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BACKGROUND: Symptomatic or ruptured juxta-renal aortic aneurysms can be managed through open surgical repair or endovascular approaches, including chimney endovascular aortic repair (chEVAR), off-the-shelf branched devices, or physician-modified endograft (PMEG). PMEG has proven to be a feasible alternative with satisfactory long-term outcomes for such conditions. CASE REPORT: We document the inaugural case of PMEG performed at our center for a 69-year-old man with a symptomatic juxta-renal aortic aneurysm. This custom-made device included fenestrations for renal arteries and a scallop for the superior mesenteric artery. The patient was discharged home on the ninth postoperative day. A six-month follow-up CTA confirmed the AAA's exclusion, with maintained patency of all visceral vessels and no evidence of endoleak. CONCLUSION: The complexity of the PMEG procedure varies based on the surgeon’s expertise and the patient’s anatomical challenges. This underscores the importance of meticulous patient selection, a process that ensures the safety and success of the procedure.

BACKGROUND: Extracranial internal carotid aneurysms are extremely rare and usually diagnosed as incidental findings although thromboembolic events or rupture can occur. Historically treated by open surgery, endovascular repair is emerging as an alternative. We present our center’s experience with both approaches. CASE REPORTS: Four internal carotid aneurysm cases are presented: Case 1 – 60-year-old male presented with an asymptomatic 20mm saccular aneurysm of the carotid bifurcation. He underwent arterial reconstruction with a bypass using a 6mm ePTFE graft and reimplantation of the external carotid artery. Case 2 – 61-year-old female presents with an asymptomatic 17mm saccular aneurysm of the internal carotid artery. Aneurismectomy and direct reconstruction through an end-to-end anastomosis was possible due to artery redundancy. Case 3 – 36-year-old patient with a history of Cushing's syndrome due to a secretory adenoma of the pituitary gland presented with an 19mm fusiform aneurysm of the internal carotid artery. After pituitary gland tumor recession, he underwent arterial reconstruction with an inlay saphenous vein bypass. Case 4 – 77-year-old female presents with a 27mm saccular aneurysm of the internal carotid artery. Endovascular aneurysm exclusion using a self-expandable covered stent was performed through a cervical carotid surgical approach. Stent occlusion was observed in the postoperative period but without neurological symptoms. CONCLUSION: Existing data on endovascular treatment’s short- and medium-term outcomes are comparable to surgery, but long-term results are unknown and high rates of technical failure have been associated to artery tortuosity. There are no specific guidelines to guide decision-making and treatment decisions must be individualized according to the morphology and location of the aneurysm and patient's comorbidities.

INTRODUCTION The femoropopliteal biomechanical characteristics make the endovascular treatment of complex lesions particularly challenging. Despite several studies reporting longer patency of femoropopliteal stenting when compared to balloon angioplasty, long-term outcomes are still marginal due to the high rate of restenosis, stent fracture, and thrombosis. This study aims to review the current literature on the outcomes of the endovascular treatment of the femoropopliteal sector with the Supera® stent. MATERIALS AND METHODS A search was carried on Pubmed database under the terms [“Supera” AND “femoropopliteal”]. Prospective and retrospective original studies were selected after title and abstract analysis. RESULTS Twelve studies were analyzed, comprising a total of 1358 limbs with femoropopliteal obstructive disease treated with the Supera® stent. The 12-month primary-patency rate (PPR) ranged from 72.6% to 94.1%, the 24-month PPR ranged from 60.8% to 83.1% and the 36-month PPR ranged from 69.5% to 76.7%. For high-complexity anatomies, including TASC C and D lesions, the 12-month PPR was >64%. There were no stent fractures reported in any of the included studies. DISCUSSION The Supera® stent showed promising results for the endovascular treatment of the femoropopliteal sector, highlighting its performance in high-complexity anatomic patterns.

