Scielo RSS http://scielo.pt/rss.php?pid=1646-706X20250003&lang=pt vol. 21 num. 3 lang. pt http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000300122&lng=pt&nrm=iso&tlng=pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000300125&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Endovascular aortic aneurysm repair (EVAR) has increasingly become the mainstream treatment of abdominal aortic aneurysms. However, because it requires ionising radiation, concerns about both patient and surgeon exposure have been raised. Methods: A retrospective analysis was conducted to evaluate all patients who underwent standard infra-renal endovascular aneurysm repair (EVAR) using aorto-bi-iliac endoprosthesis for infrarenal abdominal aortic aneurysms (AAA) from January 2018 to December 2022. All procedures were performed using the Ziehm Vision RFD mobile C-arm system (Ziehm Imaging, Nuremberg, Germany). The primary endpoint was to determine whether the Body Mass Index (BMI) was an independent predictor of intraoperative radiation exposure during EVAR procedures. Results: A total of 91 patients had recorded Dose Area Product (DAP) information. Of these, 76 had recorded height and weight for BMI calculation and were included in this study. The mean age was 73.5±8.3 years, and most patients were 72 male (94.7%). The mean BMI was 27.2±4.0 kg/m2, with 41% of patients classified as overweight and 22% as obese. Median DAP was 77.9 Gy.cm2 (inter-quartile range 51-123). DAP did not differ between sexes. A higher BMI category was associated with higher DAP values (p = 0.008). Higher DAP was also related to general anaesthesia (p=0.002) and intra-operative complications (p = 0.031). In multiple linear regression, BMI remained an independent predictor of higher DAP, with each additional kg/m2 of BMI increasing DAP by 5.15 Gy.cm2 (p = 0.010). Conclusion: Higher BMI is associated with a higher radiation dose in standard EVAR procedures, which may be relevant when reducing both patients’ and professionals’ radiation exposure. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000300129&lng=pt&nrm=iso&tlng=pt Abstract Background: With the development of advanced endovascular technologies to treat chronic total occlusions of the superficial femoral artery (SFA-CTO), endovascular procedures have become more common, with supragenicular femoropopliteal artery bypasses reserved for a subset of patients. We aim to compare outcomes of long SFA-CTOs treated with surgical bypass versus endovascular procedures. Methods: Single-centre retrospective cohort study in a tertiary centre including all patients with SFA-CTOs (femoropopliteal GLASS grade 4/TASC-II D) submitted to a supragenicular femoropopliteal artery bypass (OR group) or endovascular revascularisation procedure (EVT group) from February 2015 to January 2025. Patients undergoing revascularisation of other anatomical sectors were excluded. Baseline characteristics, peri-procedural and follow-up data were obtained. The primary endpoint is major adverse limb events (MALE). The secondary endpoints are MALE-free survival, reintervention rates, amputation rates, and mortality rates. Results: 119 patients were included (71 in the OR group vs. 48 in the EVT group). Eighty-six per cent (N=61) of the OR group received a prosthetic conduit. Median age was 68 years (IQR 63-74), and 75 patients (63%) had chronic limb-threatening ischemia. The median hospital stay was shorter in the EVT group (2 vs. 9 days; p<.001). Other characteristics, such as age, risk factors, and Leriche-Fontaine classification, did not differ between groups. During a median follow-up period of 51 months (IQR 26-78), MALE were higher in the OR group (44% vs. 25% - p=.038) despite no significant differences in MALE-free survival. A higher rate of reintervention was also found in the OR group (39% vs. 21%, p=.033). There were no significant differences in amputation or mortality rates between groups. Conclusion: Patients with long SFA-CTOs had similar rates of limb salvage and mortality after bypass or endovascular interventions. Despite similar comorbidity burdens in both groups, MALE and reintervention rates were higher after bypass, suggesting an endovascular-first approach. