270 Works

ISQUEMIA AGUDA RENAL, UMA EMERGÊNCIA CIRÚRGICA VASCULAR COM EVOLUÇÃO AINDA DESCONHECIDA

Ricardo André Correia, Joana Catarino, Isabel Vieira, Rita Bento, Rita Garcia, Fábio Pais, Tiago Ribeiro, Joana Cardoso, Rita Ferreira, Ana Garcia, Frederico Bastos Gonçalves & Maria Emília Ferreira
Introdução: A incidência de isquemia aguda renal é baixa. A experiência publicada do seu tratamento cirúrgico resume-se a séries de casos e não há indicações bem definidas para a revascularização renal em caso de isquemia aguda. Métodos: Estudo observacional retrospetivo realizado com base na consulta de processos clínicos de doentes submetidos a revascularização de artéria renal por isquemia aguda renal, num hospital universitário terciário, de Janeiro de 2011 a Junho de 2020. O endpoint primário...

FALSE ANEURYSMS OF THE RENAL ARTERY: IS IT A KNOWN DIAGNOSIS IN THE MEDICAL COMMUNITY?

Marta Machado, Rui Machado, Daniel Mendes & Rui De Almeida
Introdução: Os falsos aneurismas da artéria renal são maioritariamente causados por lesões iatrogénicas ou por trauma renal. A incidência destes está a aumentar devido ao incremento do uso de procedimentos minimamente invasivos n o tratamento da patologia renal e, consequente aumento das lesões iatrogénicas. Devido à natureza da parede, estes apresentam um alto risco de rutura e, portanto, devem ser diagnosticados e tratados precocemente. Objetivo: Avaliar a experiência do Departamento de Angiologia e Cirurgia Vascular...

Evento SPACV ON-LINE 2020

SPACV ONLINE
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POST-DISSECTION THORACO-ABDOMINAL ANEURYSMS: RESULTS OF OPEN AND ENDOVASCULAR REPAIR

Ryan Gouveia E Melo, Jorge Campos, Pedro Garrido, Alice Lopes, Ruy Fernandes E Fernandes, Luís Silvestre, Gonçalo Sobrinho, Augusto Ministro, Pedro Amorim, Mariana Moutinho, Carlos Martins, Ângelo Nobre, José Fernandes E Fernandes & Luís Mendes Pedro
Introduction/Objectives: Repair of post-dissection thoraco-abdominal aortic aneurysms (PD-TAAA) is a complex challenge. Choosing the correct approach to manage these aneurysms is not straightforward as both open and endovascular strategies are valid. Our aim was to analyze and compare the results of PD-TAAA treated by endovascular or open surgery. Methods: A seven-year (January-2013 and May-2020) single-center retrospective cohort study of patients with PD-TAAA treated by endovascular (group-1) or open (group-2) surgery was conducted. Primary outcome was...

GESTÃO DA ATIVIDADE DA CIRURGIA VASCULAR NO HOSPITAL BEATRIZ NGELO EM CONTEXTO DA PANDEMIA COVID-19

Diogo Cunha E Sá
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THE RIGHT WAY TO CATCH A FISH COMES FROM THE LEFT

Luís Loureiro, Sérgio Teixeira & Rui De Almeida
The right aberrant subclavian artery, also known as arteria lusoria, is an anatomical variation described in the literature with an incidence of < 1%. Compression related symptoms can arise from the retroesophageal space and retrotracheal course of the artery. Only a few cases are reported of ischemic symptoms derived from a stenosed or occluded right aberrant subclavian artery. We present a case of ischemic right upper limb symptoms due to an occluded right aberrant subclavian...

PARALLEL GRAFT TECHNIQUE: UMA ALTERNATIVA PARA O TRATAMENTO DE PATOLOGIA DO ARCO AÓRTICO

Rita Augusto, Jacinta Campos, Andreia Coelho, Nuno Coelho, Evelise Pinto, Carolina Semião, João Ribeiro, João Peixoto, Daniel Brandão & Alexandra Canedo
Treatment of aortic pathologies involving the aortic arch represents a great challenge for vascular surgeons. Endografting techniques, comparing to open surgery, are less invasive approaches. However, an adequate proximal landing zone remains a challenge and, regarding this issue, parallel graft techniques represent a viable endovascular treatment option in patients with challenging aortic arch pathology by extending the proximal landing zone while maintaining aortic side branches perfusion. Parallel graft techniques required a thorough planning and the...

