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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.

Enquadramento: A literacia em saúde mental é um conceito-chave no panorama da promoção e prevenção em saúde mental, contudo tem sido proposto uma expansão do conceito que pode desvirtuar o seu raio de ação. Objetivo: Analisar criticamente o conceito de literacia em saúde mental e sua evolução, a partir da sua génese e desenvolvimentos ulteriores, perspetivando potencialidades e desafios Principais tópicos em análise: Literacia em saúde mental; saúde mental positiva; saúde mental preventiva e promoção da saúde mental enquanto tradições onde ancora a génese e desenvolvimento do conceito. Conclusão: É positivo valorizar a promoção da saúde mental no conceito de literacia em saúde mental, imprimindo-lhe um cunho assente na perspetiva da salutogénese. Contudo, a adição do adjetivo positiva no termo inicial serve mais os compromissos e intentos ideológicos de algumas áreas do saber que propriamente a promoção da saúde mental. A redução do estigma associado às doenças e doentes mentais e o aumento da procura de ajuda, são objetivos de ação das intervenções ao nível da literacia em saúde mental.

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.

Lichens are organisms constituted by a symbiotic relationship between a fungus (mycobiont) and a photoautotrophic partner (photobiont). Lichens produce several bioactive compounds; however, the biotechnological exploitation of this organism is hampered by its slow growth. To start studying the possibility of exploiting lichens as alternative sources of bioactive compounds, eighteen lichens were collected in the north of Portugal in order to isolate and study the bioactivity of their photobionts. It was possible to isolate and cultivate only eight photobionts. Three of them, LFR1, LFA2 and LCF3, belong to the Coelastrella genus, the other two (LFA1 and LCF1) belong to the Chlorella genus and for the remaining three photobionts, LFS1, LCA1 and LCR1, it was impossible to isolate their microalgae. These only grow in consortium with bacteria and/or cyanobacteria. All extracts showed antioxidant activity, mainly at a concentration of 10 mg.mL−1. LFS1, a consortium extract, showed the highest antioxidant power, as well as the highest concentration of phenolic compounds (5.16 ± 0.53 mg of gallic acid equivalents (GAE).g−1). The extracts under study did not show significant antibacterial activity against Escherichia coli, Listeria or Salmonella. The Coelastrella sp. and LFA1 extracts showed the highest hyaluronidase inhibition. The LFR1 extract at a concentration of 5 mg.mL−1 showed the highest anti-inflammatory activity (79.77 ± 7.66%). The extracts of Coelastrella sp. and LFA1 also showed greater antidiabetic activity, demonstrating the high inhibitory power of α-amylase and α-glucosidase. LFR1 at a concentration of 5 mg.mL−1, due to its selective cytotoxicity inhibiting the growth of cancer cells (Caco-2 cells), is a promising anticancer agent.

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.

Enquadramento: Estudos nacionais e internacionais evidenciam reduzida literacia em saúde mental (LSM) dos adolescentes sobre a ansiedade e a necessidade de serem desenvolvidas intervenções psicoeducacionais em contexto escolar. Objetivo: Identificar as componentes de uma intervenção psicoeducacional de promoção da LSM sobre a ansiedade para adolescentes em contexto escolar. Metodologia: Realizou-se um estudo exploratório, descritivo e de natureza qualitativa, recorrendo a 2 grupos focais e à análise de conteúdo. No primeiro grupo focal, participaram 6 profissionais de saúde ou da educação e, no segundo, 6 adolescentes do 9º ano de escolaridade. Resultados: Foram identificadas as componentes de uma intervenção psicoeducacional de promoção da LSM sobre a ansiedade para adolescentes em contexto escolar, que contribuíram para o seu desenho preliminar, integrando 4 sessões de 90 minutos, com diferentes métodos e técnicas pedagógicas. Conclusão: Este estudo contribuiu para o desenho preliminar da intervenção psicoeducacional “ProLiSMental”, que pretende capacitar os adolescentes para o acesso, a compreensão e a utilização de informação útil que os ajude na prevenção, no reconhecimento e na gestão da ansiedade.

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.

Objetivo: Apresentar a tradução e adaptação transcultural de uma vinheta de ansiedade social em adolescentes para o português europeu, para integrar o Questionário de Avaliação da Literacia em Saúde Mental — QuALiSMental. Métodos: Realizou-se um estudo metodológico detradução e adaptação transcultural da vinheta de ansiedade social em adolescentes para o português europeu segundo as etapas: 1) tradução; 2) síntese das traduções; 3) retrotradução; 4) síntese das retrotraduções; 5) painel de peritos, constituído por oito profissionais de diferentes áreas da saúde; 6) cognitive debriefing, integrando seis adolescentes com uma média de idades de 14,33 anos (DP = 0,52); 7) revisão e relatório final. Ao longo deste processo, tivemos em conta as considerações éticas. Resultados: Obteve-se uma vinheta de ansiedade social nos adolescentes “João” e “Joana” no português europeu. Salientamos os resultados relativos às etapas: painel de peritos e cognitive debriefing. Foram obtidos os critérios de consenso, entre os peritos, para a equivalência semântica e idiomática, a equivalência experiencial e cultural e a equivalência conceptual. No cognitive debriefing verificou-se 100% de concordância relativamente à clareza do conteúdo da vinheta no português europeu. Conclusões: Esta vinheta pode ser utilizada na prática clínica, nos diferentes níveis de cuidados, na educação/formação e na investigação. Integrada no QuALiSMental permite a avaliação da literacia em saúde mental sobre a ansiedade em adolescentes em diversos contextos e/ou avaliação da efetividade de intervenções psicoeducacionais nesta área.