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000300135&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Acute mesenteric ischaemia (AMI) remains a surgical emergency with persistently high mortality, often attributable to delayed diagnosis and limited early prognostic clarity. Although advances in imaging and intervention have improved outcomes in selected cases, timely risk stratification remains critical to guide management and improve survival. Methods: A literature review was conducted using PubMed to identify studies published between 2015 and 2025 that examined early prognostic indicators for AMI. Key biochemical, clinical, radiological, and scoring-based predictors of mortality were extracted and analysed. Results: Nine studies met the inclusion criteria. A multifactorial prognostic framework emerged. Biochemical markers, including elevated lactate, a reduced bicarbonate-to-lactate ratio, high red cell distribution width, and a CRP/albumin ratio, were associated with increased mortality. Clinical factors-including advanced age, comorbid cardiovascular disease, haemodynamic instability, and the need for vasopressors-also showed substantial predictive value. Imaging findings (e.g., arterial occlusion, colonic involvement) and scoring systems, such as the Mannheim Peritonitis Index and the ASA classification, further enhanced risk stratification. Conclusion: Effective early risk assessment for AMI patients requires a multimodal approach integrating biochemical, clinical, and radiological data. Composite indices-such as the bicarbonate-to-lactate ratio-show promise in improving prognostic accuracy and guiding timely intervention. Prospective validation of these tools is essential to optimize outcomes and resource allocation in this high-risk population. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000300139&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Endovascular approaches have emerged as promising alternatives for treating aortic arch pathology, particularly in high-risk patients. This review provides a comprehensive analysis of total endovascular aortic arch reconstruction, focusing on Parallel Graft Techniques (PGTs) and Custom-Made Devices (CMDs). Methods: PubMed and Scopus were searched to conduct a comprehensive review comparing the technical aspects, clinical outcomes, strengths, and limitations of PGTs and CMDs. Only studies reporting on total endovascular aortic aneurysm repair were considered. Studies with fewer than five patients, published in a language other than Portuguese, English, or Spanish, and reporting hybrid/open procedures or partial aortic arch reconstructions were excluded. Findings were summarised descriptively. Results: A total of 38 studies comprising 871 patients were included (214 in PGT and 657 in the CMD group). Technical success rates were high in both groups, mostly ranging from 80% to 100%. No clear superiority was observed between the two approaches for thirty-day, aorta-related, or overall mortality. However, stroke and spinal cord ischaemia (SCI) rates appeared higher in the CMD group, ranging from 0 to 42.9% and 0 to 9.1%, respectively. The occurrence of type I and III endoleaks was higher in the PGT group (0-45.5% versus 0-32.4%), though this did not translate into a clear difference in reintervention rates. During follow-up, high target vessel patency rates were observed in both groups, typically exceeding 95%. Conclusion: PGTs appear to have non-inferior outcomes in terms of stroke rate and in-hospital and overall mortality. Although the occurrence of type I/III endoleaks remains higher in PGTs, this does not seem to affect reintervention rates. Thus, PGTs should be considered a viable option for treating complex aortic arch pathology, particularly in fragile patients, those with adverse anatomy, or in emergent situations. Large-volume prospective studies directly comparing these two techniques are currently warranted. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000300148&lng=pt&nrm=iso&tlng=pt Abstract Background: Patients with Marfan syndrome have a high risk of aneurysms or dissection of different segments of the aorta, representing a challenge in their treatment, as well as in the management of associated complications. Case report: We present a 44-year-old patient with Marfan syndrome who had an acute type A dissection in January 2011 and underwent replacement of the aortic valve (mechanical) and the ascending aorta. During follow-up, the patient developed an extent II thoracoabdominal aneurysm in the distal residual dissection area, which ruptured in the descending thoracic aorta in January 2014. Urgent open aortic repair was performed, with an interposition graft of the descending thoracic aorta. In July 2015, he underwent replacement of the remainder of the thoraco-abdominal aorta with individual bypasses to the visceral and renal arteries. In September 2019, the diagnosis of prosthetic infection led to multiple hospitalisations, necessitating prolonged antibiotic therapy. Although the inflammatory/infectious process was controlled, the aortic arch remained the last segment requiring intervention due to progressive aneurysmal dilation. Given a patient with multiple interventions and a latent infection, he was refused open repair of the aortic arch and thus proposed for endovascular repair as a last option. We aimed to use the previous surgical grafts as proximal and distal landing zones (graft-to-graft repair). To achieve sufficient proximal sealing length, we performed a left carotid-to-right