Scielo RSS http://scielo.pt/rss.php?pid=1646-706X20220004&lang=pt vol. 18 num. 4 lang. pt http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400215&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Currently, people living with HIV/ AIDS (PLWHA) attain a life expectancy similar to a non-HIV population. However, these patients experience a status of chronic inflammation, which is a known cause of arteriopathy. Yet, literature is scarce regarding the potential venous inflammatory effect, especially after varicose vein surgery. The aim of this study was to perform a descriptive analysis alongside evaluating short and long-term outcomes after varicose vein surgery in PLWHA while comparing with a control group. Methods: A retrospective nested case-control study was performed resorting to codification. All PLWHA patients which had any hospital interaction with the Vascular Surgery Department (either outpatient clinic, emergency or surgery) due to venous disease between April 2006 and December 2019 were identified. PLWHA found to have undergone varicose vein surgery within the study inclusion period were included. The immediately consecutive varicose vein surgery in a patient with no-HIV infection was included in the control group in a 1:1 ratio. Comorbidities were collected at the time of index event. Results: The cohort included 118 patients (59 PLWHA and 59 control) and had a mean follow-up of 86 [Interquartile range (IQR) 25-75%, 43-111] months. At baseline, PLWHA were younger (45.2 ± 10.71 vs 49.9 ± 10.69 years, p=0.017) and had a male predominance (54% vs 27%, p=0.003). Furthermore, there were a higher prevalence of smokers (54% vs 17%, p<0.001) and history of drug abuse (34% vs 2%, p<0.001) in the study group. Although not statistically significant, PLWHA presented higher pre-operative CEAP classifications. Regarding post-operative outcomes, no differences were found for complications, reinterventions or overall-mortality. Conclusion: To the authors knowledge, this is the first study addressing varicose vein treatment in PLWHA. In summary, PLWHA undergoing varicose vein surgery seem to be younger and have higher CEAP classifications. Nonetheless, short and long-term outcomes seem to be good and similar to a control population. Further studies with larger populations and disease specific outcomes are necessary to confirm such findings. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400219&lng=pt&nrm=iso&tlng=pt Abstract Background: Individualized risk assessment using comorbidity adjustment is an important component in modern clinical practice and can be performed considering individual comorbidities or through the use of summary measures. The Charlson Comorbidity Index adjusted to age (CCIa) is the most widely validated and used comorbidity assessment tool. Studies have proved CCIa as a strong predictor of mortality for a variety of medical and surgical conditions; however, its utility in patients submitted to elective endovascular abdominal aortic aneurysm repair (EVAR) has not been studied. Methods: Patients submitted to EVAR between January 1, 2017 and December 31, 2021 in our tertiary, academic Vascular Surgery Department were retrospectively evaluated and 123 patients fulfilled the inclusion criteria. Patient characteristics and peri-operative variables were collected and CCIa was calculated. Surgical complications were classified according to Clavien-Dindo. The area under the curve of the receiver operating characteristic curves was calculated to validate and determine the discriminating ability of CCIa in predicting complications and mortality and the Youden index used to determine the critical value. Results: Mean age was 73.49±7.95 years and mean follow-up was 30.55±16.49 months. 30-day complication rate was 16%, 30-day mortality 1.63% and overall mortality 16%. Patients with higher CCIa had higher overall mortality (p=.002) but CCIa had no impact on 30-day complication rate and on 30-day mortality. Logistic regression showed that even after adjusting for patient´s comorbidities individually, CCIa was the only independent mortality predictor (p=.003). The optimal cutoff associated with higher overall mortality was found to be ≥6. Conclusion: CCIa does not seem to predict complications and early mortality after EVAR but it seems to be a useful predictor of mid-term survival after EVAR. These results show the limited role of this score in predicting outcomes after surgery but may help identify a sub-population whose shorter life-expectancy should be considered towards the benefits of EVAR. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400230&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Vascular graft infections are a rare and severe complication of open aortic surgery. As such, strategies to improve diagnosis and management are paramount. Nevertheless, there is little evidence regarding the factors associated with a higher susceptibility of infection. Moreover, there is little consensus on the best diagnostic workup and most adequate approaches to control and mitigate this surgical complication. We aim to summarize the latest evidence on aortic graft infection through a narrative review. Methods: We conducted a literature search in a medical database (PubMed) and included studies on vascular graft infection and aortic repair. Results: So far, patient-related comorbidities (such as diabetes, smoking, advanced age and chronic kidney disease), as well as procedure-related factors (location and type of graft, postoperative hyperglycemia, bacteremia, emergency setting), have been reported. Unlike extracavitary infections, aortic graft infections may present with subtle or no clinical manifestations. Aortoenteric fistulas are the exception to the rule, carrying a significantly higher mortality rate. All patients should be thoroughly tested with full blood counts, blood cultures and extensive imaging studies. Adequate antibiotic therapy is one of the pillars of treatment and should not be delayed. The selection of the antimicrobial regimen should be personalized and made in a multidisciplinary team. Surgical strategies are of paramount importance in controlling infection. These can be divided into graft-sparing techniques and graft explantation. The choice of the appropriate approach depends on the surgeon’s experience, the extent of disease and the patient’s general status and comorbidities. Conclusion: Aortic graft infections are a rare and severe complication of vascular surgery. A swift diagnosis and management are paramount. Despite significant efforts on how to treat the infection with more adequate antibiotic and surgical therapies, effective preventive measures and a clear definition of predisposing factors remain the main areas for future studies. