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In the present study, we describe the anatomical varieties of 2 arteries: the right subclavian artery (RSA) and the popliteal artery (PA). The aberrant right subclavian artery (ARSA) is an anatomical anomaly that has a low incidence and occurs when it originates in the aortic arch, distal to the left subclavian artery. The PA begins in the ring of the adductor magnus, continuing to the femoral artery and ends at the level of the inferior border of the popliteus muscle, bifurcating into its two terminal branches: the anterior tibial artery and the tibioperoneal trunk. This division presents a great anatomical variety. The national literature on serial dissections of these vessels in fetuses is scarce. From the Fetal Anatomy Area of the Normal Anatomy Department, FCM-UNC, we aimed to determine the incidence of the anatomical varieties of these 2 arteries.Dissection was performed in fetal cadaveric material, less than 500 grams of weight, between 15 and 24 weeks, provided by the Hospital Misericordia, Córdoba. The sample for the ARSA study was 140 fetuses, 62 male and 78 female. The PA sample was 30 fetuses, 16 female, 14 male. Microdissection instruments, binocular loupes, and macro lens were used. Details of the normal anatomy and the varieties of these arteries were recorded.The results were 2 cases of retro-esophageal ARSA (1.4%); while PA presented 41 cases of type I (68%), bifurcation at the level of the inferior border of the popliteus muscle; and 19 type II cases (32%), bifurcation at the level of the superior border of the popliteus muscle; not finding any type III cases (one of its terminal branches was hypoplastic/plastic).The incidence of ARSA is within the ranges of the literature. Type 1 and type 2 PA presented, respectively, lower and higher incidence than other studies. This study contributes to the formation of a local database (Córdoba, Argentina), and could be useful for health professionals to improve diagnoses and avoid therapeutic accidents. Future research with a larger sample size is planned.Presentamos en este trabajo las variedades anatómicas de 2 arterias: la arteria subclavia derecha (ASD) y la arteria poplítea (AP). La arteria subclavia derecha aberrante (ASDA) es una anomalía anatómica que tiene una baja incidencia y ocurre cuando se origina en el arco aórtico, distal a la arteria subclavia izquierda. La AP comienza en el anillo del aductor mayor continuando a la arteria femoral y finaliza a nivel del borde inferior del músculo poplíteo, bifurcándose en sus dos ramas terminales; la arteria tibial anterior y tronco tibioperoneo. Esta división presenta una gran variedad anatómica. Es escasa la bibliografía nacional sobre disecciones en serie de estos vasos en fetos. Desde el Área de Anatomía Fetal de la Cátedra de Anatomía Normal, FCM-UNC, se propuso determinar la incidencia de las variedades anatómicas de estas 2 arterias.Se realizaron los estudios en material cadavérico fetal, menor de 500 gramos, entre 15 y 24 semanas cedidos por el Hospital Misericordia, Córdoba. La muestra de estudio de la ASDA fue de 140 fetos, 62 masculinos y 78 femeninos. La muestra de AP fue de 30 fetos, 16 femeninos, 14 masculinos. Se utilizó instrumental de microdisección, lupas binoculares, y lente macro. Se registraron los detalles de la anatomía normal y de las variedades de dichas arterias. Los resultados fueron 2 casos de ASDA (1,4%), retro-esofágicas. La AP presento 41 casos (68%) tipo I, bifurcación a nivel del borde inferior del músculo poplíteo; 19 casos (32%) tipo II, bifurcación a nivel del borde superior del músculo poplíteo; tipo III no se encontró ningún caso (una de sus ramas terminales es hipoplásica/aplásica).La incidencia de la ASDA se encuentra dentro de los rangos de la bibliografía. La AP tipo 1 y tipo 2 presentó respectivamente menor y mayor incidencia a otros estudios. Este estudio contribuye a la formación de una base de datos, autóctona de Córdoba, Argentina e ilustra a los profesionales de la salud para mejorar los diagnósticos y evitar accidentes terapéuticos. Se programa aumentar el tamaño de la muestra de material en esta línea de investigación.  

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events