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ObjectivesGuidelines recommend open bypass surgery for long occlusions of infrainguinal arteries. In situ saphenous vein bypass is a standardized technique. The aim of this study was to report preliminary six-month outcomes of a national, multicenter, observational, prospective registry based on the examination of treatment of critical Limb IscheMia with infragenicular Bypass adopting the in situ SAphenous VEin technique (LIMBSAVE).MethodsFrom January 2018 until October 2019, 428 patients from 41 centers were enrolled in the LIMBSAVE registry. Data were prospectively collected in a dedicated database, including demographics, preoperative risk factors, clinical and diagnostic preoperative assessments, intraoperative measures (including safety and effectiveness of the valvulotome during the surgical procedures), and 30-day follow-up data. Furthermore, estimated six-month outcomes according to Kaplan–Meier curves in terms of primary patency, primary assisted patency, secondary patency, and limb salvage were evaluated.ResultsPatients were predominantly male ( n = 332, 77.6%) with a mean age of 73.3 years (range 39–95). Technical success, defined as bypass pulse after use of the valvulotome, was obtained in all cases. The proximal anastomosis could be reached by the valvulotome in all cases. The mean number of valvulotome uses was 2.5 (range 1–5). No vein perforation was reported. In nine cases (2.1%), a vein lesion with intramural hemorrhage occurred. The mean length of hospital stay was 11.1 days (range 1–60). At 30-day follow-up, the overall bypass patency rate was 97.4%, and the rate of open or endo reinterventions for failing bypass was 5.4%. At six-month follow-up, the estimated primary patency, primary assisted patency, secondary patency, and limb salvage were 78.1%, 86.2%, 92.1%, and 94.7%, respectively.ConclusionsPreliminary intraprocedural outcomes of the LIMBSAVE registry show that the in situ technique with the valvulotome is safe and effective in disrupting valves and obtaining pulsatility in the saphenous vein. The complication rate related to the use of the valvulotome is low. The six-month preliminary outcomes in terms of overall patency and limb salvage are promising. Further examinations and continuous follow-up are needed to evaluate long-term outcomes.

Invertebrate Survival Journal, Vol 16 No 1 (2019)

Central Dronning Maud Land (DML; East Antarctica) is located in a key region of the Gondwana supercontinent. The Conradgebirge area (central DML) consists of orthogneisses, derived from both volcanic and plutonic protoliths, and minor metasedimentary rocks, intruded by Cambrian syn- to post-metamorphic plutons and dykes. Mafic-ultramafic boudins in the metavolcanic and metaplutonic gneisses from Conradgebirge consist of amphibolites and high-grade garnet-bearing pyroxene- and amphibole-rich granofels. They occur either as discontinuous levels or as pods boudinaged within highly-strained and strongly-migmatized gneisses. Bulk-rock major and trace-element compositions, together with geochemical discriminant diagrams (e.g., Th/Yb versus Ta/Yb and V versus Ti), suggest derivation from enriched mantle source for the mafic rocks boudinaged in metaplutonic gneisses, whereas a calc-alkaline signature is common for the mafic boudins in metavolcanic rocks. The microstructural study and P-T modelling of an ultramafic metagabbroic rock reveal a prograde metamorphic evolution from amphibolite-facies (ca. 0.5 GPa; 500 °C) up to high-P granulite-facies conditions (ca. 1.5-1.7 GPa; 960-970 °C). Partial melting is testified by "nanogranitoid" inclusions enclosed in garnet. An almost isothermal decompression down to ca. 0.4 GPa and 750-850 °C produced well-developed An + Opx-bearing symplectites around garnet. A final isobaric cooling at nearly 0.4 GPa is testified by Grt coronas around high-T symplectites. The above reconstruction traces a clockwise loading-heating P-T evolution with a peak metamorphism at high-P granulite-facies conditions suggesting crustal thickening at nearly 570 Ma, followed by a tectonically assisted rapid exhumation, and then, by an isobaric cooling. 40Ar-39Ar dating of amphibole and biotite at ~ 505-480 Ma testify mineral re-equilibration at upper crustal level (T < 650 °C) during the isobaric cooling. This tectono-metamorphic scenario seems representative of the evolution resulting from the Neoproterozoic/Early Palaeozoic (600-500 Ma) collision between parts of East- and West-Gondwana blocks that led to the final assembly of Gondwana.

International audience

AIM: The aim of this paper was to evaluate early and 3-year results of the endovascular repair (EVAR) for abdominal aortic aneurysm (AAA) using the AnacondaTM endograft in patients with severe proximal aortic neck angle. METHODS: A retrospective analysis of the AnacondaTM Italian Registry was carried out. Two groups of patients were identified according to the presence of a severe (Group A, GA: ≥ 60°) or an absent (Group B, GB

Geological records from the Antarctic margin offer direct evidence of environmental variability at high southern latitudes and provide insight regarding ice sheet sensitivity to past climate change. The early to mid-Miocene (23-14 Mya) is a compelling interval to study as global temperatures and atmospheric CO2 concentrations were similar to those projected for coming centuries. Importantly, this time interval includes the Miocene Climatic Optimum, a period of global warmth during which average surface temperatures were 3-4 °C higher than today. Miocene sediments in the ANDRILL-2A drill core from the Western Ross Sea, Antarctica, indicate that the Antarctic ice sheet (AIS) was highly variable through this key time interval. A multiproxy dataset derived from the core identifies four distinct environmental motifs based on changes in sedimentary facies, fossil assemblages, geochemistry, and paleotemperature. Four major disconformities in the drill core coincide with regional seismic discontinuities and reflect transient expansion of grounded ice across the Ross Sea. They correlate with major positive shifts in benthic oxygen isotope records and generally coincide with intervals when atmospheric CO2 concentrations were at or below preindustrial levels (∼280 ppm). Five intervals reflect ice sheet minima and air temperatures warm enough for substantial ice mass loss during episodes of high (∼500 ppm) atmospheric CO2. These new drill core data and associated ice sheet modeling experiments indicate that polar climate and the AIS were highly sensitive to relatively small changes in atmospheric CO2 during the early to mid-Miocene.