Cystic adventitial disease of the popliteal artery presenting as acute limb ischemia

Duarte Rego, Paulo Almeida & Rui Almeida
Introduction: Cystic adventitial disease is a rare cause of intermittent claudication. Its presentation as acute limb ischemia is exceedingly rare. This disease is caused by the growth of multiple cysts within the adventitia. Although its etiopathogeny isn’t fully understood most evidence supports an embryonic defect during the development of non-axial arteries. Treatment includes several options: adventitial layer excision, percutaneous aspiration of the cysts and segmental arterectomy with bypass. Methods: We present a case of acute...

SINGLE CENTER REAL-WORLD ANALYSIS OF THE USE OF ILIAC BRANCHED DEVICES FOR AORTO- ILIAC ANEURYSM REPAIR

Marta Romão Rodrigues, Ryan Melo, Pedro Garrido, Luís Silvestre, Ruy Fernandes E Fernandes, Carlos Martins & Luís Mendes Pedro
Introduction: Endovascular repair of aortic aneurysms is widely established. However, aorto-iliac aneurysms pose a challenge, specifically regarding distal sealing. A frequent approach is extending the iliac limb to the external iliac artery (EIA) with occlusion of the internal iliac artery (IIA), often with varying degree of pelvic ischemia causing significant morbidity. Iliac branched devices (IBD) allow for the creation of distal landing zones in the EIA and IIA, maintaining pelvic perfusion. We performed a descriptive...

FENESTRAÇÃO DA LÂMINA DE DISSEÇÃO COM AGULHA TIPS, UMA TÉCNICA ADJUVANTE NO TRATAMENTO ENDOVASCULAR DE ANEURISMAS DISSECANTES DA AORTA TORACO-ABDOMINAL

Ricardo Correia, Joana Catarino, Isabel Vieira, Rita Bento, Rita Garcia, Fábio Pais, Tiago Ribeiro, Joana Cardoso, Gonçalo Alves, Frederico Bastos Gonçalves & Maria Emília Ferreira
Introdução: Na dissecção crónica complicada de degeneração aneurismática, é frequente existirem fendas espontâneas entre o verdadeiro e o falso lúmen ao nível das artérias viscerais. No entanto, na sua ausência ou difícil identificação, o tratamento com recurso a f/bEVAR está limitado. Nesses casos, pode ser necessária a criação de fenestrações para permitir o acesso aos vasos viscerais. Métodos / Resultados: Apresentam-se 2 casos de procedimentos de fenestração de lâmina de disseção crónica em doentes submetidos...

TÉCNICA KISSING STENT NO TRATAMENTO DE ESTENOSE DA ARTÉRIA INOMINADA

Nelson Camacho
Abstract Introduction: The presence of symptomatic atherosclerotic stenosis of the innominate artery is an uncommon condition. The authors report the use of kissing stent technique in right subclavian and common carotid arteries with covered stents and cerebral protection by direct clamping of common carotid artery, as a hybrid endovascular alternative to treat symptomatic stenosis of the innominate artery. Case Report: A 75-year-old male was admitted to Vascular Surgery Department with repeated transient ischemic attacks (TIA’s)...

TYPE B AORTIC INTRAMURAL HEMATOMA – WHEN A SHEEP BECOMES A WOLF

Nuno Henriques Coelho, Clara Nogueira, Victor Martins, Jacinta Campos, Andreia Coelho, Rita Augusto, Evelise Pinto, Carolina Semião, João Ribeiro, João Peixoto & Alexandra Canedo
Introduction: Type B aortic intramural hematoma (B-IMH) has a complex and variable natural history: it can remain stable and resolve spontaneously or progress to dissection, aneurysm, ulcer or even rupture. The possibility of disease progression, frequently with mild or no symptomatology, poses a significant treatment dilemma. Clinical Case: We report a case of a 60 year-old-female diagnosed with an acute B-IMH, initially treated medically. However, 1-month control CTA revealed disease progression (increased B-IMH thickness and...

VENOUS ARTERIALIZATION FOR SOME PATIENTS WITH NO OPTION CRITICAL LIMB ISCHEMIA ! A DESPERATE ATTEMPT OR AN EXPERIENCE\"PROVED SUCCESSFUL TECHNIQUE?