INTRODUCTION: Congenital vascular malformations are entities with a broad spectrum of presentations and variable prognosis. They typically present at a young age and are historically associated with extensive resection surgeries and with high morbidity. This study aims to evaluate the results of arteriovenous malformations (AVMs) embolization as a first-line approach in lesions which are not suitable for surgical resection. METHODS: A retrospective analysis of the clinical records of patients with infiltrative arteriovenous malformations who underwent embolization at our center between 2019 and 2021 was performed. The Schobinger Classification was applied to categorize the clinical stage. Angiographic findings were reported according to the Yakes classification. The decrease in the Schöbinger grade after treatment, the need for reintervention and the associated complications were the main outcomes. A descriptive statistical analysis was performed. RESULTS: Nine patients undergoing embolization of infiltrative arteriovenous malformations were evaluated, accounting for a total of seventeen interventions. There was a preponderance of females (n=6; 66.7%) and the mean age of referral to the Vascular Surgery consultation and the first treatment was 16.8 (±12.9) and 20.9 (± 14.5) years, respectively. All patients were in stage II (n=4; 44.4%) or III (n=5; 55.6%) of Schöbinger. The angiographic pattern of the AVMs was classified according to the Yakes Classification, which guided the approach. Yakes type IIa was found most frequently (n=6; 55.6%), followed by type IV (n=2; 22.2%) and type IIb (n=1; 1.1%). Patients underwent AVM embolization via transarterial, transvenous or direct nidus puncture with sclerosing agents, liquid embolizers, microparticles and microcoils, separately or in combination. The median number of interventions per patient was 1 (1 – 5) and Yakes type IV appears to be associated with a higher rate of reintervention. Reduction of the Schöbinger stage was achieved in 7 (77.8%) patients with clinical resolution in 3 (33.3%). Tissue necrosis was the only complication reported in this series (n=2; 11,8%). CONCLUSION: The endovascular approach of arteriovenous malformations through nidus and/or afferent/ efferent embolization requires a detailed angiographic characterization but seems to be an effective strategy with a low risk of complications. The Yakes classification, can be useful both in guiding the approach and inpredicting the need for reintervention.

INTRODUCTION: Light induced amaurosis refers to a transient monocular or binocular vision loss triggered by bright lights. Like amaurosis fugax, light induced amaurosis is associated with carotid artery stenosis but they differ from each other in presentation and pathophysiology. It is thought to be an impairment in the regeneration of retinal visual pigments caused by the inability of carotid circulation to sustain the increased metabolic activity occurring when the retina is exposed to bright lights. With this report we aim to present a case of light induced amaurosis and its management. CASE REPORT: We describe a 74-year-old man with the isolated complaint of monocular visual loss from his left eye when exposed to bright lights. These episodes were self-limited and lasted for several minutes. His vision was reportedly good between episodes. He also complained of headache and dizziness. There were no other focal neurological deficits present. The patient had a history of peripheral artery disease, chronic heart failure, hypertension, dyslipidaemia, permanent atrial fibrillation and had a history of heavy smoking in the past. Chronic medical therapy included anticoagulation with rivaroxaban, antiplatelet therapy with acetylsalicylic acid and atorvastatin. Imaging studies (doppler ultrasonography and Computed tomography angiography) revealed a significant morphologic stenosis of the left common carotid artery, left internal carotid artery with sub occlusive disease and right internal carotid artery with 70-75% stenosis (North American Symptomatic Carotid Endarterectomy Trial - NASCET). The vertebral arteries study did not reveal significant morphologic disease. The patient was submitted to left common and internal carotid artery endarterectomy and Dacron patch angioplasty. The visual symptoms progressively improved after surgical treatment. The dizziness and headache were completely gone. CONCLUSION: Light induced amaurosis is a rare and less known symptom associated with severe carotid artery stenosis. Its timely recognition is important to not deprive patients of timely treatment.

