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Graphical Abstract This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. Graphical Abstract One of the most affected specialties

A s��ndrome do desfiladeiro toraco-braquial pode resultar da compress��o do feixe neurovascular do membro superior, no segmento abaixo da clav��cula. Neste caso o respons��vel �� o m��sculo pequeno peitoral, conhecido na literatura anglo-sax��nica como ���pectoralis minor syndrome��� (PMS). Na idade pedi��trica, apesar de poder estar presente, esta s��ndrome �� pouco frequente e est�� sub-diagnosticada. Descreve-se um jovem de 14 anos, praticante de andebol, com PMS de apresenta����o pouco habitual, tendo sido o diagn��stico confirmado por arteriografia. Foi iniciada fisioterapia e diminui����o da atividade desportiva levando, em 6 meses, a uma substancial melhoria cl��nica. Ao fim de dois anos, verificou-se a inexist��ncia de qualquer altera����o no eixo subcl��vio-axilar. Trata-se de um caso raro, segundo a literatura revista, estando a sua etiologia relacionada com a pr��tica desportiva., Angiologia e Cirurgia Vascular, Vol 13 No 1 (2017): March

We present a rare case of Stewart-Treves syndrome characterized by a diffuse angiosarcoma of the leg in a 22-year-old man with a history of chronic lymphedema due to Klippel-Trenaunay-Weber syndrome. He underwent limb disarticulation and medical treatment with cycles of doxorubicin, oral thalidomide and sunitinib with a very good response after 12 months of follow-up.

Infectious aneurysms are about 1-3% of all aneurysms of the infrarenal aorta. Its treatment is challenging and the best strategy is far from consensual. The authors report a case of a HIV + patient with multiple other co-morbidities, which was seen in the emergency department with fever and left back pain. These symptoms would prove to be in relation to a ruptured infectious aneurysm of the abdominal aorta. Facing this situation it was decided to select an endovascular technique with implantation of an aorto uni - iliac stent graft with a right-left femoro-femoral cross-over using a 8 mm PTFE graft and exclusion of the left common iliac . The patient didn't have any complication from the situation or the procedure, but died 18 months postoperatively because of a pneumonia caused by Pneumocystis jiroveci. Although it is not the ideal solution for the treatment of infectious elective aneurysms, we believe that endovascular treatment seems to be a viable option and should be taken into account in a subgroup of patients that for their co-morbidities are not good candidates for conventional surgery and for those in rupture, either as a bridge or as a final solution.

Terminal chronic kidney disease courses with high mortality and is a serious public health problem on a global scale. In Portugal, it involves about 14,000 patients of whom 5,000 are transplanted. The remaining require permanent renal replacement techniques. Every year, there are 2,200 new cases and the mortality rate is around 20%. One of the most important determinants for the survival of hemodialysis patients is the quality of vascular access. The role of the vascular surgeon is to planify and to do the best access possible, monitoring and fight for its patency and thereby improve not only the quality of life but also to combat mortality associated with complications of vascular access - first cause of hospital admission of these patients. The authors report 10 clinical cases in which the limits of the hemodialysis surgery were tested and where it was necessary commitment and imagination to prevent the vascular access loss. The management of some complications is a challenge for the vascular surgeon and currently it is necessary to find hybrid/complementary solutions. Examples of some complications and challenges are steal syndromes, venous hypertension, vascular access in unusual places and 'total' failure of vascular access. Focusing on maintaining vascular access working improves the quality of dialysis, quality of life for patients, saves vascular capital for future access and in extreme cases, saves lifes.

The author started in the year 2000, in the St Marta Hospital, a consultation for congenital vascular malformations, that was extrapolated to the Pulido Valente Hospital - CHLN where he continues to see multiple patients with this type of pathology, mainly located to the extremities.The Klippel Trenaunay syndrome, which was described as a set of anomalies constituted by the presence of a cutaneous angiomatous malformation ( port wine stain ), varicose veins and gigantism of the limbs, is undoubtedly the most common malformations that he is asked to treat. So he thought that it would be interesting to undertake an actual review of this pathology.After analyzing the various components in question he concludes that the condition is undoubtedly a set of malformations ranging from a cutaneous component, to the venous and lymphatic malformations and clear the osseous component, that causes the bone dysmorphic appearance, and that is essential a multidisciplinary approach to achieve a final satisfactory therapeutic result.