Inês Antunes, Carlos Pereira, Luís Loureiro, Gabriela Teixeira, Carlos Veiga, Daniel Mendes, Carlos Veterano, Henrique Rocha, João Castro & Rui Almeida
Introduction: Between 14–20% of patients with critical lower-limb ischemia (CLI) are not candidates for revascularization due to extensive occlusions in crural/pedal vessels. Frequently these patients are young and functionally active. In these cases, the concept of shunting blood through veins to get this reversed flow to reach the nutritive tissue capillary bed becomes attractive. Our aim is to report our very recent experience in venous arterialization. Material/Methods: We retrospectively reviewed the cases of venous arterialization...

ANEURISMA DA AORTA TORÁCICA 29 ANOS APÓS LACERAÇÃO E REPARAÇÃO PRIMÁRIA

Margarida S. Ferreira, Gil Marques, António Gonzalez, Gonçalo Sousa, João Vieira & Maria José Ferreira
A laceração traumática da aorta é uma lesão de elevada mortalidade pré-hospitalar e intra-hospitalar. A sobrevivência a este tipo de lesões é rara e escasseiam dados sobre o prognóstico a longo-prazo destes doentes. Descrevemos um caso clínico de reparação primária de laceração da aorta torácica que se apresentou 29 anos após a repa- ração inicial com aneurisma da aorta torácica na mesma topografia. Foi submetido a reparação endovascular do aneurisma. Discutem-se as técnicas de reparação...

ABOVE-KNEE AMPUTATION STUMP ISCHEMIA: A SURGICAL CHALLENGE IN PREVENTING DEATH

Inês Antunes, Carlos Pereira, Gabriela Teixeira, Carlos Veiga, Daniel Mendes, Carlos Veterano, Henrique Rocha, João Castro & Rui Almeida
Introduction: Above-knee stump ischemia is a serious condition. If left untreated usually courses with progression to irreversible ischemia. Without treatment the path from here usually leads to hip disarticulation and death. Our aim is to present our most recent experience in stump revascularization. Material/Methods: We retrospectively reviewed all patients with above-knee stump ischemia treated in our institution between July 2018 to March 2019. Results: We present four clinical cases treated in our institution in the...

CAROTID ENDARTERECTOMY: GUIDELINES VERSUS REAL-WORLD PRACTICE

Gabriela Teixeira, Pedro Sá Pinto, Ivone Silva, João Gonçalves, Sérgio Teixeira, Duarte Rego, Vítor Ferreira, Inês Antunes, Carlos Veiga, Daniel Mendes, Paulo Teles, Arlindo Matos & Rui Almeida
Introduction: A number of guidelines for the management of carotid disease are available to help clinicians in therapeutic decision and provide useful guidance for the best care of the patients. They stated that carotid endarterectomy (CEA) has some benefit in symptomatic patients with carotid stenosis of 50-69% and is highly beneficial in stenosis of 70-99%, with mortality/ stroke rate less than 6%. The maximum benefit is observed when surgery is performed within two weeks after...

MULTIPLE ANEURYSMAL DISEASE: A REVIEW

Mariana Lemos, Ivone Silva & Rui Almeida
Introduction: The degeneration of arterial aneurysms is a common manifestation of atherosclerosis, a process that involves the arterial vasculature, occurring in several arterial territories. With the increase of life expectancy, the number of patients with arterial aneurysms has increased, since its prevalence raises with age. Society of Vascular Surgery classifies arterial aneurysms according to their etiology. The most common form is the degenerative aneurysm, which can result from arterial wall degeneration due to several factors...

EMBOLIZAÇÃO SELECTIVA DE HEMORRAGIA ACTIVA APÓS BIÓPSIA DE NEOPLASIA RENAL

Carlos Veterano, Paulo Almeida, Inês Antunes, Carlos Veiga, Duarte Rego, Vítor Ferreira, João Gonçalves, Gabriela Teixeira, Daniel Mendes, Pedro Sá Pinto & Rui Almeida
A hemorragia major é uma complicação conhecida da biópsia renal percutânea, com uma taxa aproximada de 2,2%. A embolização arterial selectiva é um procedimento seguro, eficaz e pouco invasivo, com aplicação importante na gestão de hemorragias ativas, como por exemplo nas lesões iatrogénicas após biópsia renal. Caso clínico de doente do sexo feminino, 52 anos. No contexto do diagnóstico imagiológico de neoplasia renal metastizada, submetida a biopsia renal percutânea. Admitida na sala de emergência, 3...