carotid and right subclavian bypass, vertebral artery re-implantation (direct arch origin), and used the left common carotid and left subclavian artery as target vessels for an arch endograft (COOK® a-branch, CMD platform). The graft was designed with two inner branches (one antegrade for the left carotid and one retrograde for the left subclavian). The graft was placed with the nose tip advancing through the mechanical aortic valve, achieving technical and clinical success. Conclusions: Patients with Marfan syndrome are frequently affected by extensive post-dissection aortic aneurysms. Aortic replacement by traditional surgery yields good long-term results, but an endovascular approach may be the solution in cases that would otherwise be considered untreatable. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000300152&lng=pt&nrm=iso&tlng=pt Abstract Background: Symptomatic non-ruptured abdominal aortic aneurysm (AAA) is a diagnosis of exclusion. In this case report, we faced two vascular challenges: (1) establishing a diagnosis of impending rupture and (2) restructuring the intervention plan and timing after a second abdominal emergency was diagnosed and treated. Case report: A 72-year-old male presented to the emergency department with left lower quadrant abdominal pain lasting over 12 hours. Clinical assessment revealed a pulsatile midline abdominal mass and abdominal discomfort on palpation, without signs of peritoneal irritation. The patient was haemodynamically stable, and laboratory findings showed leucocytosis and elevated C-reactive protein. Abdominal computed tomography angiography revealed an infrarenal AAA measuring 85 mm with features of impending rupture, and no findings suggestive of an alternative diagnosis. The patient was admitted to the vascular ward with the aim of intervening at the first elective opportunity, but worsening abdominal pain in association with hypotension prompted an emergent decision. Open surgical repair was chosen based on the aneurysm’s anatomical features - a short neck (13 mm) with severe infrarenal angulation (approximately 90°). Intraprocedural bowel mobilisation revealed transmural ischaemia extending from the transverse colon to the mid-rectum. Collaboration with general surgery was arranged, and the patient underwent a Hartmann procedure. The patient subsequently underwent endovascular aortic repair (EVAR) 10 days after the first procedure. Conclusion: Ischaemic colitis is a recognised complication of major vascular surgery, particularly after AAA repair. In our case, the aetiology of colonic ischaemia was unclear, but it likely resulted from a state of hypoperfusion in a patient with atherosclerotic disease and poor collateral circulation. The patient presented with two life-threatening conditions, although only one was diagnosed in advance. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000300155&lng=pt&nrm=iso&tlng=pt Abstract Background: Symptomatic non-ruptured abdominal aortic aneurysm (AAA) is a diagnosis of exclusion. In this case report, we faced two vascular challenges: (1) establishing a diagnosis of impending rupture and (2) restructuring the intervention plan and timing after a second abdominal emergency was diagnosed and treated. Case report: A 72-year-old male presented to the emergency department with left lower quadrant abdominal pain lasting over 12 hours. Clinical assessment revealed a pulsatile midline abdominal mass and abdominal discomfort on palpation, without signs of peritoneal irritation. The patient was haemodynamically stable, and laboratory findings showed leucocytosis and elevated C-reactive protein. Abdominal computed tomography angiography revealed an infrarenal AAA measuring 85 mm with features of impending rupture, and no findings suggestive of an alternative diagnosis. The patient was admitted to the vascular ward with the aim of intervening at the first elective opportunity, but worsening abdominal pain in association with hypotension prompted an emergent decision. Open surgical repair was chosen based on the aneurysm’s anatomical features - a short neck (13 mm) with severe infrarenal angulation (approximately 90°). Intraprocedural bowel mobilisation revealed transmural ischaemia extending from the transverse colon to the mid-rectum. Collaboration with general surgery was arranged, and the patient underwent a Hartmann procedure. The patient subsequently underwent endovascular aortic repair (EVAR) 10 days after the first procedure. Conclusion: Ischaemic colitis is a recognised complication of major vascular surgery, particularly after AAA repair. In our case, the aetiology of colonic ischaemia was unclear, but it likely resulted from a state of hypoperfusion in a patient with atherosclerotic disease and poor collateral circulation. The patient presented with two life-threatening conditions, although only one was diagnosed in advance.