The diagnosis and treatment of lymphedemas of the extremities, although relatively common in the western countries, mainly in the area of oncology, are scarcely mentioned in the international literature and in Portugal very little work has been devoted to this area. Nevertheless, they may cause severe functional and aesthetic disability, the main reason why decided to reassess its pathology, with an emphasis on the clinical diagnosis and medical therapy. We stress the importance of oedema of the instep the value of the Stemmer's sign in the diagnosis, and the complete decongestive physiotherapy in the management. When associated to the pharmacological therapy and the correct use of elastic stockings, the control of most of the cases can be achieved. Surgical therapy is reserved for rare cases and should be regarded as an adjuvant to intensive medical therapy, which should accompany the patient throughout life time.

Hypothenar hammer syndrome (HHS) is a rare condition and is a term used to described an aneurysm or thrombosis of the ulnar artery. It is considered an occupational or recreational injury and usually results of repetitive trauma to the hypothenar region, where th unique anatomy after the artery leaves the Guyon canal, allows the arterial injury. Clinical manifestations are more often unilateral, involving the dominant hand. However, some authors report the existence of a previous arteriopathy, predisposing to the injury, after repetitive palmar trauma.The authors report the clinical case of a 60 year-old woman, with an ulnar aneurysm in the non dominant hand, without evident existence of repetitive trauma. The pathological examination of the artery revealed muscular hyperplasia, without the characteristics of muscular fibrodysplasia. The authors believe that this case, once again, demonstrates the existence of an autonomous and "previous" arteriopathy associated to the traumatic lesion.

Chylopericardium is a rare entity which is usually associated with trauma (thoracic duct lesions), neoplasia or filaria infection. Primary forms are even rarer and are caused by lymphatic circulation malformations. We present the case of a 52-year-old male patient with primary chylopericardium. We discuss the diagnostic approach, as well as the favorable clinical evolution with conservative management.

The field of chronic venous disorders suffered, in the past, from lack of precision in diagnosis and classification. These deficiencies led to conflicting reports in studies of management of specific venous problems. To solve these troubles, the CEAP classification for chronic venous disorders was created in 1994, and was incorporated into the International Reporting Standard in Venous Disorders, in 1995. Actually it is generally accepted and used. In 2004 an "ad hoc" committee of the American Venous Forum working with an international liaison committee, has recommended a number of practical changes, that include a refinement of several definitions used in describing these disorders and a simpler alternative to the full (advanced) CEAP classification, the so called basic CEAP version. The author presents a revision of this document and adapts the nomenclature used to the portuguese language. He gives special attention to the fact that CEAP classification is a descriptive one which is associated to a venous severity and a quality of life scores that are instruments for longitudinal research to assess outcomes. Finally the author advises to use of these scores specially when it is necessary to evaluate the outcomes of the treatment with veno- active drugs.

Salmonella tiphymurium infection frequently causes gastroenteritis but some cases have a predilection for damaged blood vessels, especially those affected by atherosclerosis. The abdominal aorta is the most frequent location. Salmonella aortitis with mycotic aneurysm formation is a rare but serious condition, due to the high risk of rupture. We report the clinical case of a 61 year old man with a history of diabetes and hypertension, who was previously admitted with Salmonella gastroenteritis for which he had been treated with proper antibiotics. He was readmitted with fever, nausea and low back pain. Salmonella thyphimurium was isolated in blood cultures. The investigation revealed a pseudoaneurysm formation on the abdominal aorta. He was submitted to surgical vascular grafting with aneurysm resection and antibiotic therapy before and after surgery, with excellent clinical outcome. Bacteremia due to Salmonella Typhymurium must always raise the suspicion of focalization, especially a vascular infection. Particular attention should be given to predisposing factors, such as pre-existent atherosclerosis and age. The advised treatment of mycotic aneurysm due to a Salmonella agent must be a combined medical and surgical therapy.

voir basilic : http://emotion.inrialpes.fr/bibemotion/2006/Per06/ type: Mémoire de Fins d'Etudes institution: Conservatoire National des Arts et Métiers address: Grenoble (FR)

voir basilic : http://emotion.inrialpes.fr/bibemotion/2005/Per05/ type: Technical Report institution: Conservatoire Nacional d'Arts et Métiers (CNAM) Centre d'enseignement de Grenoble address: Grenoble (FR)