RUPTURED IDIOPATHIC SPLENIC ARTERY PSEUDOANEURYSM — A CASE REPORT AND LITERATURE REVIEW

Andreia Coelho, Daniel Brandão, Miguel Lobo, Jacinta Campos, Rita Augusto, Nuno Coelho, Ana Carolina Semião, João Pedro Ribeiro & Alexandra Canedo
Introduction: Splenic artery pseudoaneurysms (SAP) represent a rare clinical entity typically caused by sequelae of pancreatitis or abdominal trauma. Unprovoked, spontaneous SAP are exceedingly rare, with only two other case reports in the literature up to date. In this paper we pretend to present a case of a ruptured idiopathic SAP successfully treated endovascularly. Methods: Relevant medical data were collected from hospital database. Results: The patient is a 75-year-old male with no past history of...

Exposição a radiação ionizante: uma responsabilidade do Angiologista e Cirurgião Vascular

Frederico Gonçalves
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APLICATION OF MODIFIED TECHNIQUE OF RETROANTEGRADE CATHETERIZATION OF THE SUPERFICIAL FEMORAL ARTERY

Ricardo Gouveia, Pedro Brandão, Pedro Sousa, Jacinta Campos, Andreia Coelho, Rita Augusto, Nuno Coelho & Alexandra Canedo
Although the femoral antegrade access is the ideal approach for endovascular treatment of infra-inguinal occlusive disease, there are situations where this is not feasible. And how to solve the problem of an approach when, after a retrograde femoral puncture for a diagnostic angiography, we intend to treat endovascularly the infra-inguinal sector of the punctured side? To apply an inversion technique of a retrograde access is a viable alternative. We present the case of a patient...

THORACOSCOPIC SYMPATHECTOMY IN PATIENTS WITH PALMAR HYPERHIDROSIS: EVALUATION OF QUALITY OF LIFE AFTER SURGERY

Lisete Aires Silva, Mafalda Botelho De Melo, Joana Andrade Barros, Miguel Jeri, João Vasconcelos, Miguel Maia, João Almeida Pinto & José Vidoedo
When approaching patients with primary palmar hyperhidrosis (PH), refractory to conservative treatment, endoscopic thoracic sympathectomy (ETS) is a safe and effective alternative. Methods and materials: Retrospective study in order to assess the quality of life of patients with PH undergoing ETS, from 1 of January 2009 to 31 of December 2014. The data was collected from the medical registries of each patient and from a clinical interview with the application of the quality of life...

ANEURISMA DA VEIA ÁZIGOS — ACHADO RARO EM ESTUDO DE IMAGEM. TRATAR OU NÃO TRATAR?

Andreia Coelho, Miguel Lobo, Victor Martins, Ricardo Gouveia, Jacinta Campos, Rita Augusto & Alexandra Canedo
O aneurisma da veia ázigos é uma entidade clínica rara, descrita num número reduzido de case reports na literatura. Neste artigo, descreve-se o caso de um aneurisma da veia ázigos, diagnosticado acidentalmente numa angio-tomografia computorizada (AngioTC) durante a investigação clínica de um quadro de hemoptises, numa doente do sexo feminino de 82 anos hipocoagulada com varfarina. Foi diagnosticada uma traqueobronquite e repetiu-se AngioTC após resolução do quadro agudo, que revelou trombose completa do aneurisma. Decidiu-se...

ENDOVASCULAR TREATMENT OF A JUXTARENAL AORTIC ANEURYSM WITH THE CHIMNEY TECHNIQUE

Ryan Gouveia E Melo, Ruy Fernandes E Fernandes, Luís M. Pedro, Luís Silvestre, Gonçalo Queiroz E Sousa, Pedro Garrido & J. Fernandes E Fernandes
Endovascular treatment of juxtarenal aortic aneurysms is a complex challenge to the vascular surgeon. We present a case of an 83 year old man with a large juxtarenal aneurysm treated with an endovascular approach with chimneys to the left renal artery and superior mesenteric artery. Fenestrated aortic endovascular repair has been considered the preferred endovascular approach in juxtarenal aneurysms, however when the risk of rupture is considered high to wait for a manufactured device and/or...

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