WHAT THIS PAPER ADDSThis observational prospective multicentre series reports the longest term results of the third generation Anaconda device in infrarenal aortic aneurysms with good data consistency. The endograft provided high technical success. During this five year assessment, secondary interventions were performed in 35 of 176 patients (19.9%) and a significant aneurysm diameter decrease of À13.5% was observed, yet the limb occlusion rate remained high (15 limbs [4.3%] in 14 patients [7.9%]) and was significantly higher when additional leg extensions were implanted. Moreover, distal arterial embolisation occurred in some cases. Finally, implantation outside instructions for use should be avoided as it led to significantly higher rates of migration, surgical conversion, and aneurysm sac expansion.Objective: A significant decrease in aneurysm related survival is observed at long term follow up after infrarenal endovascular aneurysm repair (EVAR) compared with open repair. Therefore, longer term results with new generation endografts are essential. The aim of this post-approval French multicentre prospective observational study (EPI-ANA-01) was to evaluate the technical success and five year mortality and secondary intervention rates of the third generation Anaconda TM endograft. Methods: From June 2012 to October 2013, 176 consecutive unruptured infrarenal abdominal aortic aneurysms were included (160 male patients, mean age 75.3 AE 8.4 years). Survival, freedom from type Ia endoleak, limb events, and re-interventions were estimated using the KaplaneMeier method. Anatomical and clinical characteristics were compared according to the occurrence of migration, conversion, adverse limb events, endoleak, and sac enlargement. Results: The primary technical and clinical success rates were 98.3% and 94.9%, respectively. A hostile neck was identified in 33.9% of patients and 10.7% were treated outside instructions for use (IFU). An early post-operative ( 30 days) mortality rate of 1.7% was observed. At one and five years, respectively, the overall survival rate was 94.9% and 65.9% (aneurysm related in four patients [2.3%]) and the clinical success rate was 90.9% and 70.6%. Secondary interventions were performed in 35 of 176 patients (19.9%). The overall limb occlusion rate was 7.9% and the aneurysm sac diameter decreased significantly (pre-operative diameter 53.9 AE 8.6 mm vs. 42.3 AE 14.7 mm at five years; p < .001). Patients treated outside the instructions for use (IFU) had significantly higher rates of migration, surgical conversion, and aneurysm sac expansion (p ¼ .03).
Conclusion:The Anaconda endograft provides high technical success and satisfactory five year aneurysm exclusion and clinical success rates. However, implantation outside the IFU should be avoided, as it leads to significantly worse outcomes, and caution over the risk of limb occlusion and distal embolisation should be observed.
Thirty patients presenting with phlebographically confirmed deep venous thrombosis were treated with a very low molecular weight heparin fragment (CY 222) in an open and prospective phase-2 trial. A uniform dosage of 750 IC anti-factor Xa units/kg/day was administered subcutaneously for 10 days or more to patients whose thromboses were categorized as postsurgical (17 cases) or medical (13 cases). The clinical symptoms of venous thrombosis diminished in 93% of the patients overall. The extent of vascular clearing was assessed by an original scoring system which compared the pre- and posttreatment phlebo-graphies. The effect of treatment was globally rated ‘very good’ (more than 75 % lysis) in 37% of the patients, ‘good’ (about 50% lysis) in 40% and ‘poor’ (0–25% lysis) in 17%; the phle-bographic thrombosis worsened in 6.6%. Little change occurred in laboratory tests exploring thrombolysis, but a strong anti-factor Xa activity was detected.
50 jugulo-subclavian venous junctions were removed to study the endovenous structures of the subclavian vein and of this junction. The diameter of the subclavian vein is always less than that of the internal jugular vein. Valvules were constantly found, whereas endovenous structures such as those found in the ilio-caval junctions were very rare. In view of these findings, these structures may be regarded as of embryologic origin.
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