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400237&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Peripheral arterial disease (PAD) affects more than 202 million people worldwide, 1.3% of which with chronic limb-threatening ischaemia (CLTI). PAD is associated with an elevated mortality and morbidity. However, the evolution from claudication or from asymptomatic PAD to CLTI is not completely understood and cardiovascular risk factors are unable to fully explain it. The aim of this opportunistic review is to understand the role of inflammation in the evolution to CLTI and to analyse if inflammation can increase the mortality risk. Methods: A systematic search of the PubMed database was performed with the keywords and medical subject heading (MesH): “inflammation”, “cytokine”, “prognosis”, “death”, “mortality”, “CLTI” and “CLI”. Of 146 papers, 8 articles and 1622 patients were included Results: We verified that inflammation is important for the initiation and progression of PAD. There are several candidate inflammatory triggers, including the cardiovascular risk factors (age, nicotine abuse, diabetes mellitus, hypercholesterolemia). However, these traditional risk factors, fail to explain the variable nature of disease progression between individuals and the pro-inflammatory polymorphisms could be a key element. Several studies also proved that patients with CLTI have a marked elevated level of cytokines. The increase inflammatory burden in patients with PAD, particularly with CLTI could explain the increased inflammation and may help to explain why the prevalence of clinically manifested coronary artery disease in PAD is much higher than the prevalence of PAD in coronary artery disease patients. Conclusion: Anti-inflammatory therapy and revascularization can avoid the systemic consequences of inflammation in patient with CLTI and should be timely implemented. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400241&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Out of Hospital Cardiac Arrest (OHCA) is one of the main causes of death worldwide. Most of the intrinsic causes of OHCA tend to be of cardiac origin, however, non-cardiac etiologies such as acute aortic dissection (AAD) may be more common than previously thought. The aim of this focused review is to summarize current knowledge on the association between OHCA and AAD. Methods: A systematic review was previously performed on the incidence of AAD in the context of OHCA. For this publication, the selected references were reviewed to address three pre-determined questions: 1) How prevalent is Acute Aortic Dissection in Patients presenting with Out of Hospital Cardiac Arrest? 2) What clinical signs are associated with OHCA due to Acute Aortic Dissection? 3) How can we treat these patients and what is their prognosis? Results: AAD may cause OHCA due to several reasons, such as retrograde involvement of the coronary arteries, aortic valve insufficiency, pericardium tamponade, aortic rupture, massive stroke, visceral malperfusion or hypertensive induced heart failure, for example. Since both the treatment and diagnosis of acute aortic dissections have improved, a growing number of OHCA due to AAD patients have been diagnosed and managed, however, the epidemiology and outcomes of these patients are still not fully understood. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400245&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Secondary Aortoesophageal fistula (AEF) is a rare but serious complication following thoracic endovascular aneurysm repair (TEVAR), which may lead to fatal outcomes. Case report: We present the case of a 62-year-old patient developing a secondary AEF one-month after TEVAR. The patient was managed in a staged approach: first, an oesophagus defunctionalisation by cervical oesophagus stapling, followed by drainage gastrostomy and creation of a feeding jejunostomy. Two-weeks later, the patient underwent stent graft explantation, extensive debridement, in situ aortic reconstruction with interposition of a silver and Triclosan impregnated Dacron graft, esophagectomy, eosophagogastrostomy and intercostal muscle flap plasty. After 4 years of follow-up, the patient remains clinically well and free from recurrence. Conclusion: The diagnosis of AEF requires a high index of suspicion. A prompt and aggressive multidisciplinary approach is necessary to obtain long-term survival and freedom from recurrence. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400249&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Percutaneous endovenous treatment is the first-line therapy for chronic nonmalignant iliocaval venous obstruction (ICVO) due to low morbidity and suitable medium and long-term results. Open surgical procedures are only used as a last resort therapy. However, there is a lack of updated data regarding surgical techniques and outcomes. We present two cases of surgical venous reconstructions to treat ICVO using expanded polytetrafluoroethylene (ePTFE) grafts and discuss the evidence regarding technical aspects to improve long-term patency. Case reports: The first case concerns a 69-year-old male with chronic edema and venous ulceration associated with ICVO secondary to iliocaval stent thrombosis. After an unsuccessful endovascular treatment attempt, we performed a surgical iliocaval bypass using a 10mm ringed ePTFE graft. After three months, complete ulcer