Peripheral bypass grafting with autologous vein is the gold standard treatment of peripheral artery disease. In cases when the great saphenous vein is not available the arm veins or small saphenous veins are possible alternatives. The use of small saphenous vein as a bypass conduit is not a spread practice. We present two cases of revascularization procedures using the small saphenous vein as a conduit and a literature review on the theme.

Introdução: A técnica criss-cross combina acesso vascular anterógrado e retrógrado da veia poplítea, de modo a obter recanalização venosa em doentes com trombose venosa profunda (TVP) ileofemoral associada a trombose das veias poplítea e gemelares. Caso clínico: Doente do sexo feminino de 57 anos, com antecedentes de histerectomia radical e linfadenectomia de nódulos linfáticos pélvicos em 2013, devido a neoplasia uterina, com consequente linfedema crónico do membro inferior direito. Admitida na urgência por edema grave do membro inferior direito, com 7 dias de evolução. À observação, a paciente apresentava edema da coxa e perna, cianose da perna, dor gemelar, extremidades quentes e pulsos distais palpáveis. Estudo com ecodoppler a objetivar trombose dos eixos venosos do membro inferior direito. Estudo com TC contrastado excluiu extensão proximal do trombo para a veia ilíaca comum direita ou veia cava; excluiu tromboembolismo pulmonar e evidenciou clips cirúrgicos em proximidade com a veia ilíaca externa direita, causando uma respetiva redução luminal superior a 50%. A doente foi submetida a trombectomia e fibrinólise dirigida por cateter. Obteve-se acesso vascular através de punção ecoguiada da veia poplítea. Após colocação de introdutores em sentido retrógrado e anterógrado, realizou-se trombectomia das veias gemelares até à veia femoral comum, com recurso a aspiração por cateter. Instituiu-se perfusão de alteplase e heparina não fracionada por via periférica, mantidas durante 72 horas, com controlo angiográfico a cada 24h. Após recanalização satisfatória, realizou-se angioplastia com balão 14x40mm, seguida de stent 14x80mm na veia ilíaca externa. Não ocorreram complicações hemorrágicas major. O tratamento invasivo foi complementado com drenagem postural e meia elástica compressiva, permitindo melhoria clínica imediata e progressiva. Após dois dias, a doente recebeu alta medicada com heparina de baixo peso molecular. Em consulta de follow-up após um mês, constatou-se melhoria clínica progressiva e alterada hipocoagulação para rivaroxabano ad aeternum. Conclusão: A técnica de criss-cross permite recanalização do inflow e outflow, restaurando patência venosa e mantendo a função valvular, aspetos com eventual papel crítico nos resultados após TVP ileofemoral extensa.

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 artery treated with a hybrid procedure. The patient was submitted to a left subclavian artery stenting and left to right axillary bypass without complications.

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 performed in our institution between April 2018–2019. Results: Four patients were treated: 3 males/1 female with mean age of 58.5 years. All patients had PAD stage 4. All patients were studied with arteriography and ultrasound and were considerate no revascularizable (2 of them after an attempt of endovascular/surgical treatment). In one patient a trial with endovenous prostaglandin was performed, without clinical response. In all cases, the patients were facing a major amputation. Arterialization was performed as a last attempt to save the limb. Regarding the surgical procedures, the donor inflow artery was the infragenicular popliteal artery in 2 cases, distal femoral artery in 1 case and anterior tibial artery in 1 case. In 3 cases the bypass used the great saphenous vein (GSV) in situ to arterialize the medial marginal vein; in 1 case was used an inverted GSV bypass with the distal anastomosis at the posterior tibial vein. The venous valves were destroyed by combination of Fogarty catheter (proximally) and angioplasty balloon (distally). Collaterals were ligated to focalize the blood flow. In all patients marked improvement in foot perfusion was achieved. Two of them had excellent evolution in the postoperative period and healed foot lesions. One patient was amputated with permeable bypass. One patient presented good initial evolution but later had bypass thrombosis (presum- ably due to inadequate arterial inflow from the anterior tibial artery) and undergone major amputation. Discussion/Conclusions: Despite advances in surgical and endovascular techniques, an important number of patients with CLI are not candidates to arterial revascularization and most patients with inoperable CLI will face a major amputation. In that setting, venous arterialization should be considered but not all patients are candidates to this procedure and a careful preoperative evaluation is required. Our preliminary experience is encouraging: the procedure was relatively straightforward, the resulting improve in foot perfusion was surprisingly good, the patency rate and limb salvage rate was 75 and 50%. In our opinion the major issues are selection of inflow artery and outflow vein and the learning curve in interpretation of the angiographic result to guide optimal focalization of the blood flow.

