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Introdução: A presença de estenose aterosclerótica sintomática da artéria inominada é uma patologia pouco frequente. Os autores apresentam a utilização da técnica kissing stent nas artérias subclávia e carótida comum direitas com stents cobertos com proteção cerebral por clampagem direta da carótida comum, como alternativa endovascular “híbrida” para o tratamento da estenose sintomática da artéria inominada. Caso Clínico: Doente de 75 anos, sexo masculino, admitido no Serviço de Cirurgia Vascular por acidentes isquémicos transitórios (AIT’s)...

Introdução/Objetivos: A dissecção aórtica tipo A (AD) geralmente requer tratamento cirúrgico urgente e a substituição do segmento aórtico continua o gold standard. No entanto, é um procedimento muito agressivo e alguns doentes são excluídos do tratamento pelas suas comorbilidades. Atualmente, o tratamento endovascular representa uma alternativa, ainda sem indicações precisas. O nosso objetivo é apresentar um caso de tratamento híbrido de uma AD tipo A com recurso a um acesso vascular cardíaco transapical. Material/Métodos: revisão...

Introduction: The May Thurner syndrome (MTS), results from compression of left common iliac vein (LCIV) between the fifth lumbar vertebra, posteriorly, and the right common iliac artery (RCIA), anteriorly. This phenomenon can cause venous stasis in the pelvis and in the left lower limb. The Nutcracker syndrome (NCS) result from compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, called Anterior NCS, or more rarely by compression of the...

Pulmonary artery pseudoaneurysms may be caused by infection, trauma, neoplasm or iatrogenic lesions, such as pulmonary artery rupture during right heart artery catheterization. Clinical presentation can range from an incidental finding to a life-threatening bleeding with massive hemoptysis. We present a case of a 67 year old woman with systemic sclerosis that developed massive hemoptysis after right heart catheterization. Computer tomography angiography showed a pulmonary artery pseudoaneurysm in the posterior basal segmental branch of the...

O aneurisma da aorta abdominal (AAA) ocorre mais frequentemente em homens de idade avançada, raça caucasiana, com historial tabágico ou história familiar de AAA. Os AAA parecem ter indicação para rastreio populacional pela sua prevalência (4-8%) e mortalidade (80-90%); existência de período de latência até à rotura do aneurisma; uso de técnica eficaz, económica e segura para rastrear; e, tratamento com baixa taxa de mortalidade. O objetivo deste trabalho foi efetuar uma análise crítica dos...

Popliteal vein aneurysm is a rare but potentially fatal entity due to possible thromboembolic complications. The purpose of this paper is to describe two institutional cases and to review the literature. In one case the diagnosis was made after the occurrence of symptomatic pulmonary embolism and in another, incidentally. In both cases the treatment was by conventional surgery without perioperative complications. From the literary review, a total of 43 popliteal vein aneurysms published between 206...

Previously considered a rare clinical condition, the development of more sophisticated imaging methods and endovascular intervention for deep venous thrombosis (DVT) led to a more frequent identification of May-Thurner Syndrome. We present a 68 years-old woman with history of chronic pain and edema in the left lower limb and a CT-scan finding of left common iliac vein compression. Phlebography confirmed a stenosis in the confluence of the left common iliac vein with the inferior vena...

Paragangliomas (PGLs) are neuroendocrine neoplasms that can occur throughout the body wherever there is paraganglia. Representing 0.03% of all tumours, PGLs are extremely rare. Although predominantly benign and amenable to cure by surgical ressection, up to 6% can be malignant. To date, three genes have been identified that are associated with Familial PGLs. All three encode subunits (D, B and C) of the enzyme succinate dehydrogenase complex (SDH), which is part of the Kreb's cycle...

Objetivo: Avaliar a nossa experiencia no tratamento cirúrgico endovascular da Síndrome de May-Thurner primaria (SMT). Introdução: A Síndrome de May-Thurner resulta da compressão da veia ilíaca comum esquerda pela artéria ilíaca comum direita contra o corpo vertebral da quinta vértebra lombar. Material e Métodos: Analise retrospectiva baseada nos registos clínicos e imagiológicas relativos a vinte e um doentes diagnosticados com a SMT primaria submetidos a tratamento cirúrgico endovascular . Foi usado o programa SPSS statistic...

Introdução: As características do colo aneurismático, em particular a presença de trombo, podem limitar o tratamento por EVAR. Objetivos: Estudar se a presença de trombo no colo aneurismático e o tipo de endoprótese utilizada (fixação supra ou infra-renal) têm impacto na função renal dos doentes tratados por EVAR na nossa instituição. Materiais/Métodos: Análise retrospectiva da base de dados de doentes com AAA tratados por EVAR na nossa instituição entre dezembro/2001 e dezembro/2013. Para cada doente...

