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Introduction: Cystic adventitial disease (CAD) is characterised by the accumulation of gelatinous fluid within the adventitial layer of a blood vessel. Over 90% of CAD occurs in the arterial system. Venous CAD most commonly involves the iliofemoral rather than the popliteal segments. Report: This is the report of a 49 year old female patient with a previous right leg deep vein thrombosis (DVT). She presented to a vascular outpatient appointment with recurrent right lower extremity swelling. Venous duplex ultrasound showed an ectatic and incompetent right popliteal vein. Computed tomography (CT) venography showed focal ectasia of the right popliteal vein resulting from an eccentric low density cyst with a diameter of 15 mm. Under general anaesthesia, the patient was placed in the prone position. A lazy S incision was performed in the right popliteal fossa. The popliteal vein had an eccentrically thickened lateral bulge. After heparinisation, a longitudinal venotomy, endophlebectomy, and en bloc cyst removal were performed sequentially. Popliteal patch venoplasty was performed subsequently using the ipsilateral small saphenous vein. After six months, the patient remains on rivaroxaban. A follow up venous duplex ultrasound showed vein reflux through a standard calibre popliteal vein without evidence of cyst recurrence. Conclusion: Venous CAD is a rare disease and should be considered if previous DVT or symptoms mimicking DVT occur. Cyst resection and reconstruction with vein patch, venous or synthetic graft is the most commonly used strategy and has lower rates of cyst recurrence and need for re-operation.

Introduction: In chronic aortic dissection complicated by aneurysmal degeneration, the absence of spontaneous tears between the true and false lumen at visceral artery level may limit treatment by fenestrated/branched endovascular aneurysm repair (F/BEVAR). The creation of new fenestrations may be required to allow access to the visceral vessels. Technique: In this video, the endovascular treatment of a 70 year old white man with chronic type B aortic dissection complicated by Crawford type II thoraco-abdominal aortic aneurysmal degeneration is presented. The right renal artery had a false lumen origin without nearby visible re-entry tears. He underwent dissection flap fenestration at visceral vessel level using a transjugular intrahepatic portosystemic shunt (TIPS) needle and subsequent dilation with a high pressure balloon. A Zenith TX2 dissection endovascular graft was deployed proximally and extended distally with a Zenith dissection endovascular stent until the fenestration level was reached. In a second stage, a F/BEVAR was performed, with fenestration to the left renal artery and branches to right renal artery, superior mesenteric artery, and coeliac trunk. One year follow up computed tomography angiography showed visceral branch patency and a reduction of the aneurysm sac. Discussion: The chronic dissection flap may be thick and fibrotic, creating a technical challenge for endovascular fenestration. The off label use of a TIPS needle in this procedure created a new fenestration at the desired level and allowed definitive post-dissection treatment of the thoraco-abdominal aneurysm.

Objectivos: O tratamento endovascular de aneurismas da aorta abdominal é uma alternativa à intervenção cirúrgica convencional, aplicável no contexto de urgência. Em casos anatomicamente favoráveis parece existir uma vantagem significativa a curto e médio prazo, pese embora uma maior taxa de re-intervenções. Material e Métodos: Foi realizada uma análise retrospectiva dos registos de procedimentos endovasculares na aorta abdominal em contexto de urgência, desde o ano de 2004. Analisaram-se um total de 47 doentes, dos quais em 4 a técnica revelou-se inexequível. O tempo médio de follow-up foi de 28,5 meses (1 a 60 meses). Resultados: Verificou-se sucesso técnico em 91% dos casos (43/47). Registou-se uma taxa de mortalidade aos 30 dias de 19% (8/43) nos doentes tratados, e de 23% (11/47) com base na intenção de tratar. Dos doentes tratados, 18 apresentavam-se sintomáticos, 25 com rotura estável e 4 com rotura de aneurisma da aorta abdominal hemodinamicamente instável documentada por tomografia computorizada abdominal. O seguimento destes doentes revelou um caso de endoleak tipo I proximal, tratado cirurgicamente através da colocação de um cuff proximal e dois casos de endoleak tipo II que não se associaram a crescimento do aneurisma, pelo que se optou pelo acompanhamento seriado sem tratamento até à data. Conclusões: Os autores concluem que a experiência institucional com o tratamento endovascular do aneurisma da aorta abdominal em contexto de urgência é favorável, comparando-se aos resultados publicados em grandes séries. A menor mortalidade e morbilidade associada ao procedimento permite tratar um maior espectro de doentes. O seguimento é fundamental para uma atempada detecção e correcção de complicações.Objectives: The endovascular treatment of abdominal aortic aneurysms is an alternative to surgical intervention, applicable in emergency situations. In anatomically suitable cases, appears to be a significant advantage in the short and midterm results, despite a higher rate of re-interventions Methods: We performed a search in the records of all rEVAR done since the year 2004. We reviewed a total of 47 patients, 4 of which the technique has proved unfeasible. The median follow-up is 28.5 months (1-60 months) Results: There was a technical success in 91% of cases (43/47). The overall mortality at 30 days was 19% (8/43) in treated patients, and considering the intention to treat, the mortality rose to 23% (11/47). In the patients treated, 18 were symptomatic, 25 had a hemodynamically stable rupture and 4 were hemodynamically unstable. The follow-up of these patients has detected a case of proximal type I endoleak, witch was treated surgically by placing a proximal cuff, and two cases of type II endoleak that were not associated with aneurysm growth, and we chose not to treat. Conclusions: The authors conclude that the institutional experience with the endovascular treatment of abdominal aortic aneurysms in emergency is favourable compared to the results published in large series. The lower mortality and morbidity associated with the procedure allows treating a broader spectrum of patients. Follow-up is essential for a timely detection and correction of complications.