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 de um caso clínico e literatura. Resultados: Homem de 65 anos com antecedentes de doença pulmonar obstrutiva crónica, fibrilação auricular e hipertensão arterial; recorreu ao serviço de urgência por dor abdominal. Realizou angio-TAC que revelou uma AD tipo A e uma úlcera (PAU) na aorta ascendente (AA). Após a avaliação por cirurgia cardíaca, foi considerado não candidato para cirurgia convencional. A angio-TAC foi repetida após duas semanas de tratamento médico e revelou crescimento do falso aneurisma, com risco iminente de rutura. Ponderamos o tratamento endovascular e diferentes opções foram consideradas, a decisão final foi propor um tratamento híbrido. O procedimento foi iniciado com um bypass femoro-axilar direito e embolização do tronco braquiocefálico. Em seguida, uma endoprótese (Valiant®) foi libertada abaixo da artéria subclávia esquerda e dois periscópios (Viabahn®) foram progredidos das artérias axilar e carótida esquerdas e a segunda endoprótese (Valiant®) foi libertada, dentro da primeira, com cobertura da carótida e subclávia esquerdas. Após várias tentativas, não foi possível progredir a terceira endoprótese para a Aorta Ascendente por falta de suporte e instabilidade hemodinâmica e o procedimento foi interrompido. Posteriormente, a angio-TAC foi repetida e revelou dissecção da AA permeável e o falso aneurisma não tratado. Foram discutidas outras opções e foi ponderado um acesso vascular anterógrado (transapical) com o objetivo de conseguir o suporte para progredir a endoprótese. Com o apoio de um cirurgião cardíaco, o ápice cardíaco foi abordado e puncionado e um fio guia rígido foi avançado, criando um throught-and-through, do apéx cardíaco até à artéria femoral, o que permitiu o avanço da endoprótese (Valiant®) por via retrógrada e a sua libertação em rapid pacing sem intercorrências e com bom resultado final. Discussão/Conclusões: o tratamento endovascular AD tipo A é uma alternativa em doentes de alto risco clínico e características anatómicas adequadas, ainda que tecnicamente possa ser desafiante. Quando a progressão da endoprótese por acesso vascular retrógrado não é conseguida, a abordagem cardíaca transapical é uma alternativa a ser considerada.

O priapismo isquémico é uma ereção persistente, sem relação com estímulo sexual, caracterizada pela redução ou ausência de fluxo sanguíneo intracavernoso. Apresenta-se um caso clínico de um homem de 30 anos, com priapismo com 48 horas de evolução. Foi submetido noutra instituição à drenagem dos corpos cavernosos, instilação de efedrina e criação de shunt cavernoso-esponjoso, sem melhoria do quadro. Ao ecoDoppler observou-se ausência de fluxo nas artérias cavernosas, trombose das veias cavernosas e fluxo venoso dorsal normal. Foi submetido a cirurgia de Grayhack, com construção de pontagens cavernoso-femoral bilateral por transposição segmentar da veia grande safena. Apresentou boa evolução clínica e resolução do priapismo. No 7.◦ dia de pós-operatório apresentou trombose das pontagens, com fluxo de baixa resistência nas artérias cavernosas.