Venous ulcers in patients with post thrombotic syndromes are complex situations with multiple therapeutic options. They are responsible for high morbidity rates, conservative treatment is very slow and recurrences are very common. Deep venous reconstructive surgery is an alternative, but it should be based on the morphologic and functional aspects of the venous system and only adopted after a very careful study, including venography. The authors describe a morphological "pattern", found in some of these patients and related to the competence of the saphenous femoral junction, rendering possible to perform a valvular transposition. Seven patients with post thrombotic ulcers who have been treated during the last 6 years in which the pattern already described was detect, underwent a transposition of the superficial femoral vein, to the great saphenous vein and when necessary complemented with skyn grafts. Before the operation all patients had ulcers with more than 3 cm in size (3.2-5.4 cm) and with more than 4 months duration (4-16 months). All ulcers healed in the postoperative period (mean time 28 days). All patients have been reevaluated in 2003 and it was diagnosed the thrombosis of two procedures, one of them with the recurrence of the ulcer who healed with conservative treatment. The authors consider this method as a very easy technique to perform, although rarely used, and a valid alternative in a highly selected group of patients.

Traumatic lesions of the femoral veins during varicose veins surgery are very uncommon and they raise several therapeutic difficulties. They occur in 1/1000 cases of varicose veins operated. The authors describe four cases of lesions of this type that were seen and treated for the last six years, probably because there was an increase in the number of varicose veins operated on in the Lisbon area. The authors discuss the surgical options and they concluded that these complications can be minimized with good anatomical and surgical skills, specially of the saphenous-femoral and saphenous-popliteal junctions.

Venous aneurysms of the lower limbs are rare. When they involve the deep venous system, they can be associated with deep venous thrombosis and pulmonary embolism. The authors report the case of a 63-year-old women evaluated by duplex imaging and venography, in the context of a pulmonary embolism, and detected bilateral large aneurysms of the femoral veins (5 cm in the right femoral vein and 4 cm in the left femoral vein). The aneurysms were located at the bifurcation of the common femoral vein with the superficial and profound veins.The right aneurysm was partially thrombosed. The patient was asymptomatic in the lower-limb extremities. After a period of anticoagulation, the authors proceeded to surgically excise the right aneurysm and replaced the venous system using a polytetrafluoroethylene (PTFE) graft with the construction of an a-v fistula.The patient had no complications in the postoperative period and her 8-month follow-up examination revealed no symptoms, not even leg edema. The duplex scan showed patency of the graft. She continued with oral anticoagulation. The histologic examination revealed an eosinophilic inflammatory reaction of the vein wall, compatible with the diagnosis of Churg-Strauss syndrome.The authors conclude that they have probably described the first case in the international literature of a venous aneurysm with a Churg-Strauss syndrome and pulmonary embolism.

The female varicocile is associated to the pelvic congestion syndrome that is described. Five patients 31 to 52 years old are presented. Four of them have continuous pelvic pain and the fifth had huge vaginal and vulvar varices. Flebography of the left ovarian vein showed retrograde flux of the dilated vein. Sclerotherapy with Aethoxysklerol 3% was performed. There was an immediate relief of symptoms. During the follow up period between 9 and 12 months the five patients were asymptomatic. There are publications of embolization of the ovarian vein, however the present cases are the first ones in which the selective Sclerotherapy was the only treatment used with good results.

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina Abstract Background Portugal is Europe’s highest diabetes prevalence country. Patient-centered medicine (PCM) increases therapy adherence mainly by doctor-patient relationship improvement. The absence of published studies in Portugal about the relationship between PCM, diabetes self-care and glycemic control makes the present study important. Objectives To study the influence of PCM in diabetes self-care activities in diabetics type 2 of two Family Health Units (FHU) of Portugal’s central region according to gender and age. Methods A cross-sectional quasi-random study was conducted in the Mondego and Manuel Cunha FHU´s adults diabetic patients population. The Summary of Diabetes Self-Care Activities scale (SDSCA) and the Patient Perception of Patient-Centeredness (PPPC) scale were applied and were completed in the end of the consultation appointment for each diabetic patient invited in randomly chosen days in 2021. Latest Hemoglobin A1C value, age and gender were also collected. Linear regressions, logistic regressions, multivariate regression models and the Pearson correlation were used. Results A total of 298 type II diabetic patients were studied,136 (45,6%) females, age ranging from 29 to 93 years of age. Mean of HbA1C was 6.97±1.04 % and prevalence of HbA1c ≥7% was of 105 patients (35.2%). Linear regressions for SDSCA factors associations with PPPC adjusted for sex and age showed significant associations for general diet (β=-0.07, p