Enquadramento: Devido à pandemia COVID-19 encerraram-se estabelecimentos de ensino e confinaram-se os estudantes. Objetivos: Conhecer as mudanças sociofamiliares, académicas e comportamentais dos estudantes de enfermagem, provocadas pela pandemia COVID-19; caracterizar perceções de saúde, informação e adesão às medidas veiculadas. Metodologia: Estudo quantitativo descritivo-correlacional com 425 estudantes de enfermagem. Utilizou-se o COVID-19 International Student Well-Being Study (C19 ISWS). Cumpriram-se pressupostos éticos. Resultados: Suspensas aulas presenciais, os estudantes regressaram ao domicílio familiar, reduziram contactos com amigos e privilegiaram comunicações online. Manifestaram stress face às mudanças no ensino e à possibilidade de não concluírem o ano letivo. Reportaram aumento de materiais online, mas não identificaram acréscimo de trabalho académico. Referiram menos recursos financeiros. Consideraram informações da Direção-Geral da Saúde atempadas e compreensíveis e aderiram fortemente às medidas implementadas. Os consumidores, diminuíram significativamente consumos de tabaco, álcool e outros. Conclusão: A pandemia COVID-19 trouxe alterações à vida dos estudantes de enfermagem, marcadas por retorno à casa da família, preocupações com sucesso escolar e afastamento das sociabilidades académicas, aderindo massivamente às medidas sanitárias recomendadas.

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: Comparatively to open repair, endovascular aneurysm repair has reduced transfusion rates but there’s no recommendation about number of red blood cells units to be crossmatched preoperatively. Our aim is contribute to the analysis of red blood cells units needs in endovascular and hybrid aortic aneurysm repair and developing a protocol for maximum surgical blood orders schedule. Material and Methods: We retrospectively analyzed our prospective database of elective endovascular aneurysm repair from 2001 to 2012. We analyzed patients’ age, gender, ASA classification, maximum surgical blood orders schedule, red blood cells units transfused and timings, types of endoprosthesis, red blood cells units consumption/endoprosthesis’ type ratio, crossmatch to transfusion ratio, conversion to open repair, hemoglobin concentrations before surgery and discharge. Results: We selected 187 patients, 90% men, mean age 73.1, ASA mode III. The endoprosthesis were aorto-bi-iliac in 71%, aorto-uni-iliac in 23% and thoracic in 6%. Of these, 72,6% of the patients did not require blood transfusion. We transfused 171 red blood cells units. Crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 after. The ratio of red blood cells units consumption/endoprosthesis in the first 24 hours was 0.21 red blood cells units/aorto-bi-iliac, 0.46 red blood cells units/aorto-uni-iliac, 0.8 red blood cells units/thoracic, 1.3 red blood cells units/hybrid-thoracic and 2 red blood cells units/hybrid-aorto-bi-iliac. A statistical correlation was observed between red blood cells units transfused postoperatively and type of endoprosthesis (p < 0.001) and between ASA classification and red blood cells units transfused after 24 hours (p < 0.01). Discussion: Guidelines from the British Society of Haematology are based on a crossmatch to transfusion ratio of 2:1. Our crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 from 2011 to 2012. Conclusion: These results changed our policy of maximum surgical blood orders schedule for endovascular aneurysm repair. We now type and screen aorto-bi-iliac and aorto-uni-iliac. We crossmatch two red blood cells units for thoracic, three red blood cells units for hybrid thoracic and four red blood cells units for hybrid abdominal procedures. This may lead to financial savings, improved efficiency and reduce workload in hematology department.

Isolated acute abdominal aortic dissection is a relatively rare event. Its natural history is not fully understood and its optimal treatment is not established. Open surgery represents the most described treatment but endovascular intervention has had increasing application. Isolated chronic abdominal aortic dissection is even less described in the literature. We describe three patients with isolated chronic abdominal aortic dissection who underwent endovascular treatment in our institution. Mean age at presentation was 82 years. Indication for surgical intervention was aneurismal degeneration. Mean aortic diameter at presentation was 46.7 mm. There was no perioperative mortality or reinterventions. Mean follow-up was 5.3 years (2-12 years). Late reintervention was needed in one patient, eight years after initial surgery, due to type 1 endoleak. According to our experience, endovascular intervention represents an effective and durable treatment option in isolated chronic abdominal aortic dissection. However, long-term follow-up is mandatory. Furthermore, larger studies are still needed to understand this disease and its adequate treatment.

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