Introduction: Transcutaneos oxygen tension (TcPO2) is a noninvasive method that reflects the balance between local oxygen supply and skin oxygenation and is particularly useful in evaluating diabetic vascular disease, because its measurements are not influenced by medial arterial calcifications. The aim of the present study was to determine the predictive value of TcPO2 for foot ulcer healing in diabetic patients submitted to a conservative treatment. Material/Methods: 127 diabetic patients (135 limbs) with chronic foot ulcers were prospectively evaluated. The age was 67, 2 ± 11, 8 years (mean ± SD) and the diabetes duration was 17,6 ± 9,8 years (mean ± SD). TcPO2 mapping (mmHg) of the involved limb was obtained. Conservative ambulatory treatment was prescribed and wound healing was routinely evaluated. The patients were divided into three groups according to the clinical outcome: complete wound healing, improved wound healing and impaired wound healing. Results: A significant correlation was found between the presence of infection and TcPO2 values, 26,24 ± 15, 04 (mean TcPO2 with infection ± SD) and 34, 14 ± 16, 9 (mean TcPO2 with no infection ± SD), pIntrodução: A avaliação da pressão transcutânea de O2 (TcPO2) constitui um método não invasivo de diagnóstico que nos permite quantificar a difusão de oxigénio a nível tecidular. Dado que a sua leitura é independente da calcificação arterial a sua utilização na população diabética é de particular relevância. O presente trabalho teve como objectivo avaliar o valor preditivo da TcPO2 relativamente á cicatrização de lesões do pé em doentes diabéticos submetidos a tratamento conservador. Material e Métodos: 127 pacientes diabéticos (135 membros) com úlceras crónicas foram avaliados prospectivamente tendo-se procedido, respectivamente á medição dos valores da TcPO2. A idade média foi de 67, 2 ± 11, 8 anos (média ± dp) e o tempo médio de duração da diabetes foi 17,6 ± 9,8 anos (média ± dp). No follow-up final, os doentes foram divididos em três grupos, de acordo com a evolução clínica: cicatrização completa, melhoria da cicatrização e má evolução da cicatrização. Resultados: Houve correlação significativa entre a presença de infecção e os valores de PTcO2 medidos, 26, 24 ± 15, 04 (média TcPO2 com infecção ± dp) e 34, 14 ± 16, 9 (média PTcO2 sem infecção ± dp), p

ABSTRACT Introduction: Abdominal aortic aneurysm has a lower incidence in the female population, but a higher complication rate. It was been hypothesized that some anatomical differences of abdominal aortic aneurysm in women could be responsible for that. We proposed to analyze our data to understand the differences in the clinical and anatomical characteristics and the outcomes of patients undergoing endovascular aneurysm repair, according to gender. Methods: A retrospective analysis of patients undergoing endovascular aneurysm repair between 2001-2013 was performed. Patients were divided according gender and evaluated regarding age, atherosclerotic risk factors, aneurysm anatomic features, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality. Two statistical studies were performed, first comparing women and men (Group A) and a second one comparing women and men, adjusted by age (Group B). Results: Of the 171 patients, only 5.8% (n=10) were females. Women were older (P

Abstract Introduction: Endovascular aneurysm repair (EVAR) is the therapy of choice in high risk patients with abdominal aortic aneurysm. The good results described are leading to the broadening of clinical indications to younger patients. However, reintervention rates seem higher and even with successful treatment sometimes there is growth of the aneurysm sac and rupture, meaning a failure of the therapeutic goal. This study proposes to analyse the impact of age in patients' selection and post-EVAR results. Methods: The clinical records of consecutive patients undergoing endovascular aneurysm repair, between 2001 and 2013, were retrospectively reviewed. Patients were divided according to age groups (80 years). Gender, body mass index, aneurysm anatomic features, neck characteristics, iliac morphology, surgical indication, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality were analysed and compared. Results: The study included 171 patients, 161 (94.1%) men, and mean age 74.1±8.9 years. The age group under 70 had 32% of the patients. Only three characteristics were found different among age groups: 1) body mass index was higher in younger patients, with a considerable trend toward significance (P=0.06); 2) surgical indication, in the younger group, surgeon's and the patient's option were more proeminent (P