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina Introdução: A pandemia COVID-19 teve vastas repercussões a nível da saúde das populações. Os sistemas de saúde e os seus profissionais encabeçaram a luta contra o vírus tendo sido sujeitos a desafios sem precedentes e a pressões profundas e prolongadas com consequências importantes para a sua saúde mental.Objetivo: Esta revisão visou identificar de forma sistemática a prevalência e os fatores de risco das patologias de saúde de mental mais relevante entre os profissionais de saúde em funções nos vários países aquando da pandemia COVID-19. Métodos: Foi realizada uma pesquisa na plataforma COVID-19 L-OVE entre 1 de outubro de 2021 e 1 de janeiro de 2022. A estratégia de pesquisa compreendeu a utilização das seguintes palavras-chave: “mental health”, “healthcare workers”. A qualidade dos estudos foi avaliada utilizando as checklists do National Institutes of Health (NIH) “Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies” e “Quality Assessment Tool for Case-Control Studies”. Selecionaram-se apenas os estudos primários, originais e reportando dados publicados em peer-reviewed journals no ano de 2021 e disponíveis na língua inglesa. Incluíram-se estudos do tipo coorte, caso-controlo, longitudinal e transversal. A informação relevante de cada estudo foi extraída de forma individual utilizando tabelas personalizadas para o efeito. Dados adicionais não integráveis nas tabelas foram extraídos caso a caso. Resultados: Identificaram-se 113 estudos relevantes, realizados num total de 41 países e com um número de participantes entre os 50 e os 56656. A maioria dos estudos incluídos reportou prevalências elevadas de problemas de saúde mental entre os profissionais de saúde, aumentadas face ao período pré-pandemia. Os fatores de risco interpessoais mais proeminentes foram o sexo feminino, a idade mais jovem e a doença psiquiátrica pré-existente. Quanto a fatores institucionais, destacaram-se o trabalho na linha da frente e o trabalho como enfermeiro. O fator comunitário dominante foi a falta de apoio social. Conclusão: Esta revisão destaca as repercussões da pandemia COVID-19 na patologia de saúde mental entre os profissionais de saúde. A análise revela disparidades de suscetibilidade entre subgrupos destes profissionais. As consequências são várias e afetam tanto os profissionais como os pacientes. O presente estudo realça a necessidade da elaboração de medidas baseadas na evidência que permitam recuperar a saúde mental dos profissionais de saúde. Introduction: The COVID-19 pandemic had vast repercussions in population health. Healthcare systems and healthcare workers lead the fight against the virus, having been subjected to unprecedented challenges and to profound and prolonged pressure which resulted in important consequences for their mental health. Aims: This review aimed to systematically identify the prevalence and risk factors for most relevant mental health disorders among healthcare workers in various countries during the COVID-19 pandemic. Methods: Research was conducted on the COVID-19 L-OVE platform between October 1st 2021 and January 1st 2022. The research strategy included the use of the following keywords: “mental health”, “healthcare workers”. Study quality was evaluated using National Institutes of Health (NIH) “Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies” and “Quality Assessment Tool for Case-Control Studies”. Only original, primary studies reporting data and published in peer-reviewed journals in the year of 2021 and available in the English language were selected. The study designs included were cohort, case-control, longitudinal and cross-sectional. Relevant information of each study was individually extracted into custom tables. Additional data not appropriate for table inclusion was extracted on an individual case basis depending on its relevancy for this revision. Results: Literature review resulted in the identification of 113 relevant articles, conducted in a total of 41 countries and with participants ranging from 50 to 56656. The majority of studies reported elevated prevalence of mental health disorders amongst healthcare workers, increasing in comparison to the pre-pandemic period. Most prominent personal risk factors were female sex, younger age, and pre-existent psychiatric condition. Regarding institutional factors, frontline work and working as a nurse were highlighted. Finally, lack of social support was the dominant community risk factor. Conclusion: This review accentuates the COVID-19 pandemic’s repercussions on mental health disorders among healthcare workers. Analysis reveals disparities in susceptibility among subgroups of these professionals. Consequences are various and affect both healthcare professionals and patients. The present study highlights the need for evidence-based measures that allow for healthcare’s workers mental health to be recovered.