.
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Affiliation(s)
- H Van Damme
- Department of Cardiovascular, CHU Liège, Belgium
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42
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Defraigne JO, Otto B, Sakalihasan N, Limet R. Spinal ischaemia after surgery for abdominal infrarenal aortic aneurysm. Diagnosis with nuclear magnetic resonance. Acta Chir Belg 1997; 97:250-6. [PMID: 9394968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 76-year-old man underwent surgery for an infrarenal aortic aneurysm reaching 6 cm in maximal transverse diameter. The aorta was crossclamped below the level of the renal arteries. A tube graft was interposed and tend between the infrarenal aorta and the aortic bifurcation. Due to leakage on the suture line two consecutive episodes of crossclamping for a total duration of 40 min. were required. No hypotension was noted during or after the procedure. After operation, the patient complained of difficulties to move both legs and neurologic examination demonstrated paraparesis, with mild sensory deficit. Faecal and urinary incontinences were also noted and urodynamic testing demonstrated sphincterovesical palsy. Nuclear magnetic resonance imaging detected an ischaemic zone in the spinal cord at the level of T11. Faecal incontinence and motor deficit partially resolved but no bladder function recovery was observed. Spinal ischaemia is a rare complication after abdominal aortic surgery. Several risk factors have been suggested which include level and duration of the aortic crossclamping, possible interruption of the spinal cord blood supply via the greater medullary artery (the so-called artery of Adamkiewicz), presence of intra- or postoperative episodes of hypotension, atheromatous embolization, underlying occlusive arteriosclerosis of spinal arteries, and respect or not of the hypogastric circulation. In our case, the duration of the crossclamping and interruption of the blood flow in lumbar arteries probably supplying the distal spinal cord were likely contributive factors.
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Affiliation(s)
- J O Defraigne
- Department of Cardiovascular Surgery, C.H.U. Liège, Domaine Universitaire du Sart-Tilman, Belgium
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43
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Van Damme H, Keppenne V, Sakalihasan N, Andrianne R, Limet R. Uretero-arterial fistula: two observations. Acta Chir Belg 1997; 97:133-6. [PMID: 9224518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Two cases of life-threatening haematuria, secondary to an uretero-arterial fistula, are reported. Both cases present predisposing causative factors. One patient had a combination of previous aorto-bifemoral bypass grafting, an iliac artery aneurysm (retrogradely perfused), and an indwelling ureteral stent for ureteral compression. The other patient had previous aortoiliac surgery and obstructive uropathy with chronic urinary tract infection. Preoperative diagnosis of uretero-arterial fistula was made in only one patient. He was successfully operated (exclusion of the iliac aneurysm). In the other patient, nephrectomy was attempted to control reno-ureteral bleeding of unknown origin. Fatal recidive of brisk haematuria occurred some days later. Factors contributing to the development of uretero-arterial fistula, their diagnosis and optimal treatment are discussed.
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Affiliation(s)
- H Van Damme
- Department of Cardiovascular Surgery, University Hospital Sart-Tilman, Liège, Belgium
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Detry O, Honoré P, Meurisse M, Defraigne J, Defechereux T, Sakalihasan N, Limet R, Jacquet N. Advantages of inferior vena caval flow preservation in combined transplantation of the liver and heart. Transpl Int 1997. [DOI: 10.1111/j.1432-2277.1997.tb00559.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Demarche M, Sakalihasan N, Limet R. [A case of myocardial rupture in closed thoracic injury]. Rev Med Liege 1997; 52:105-9. [PMID: 9173476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M Demarche
- Service de Chirurgie cardiovasculaire, Université de Liège
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46
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Defraigne JO, Antoine PH, Sakalihasan N, Thiry A, Limet R. [An often misdiagnosed cervical mass: carotid chemodectoma]. Rev Med Liege 1997; 52:485-497. [PMID: 9289786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- J O Defraigne
- Service de Chirurgie Cardio-vasculaire, CHU Sart Tilman, Liège
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47
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Detry O, Honoré P, Meurisse M, Defraigne JO, Defechereux T, Sakalihasan N, Limet R, Jacquet N. Advantages of inferior vena caval flow preservation in combined transplantation of the liver and heart. Transpl Int 1997; 10:150-1. [PMID: 9090003 DOI: 10.1007/s001470050030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Only a few cases of combined liver and heart transplantation have been reported in the literature, and no standard surgical procedure has yet been established. We report the successful transplantation of both liver and heart in a 28-year-old patient suffering from homozygous beta-thalassemia. We used Belghiti's technique of inferior vena caval flow preservation for liver transplantation, which avoids inferior vena cava occlusion by a side-to-side caval anastomosis. Applied to combined liver and heart transplantation, preservation of caval flow during liver transplantation may allow early discontinuation of cardiopulmonary bypass and, thus, minimize the general consequences of prolonged bypass.
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Affiliation(s)
- O Detry
- Department of Abdominal Surgery and Transplantation, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Belgium
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Affiliation(s)
- A Verloes
- Centre for Human Genetics, Liège University, CHU Sart Tilman, Belgium
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49
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Sakalihasan N, Pincemail J, Defraigne JO, Nusgens B, Lapiere C, Limet R. Decrease of plasma vitamin E (alpha-tocopherol) levels in patients with abdominal aortic aneurysm. Ann N Y Acad Sci 1996; 800:278-82. [PMID: 8959014 DOI: 10.1111/j.1749-6632.1996.tb33332.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- N Sakalihasan
- Department of Cardiovascular Surgery, University Hospital of Liège, Belgium
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Defraigne JO, Sakalihasan N, Piérard GE, Limet R. [A frequently unrecognized cause of vascular lesions: Behçet's disease]. Rev Med Liege 1996; 51:639-46. [PMID: 8984559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J O Defraigne
- Service de Chirurgie cardio-vasculaire, Université de Liège
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