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Introdução: O stress ergonómico associado à execução procedimentos endovasculares leva o cirurgião vascular a assumir frequentemente um conjunto de posturas e movimentos para controlo imagiológico do procedimento. Isto condiciona um aumento do risco a longo termo de desenvolvimento de patologia músculo-esquelética. A utilização de smart glasses (óculos inteligentes) poderá ter um papel na redução deste risco, permitindo ao profissional controlar o procedimento sem necessidade de reposicionamento constante. Através da aplicação do questionário Quick Exposure Check (QEC), compa- ramos o risco ergonómico durante a realização de procedimentos endovasculares com e sem a utilização de smart glasses. Métodos: O QEC foi aplicado por um observador externo durante a realização de procedimentos endovasculares com e sem a utilização de smart glasses Epson Moverio BT-35E®. Os dois grupos de procedimentos foram comparados relativamente ao score total no QEC e aos scores parciais que avaliam o risco relativo a diferentes segmentos anatómicos (coluna cervical, coluna lombar, ombro/braço e punho/mão). Os scores parciais de auto-percepção de stress e de ritmo de trabalho, avaliados pelo profissional, foram também comparados. Resultados: O QEC foi aplicado a um total de 12 procedimentos. Os procedimentos com utilização de smart glasses (n=6) obtiveram um score total médio significativamente mais baixo no QEC (83.7 – risco ergonómico baixo), comparativamente aos procedimentos sem utilização de smart glasses (108.3 – risco ergonómico moderado; p=0.009). Os scores parciais médios relativos à coluna cervical e lombar foram também significativamente mais baixos neste grupo (lombar: 11.3 vs 18; p=0.002) (cervical: 18 vs 26.7; p=0.002). Não se encontraram diferenças estatisticamente significativas para os scores parciais médios relativos ao ombro/braço e punho/mão, nem para os scores parciais médios de auto-percepção de stress e de ritmo de trabalho. Conclusão: A utilização de smart glasses durante a cirurgia endovascular mostrou reduzir o risco ergonómico, avaliado pela escala QEC, de moderado para baixo. Esta redução traduz-se principalmente numa diminuição do risco de patologia músculo-esquelética a nível da coluna e do pescoço.

Abstract Objective: The endovascular repair of aortic abdominal aneurysms exposes the patients and surgical team to ionizing radiation with risk of direct tissue damage and induction of gene mutation. This study aims to describe our standard of radiation exposure in endovascular aortic aneurysm repair and the factors that influence it. Methods: Retrospective analysis of a prospective database of patients with abdominal infra-renal aortic aneurysms submitted to endovascular repair. This study evaluated the radiation doses (dose area product (DAP)), fluoroscopy durations and their relationships to the patients, aneurysms, and stent-graft characteristics. Results: This study included 127 patients with a mean age of 73 years. The mean DAP was 4.8 mGy.m2, and the fluoroscopy time was 21.8 minutes. Aortic bilateral iliac aneurysms, higher body mass index, aneurysms with diameters larger than 60 mm, necks with diameters larger than 28 mm, common iliac arteries with diameters larger than 20 mm, and neck angulations superior to 50 degrees were associated with an increased radiation dose. The number of anatomic risk factors present was associated with increased radiation exposure and fluoroscopy time, regardless of the anatomical risk factors. Conclusion: The radiation exposure during endovascular aortic aneurysm repair is significant (mean DAP 4.8 mGy.m2) with potential hazards to the surgical team and the patients. The anatomical characteristics of the aneurysm, patient characteristics, and the procedure's technical difficulty were all related to increased radiation exposure during endovascular aortic aneurysm repair procedures. Approximately 40% of radiation exposure can be explained by body mass index, neck angulation, aneurysm diameter, neck diameter, and aneurysm type.