healing was observed. The other patient was a 63-year-old female with disabling chronic edema of the right lower limb and venous claudication consequent to the ligation of the right common femoral vein to correct an iatrogenic vascular injury during orthopedic surgery. The patient underwent venous bypass between the deep femoral vein and the ipsilateral common iliac vein using a 12mm ringed ePTFE graft. A marked improvement in clinical symptoms was observed after treatment. A venous stent was used later to treat an anastomotic stenosis. Conclusion: Our experience supports open venous reconstruction as a viable option for patients with benign ICVO and debilitating symptoms not amenable to endovascular treatment. Important technical aspects such as adequate inflow vein, the choice of the prosthetic graft, long-term anticoagulation, and the creation of a distal arteriovenous fistula should be considered to improve patency. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400253&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Vasculitides are diseases usually caused by the deposition of immune complexes in the vascular endothelium, triggering inflammation with or without vessel necrosis. Leukocytoclastic vasculitis affects small-caliber vessels, especially venules, it’s treatment can be long and complex and the condition may become extended when not followed correctly. This paper aims to report a form of vasculitis that manifests itself, among other forms, through skin ulcers, focusing on the clinical approach of the phenomenon and disease. Case report: Female patient, 54 years old, presenting chronic venous disease and acute leukocytoclastic vasculitis, associated with persistent ulcers, pruritus and paresthesia that affected both legs and feet. The treatment, based on the use of vasodilators, corticoids and oral antibiotics, followed by dressings with antimicrobial action on the lesions, led to a complete remission of the wounds and reduction of symptoms within 6 months. As for the venous disease, radiofrequency thermoablation of saphenous veins was performed in association with phlebectomy of tributary veins, leading to significant improvement of the swelling and local paresthesia. Conclusion: The treatment of patients with cutaneous ulcers associated with vasculitis demands the use of several medications and tends to be long-term. Patient’s compliance is extremely important for improving the prognosis of the disease. In addition, radiofrequency thermoablation is shown to be an effective and safe option for the treatment of incompetent saphenous veins, with less recurrence of cutaneous ulcers compared to surgery. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400256&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Vasculitides are diseases usually caused by the deposition of immune complexes in the vascular endothelium, triggering inflammation with or without vessel necrosis. Leukocytoclastic vasculitis affects small-caliber vessels, especially venules, it’s treatment can be long and complex and the condition may become extended when not followed correctly. This paper aims to report a form of vasculitis that manifests itself, among other forms, through skin ulcers, focusing on the clinical approach of the phenomenon and disease. Case report: Female patient, 54 years old, presenting chronic venous disease and acute leukocytoclastic vasculitis, associated with persistent ulcers, pruritus and paresthesia that affected both legs and feet. The treatment, based on the use of vasodilators, corticoids and oral antibiotics, followed by dressings with antimicrobial action on the lesions, led to a complete remission of the wounds and reduction of symptoms within 6 months. As for the venous disease, radiofrequency thermoablation of saphenous veins was performed in association with phlebectomy of tributary veins, leading to significant improvement of the swelling and local paresthesia. Conclusion: The treatment of patients with cutaneous ulcers associated with vasculitis demands the use of several medications and tends to be long-term. Patient’s compliance is extremely important for improving the prognosis of the disease. In addition, radiofrequency thermoablation is shown to be an effective and safe option for the treatment of incompetent saphenous veins, with less recurrence of cutaneous ulcers compared to surgery. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400257&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Vasculitides are diseases usually caused by the deposition of immune complexes in the vascular endothelium, triggering inflammation with or without vessel necrosis. Leukocytoclastic vasculitis affects small-caliber vessels, especially venules, it’s treatment can be long and complex and the condition may become extended when not followed correctly. This paper aims to report a form of vasculitis that manifests itself, among other forms, through skin ulcers, focusing on the clinical approach of the phenomenon and disease. Case report: Female patient, 54 years old, presenting chronic venous disease and acute leukocytoclastic vasculitis, associated with persistent ulcers, pruritus and paresthesia that affected both legs and feet. The treatment, based on the use of vasodilators, corticoids and oral antibiotics, followed by dressings with antimicrobial action on the lesions, led to a complete remission of the wounds and reduction of symptoms within 6 months. As for the venous disease, radiofrequency thermoablation of saphenous veins was performed in association with phlebectomy of tributary veins, leading to significant improvement of the swelling and local paresthesia. Conclusion: The treatment of patients with cutaneous ulcers associated with vasculitis demands the use of several medications and tends to be long-term. Patient’s compliance is extremely important for improving the prognosis of the disease. In addition, radiofrequency thermoablation is shown to be an effective and safe option for the treatment of incompetent saphenous veins, with less recurrence of cutaneous ulcers compared to surgery.