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Introduction: Gluteal pseudoaneurysms are extremely rare and respond to pelvic trauma, penetrating wounds, inflammation or infection in the gluteal region. Clinical cases: Two men, 73 and 82 years respectively, who presented gluteal pseudoanerysm after drainage of perianal abscess the first one and after trauma the second one. In both cases the diagnosis was made by imaging tests (doppler ultrasound that was completed with computed tomographic angiography). The first one was successfully treated by ultrasound-guided injection of thrombin at the pseudoaneurysm sac. However, secondary treatment with thrombin injection and coil embolization was performed due to pseudoaneurysm reperfusion. The second one was successfully treated by embolization with hydrocoils through contralateral percutaneous femoral access as well as thrombin injection by direct ultrasound-guided puncture. Discussion: The incidence, presentation and surgical strategy are discussed. Current literature is also reviewed. Conclusion: Ultrasound scan is the first diagnostic test, computed tomographic angiography can give more topographic information. We found selective percutaneous embolization to be the treatment of choice. Open surgical treatment should be reserved for selected cases., Portuguese Journal of Cardiac Thoracic and Vascular Surgery, Vol. 28 No. 3 (2021): July - September

OBJECTIVES: We sought to analyze the collected worldwide experience with use of snorkel/chimney endovascular aneurysm repair (EVAR) for complex abdominal aneurysm treatment. BACKGROUND: EVAR has largely replaced open surgery worldwide for anatomically suitable aortic aneurysms. Lack of availability of fenestrated and branched devices has encouraged an alternative strategy utilizing parallel or snorkel/chimney grafts (ch-EVAR). METHODS: Clinical and radiographic information was retrospectively reviewed and analyzed on 517 patients treated by ch-EVAR from 2008 from 2014 by prearranged defined and documented protocols. RESULTS: A total of 119 patients in US centers and 398 in European centers were treated during the study period. US centers preferentially used Zenith stent-grafts (54.2%) and European centers Endurant stent-grafts (62.2%) for the main body component. Overall 898 chimney grafts (49.2% balloon expandable, 39.6% self-expanding covered stents, and 11.2% balloon expandable bare metal stents) were placed in 692 renal arteries, 156 superior mesenteric arteries (SMA), and 50 celiac arteries. At a mean follow-up of 17.1 months (range: 1-70 months), primary patency was 94%, with secondary patency of 95.3%. Overall survival of patients in this high-risk cohort for open repair at latest follow-up was 79%. CONCLUSIONS: This global experience represents the largest series in the ch-EVAR literature and demonstrates comparable outcomes to those in published reports of branched/fenestrated devices, suggesting the appropriateness of broader applicability and the need for continued careful surveillance. These results support ch-EVAR as a valid off-the-shelf and immediately available alternative in the treatment of complex abdominal EVAR and provide impetus for the standardization of these techniques in the future.