Introdução e objetivos: O dióxido de carbono (CO2) é um meio de contraste que não causa nefrotoxicidade. Pelas suas vantagens e pela inexistência em alguns centros hospitalares de sistemas “dedicados” de libertação de CO2, têm sido desenvolvidos sistemas “homemade”. Os autores descrevem uma técnica de flebografia de subtração digital utilizando um sistema de libertação de CO2 desenvolvido no seu centro hospitalar. Apresentam ainda os resultados preliminares da sua aplicação. Material e métodos: Foi utilizado um...

Introduction: Endovascular Aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (r-AAA) has been increasingly advocated due to short term benefits. Survival after discharge seems to be similar between EVAR for rAAA (r-EVAR) and for elective patients (el-EVAR). Still, due to higher anatomical complexity more graft-related complications may arise in r-EVAR patients. Methods: MEDLINE databases were searched to identify publications reporting on outcomes after r-EVAR and el-EVAR. Landmark EVAR randomized controlled trial results were used as...

Introduction: Chronic Mesenteric Ischemia (CMI) resulting from an impaired blood flow of the splanchnic organs is characterized by an insidious clinical course and is often an underestimated and undertreated disease. The natural history is progressive, caused by atherosclerosis progression in a polymorbidity and aging society. Due to collateralization, diffuse stenotic lesions can remain asymptomatic for a long time and usually manifests when an acute medical or surgical event occurs. In those cases, the clinical suspicion...

Background: The surge of the COVID-19 pandemic in Portugal and the implemented public health measures were accompanied with a noticeable decrease in patients’ attendance to the Emergency Department (ED). Objectives: This study aims to evaluate the impact of COVID-19 pandemic on Vascular Surgery ED admissions, by comparing clinical and demographic characteristics of patients visiting the ED during the pandemic and the homologous period of 2019. Methods: We retrospectively collected data from patients admitted to the...

Aorto-iliac occlusive disease sometimes extends proximally with involvement of the renal arteries and visceral aorta, with loss of renal functional mass and intestinal ischemia. In this article we report the case of a patient presenting with progressive disabling intermittent claudication caused by chronic juxtarenal aortic thrombosis with proximal progression and involvement of the left renal artery, with a functional kidney preserved by the collateral circulation. This imagiologic finding led to a change in the usual...

Chronic periaortitis and retroperitoneal fibrosis are related entities that develop with periaortic inflammation and deposition of fibroinflammatory tissue in the retroperitoneal space. This pathological fibroinflammatory process may be associated with endovascular treatment of abdominal aortic aneurysms (EVAR) as well as the treatment of aortoiliac arterial occlusive disease with stent/stent-graft implantation. We performed a systematic review of the literature in the MEDLINE database of original articles that documented the development of periaortitis after endovascular aortoiliac treatment...

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Introduction: Subclavian arterial puncture is a relatively frequent complication of attempted placement of central venous catheters (CVC). The placement of a CVC in the artery is rarer, but with potential serious complications especially in its withdrawal. Anticipating these complications, control of potential bleeding in catheter withdrawal is usually performed by surgical or endovascular approach with endoprosthesis release. Our goal is to present the treatment with a percutaneous arterial closure device. Materials / Methods: Presentation of...

Introdução: A presença de múltiplos vasos renais é frequente na população geral e, quando presente num dador, aumenta a complexidade da cirurgia de transplantação renal, aumentando o risco de complicações. Embora a transplantação de enxertos de dador cadáver com estas características seja aceite, o mesmo procedimento em dador vivo permanece controverso. O objetivo deste trabalho é apresentar o caso de uma cirurgia de transplantação de dador vivo com anatomia vascular complexa – duas artérias e...

Introdução: A relaqueação da junção safeno-femoral é considerada um procedimento complexo e demorado, com risco de lesões linfáticas e neurológicas. As técnicas endovenosas para tratamento das varizes, a excisão de trajetos e a injeção de espuma substituíram a maioria das indicações para esta técnica. No entanto, ainda no deparamos com alguns doentes, em que essas técnicas não resolverão o problema, pelo que procurámos protocolar uma técnica de relaqueação da crossa que pudesse ser utilizada em...

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Introduction: Severe ilio-femoral occlusive disease can limit the endovascular treatment of aorto-iliac aneurysms. In high surgical risk patients, inventive and staged hybrid interventions can be the answer to achieve definitive treatment. Clinical Case: A 68-year-old male, with multiple comorbidities, presented with simultaneous occurrence of bilateral common iliac aneurysms and severe ilio-femoral occlusive disease associated with right critical limb-threatening ischemia. In order to exclude the iliac aneurysms, preserve pelvic flow and revascularize the threatened limb we...

Introduction/Objectives: The Corona Virus Disease of 2019 (COVID-19) has taken a major toll on the public health system, with restrictions in all clinical activity, from consultations and exams to number and type of surgeries. Patients apprehension to resort to medical aid and hospitals leads to late admissions and, in our perception, more severe presentations of the underlying pathology, namely, in Chronic limb threatening ischemia (CLTI). Need for testing prior to non-emergent surgery causes larger delays...