Scielo RSS http://scielo.pt/rss.php?pid=1646-706X20250002&lang=pt vol. 21 num. 2 lang. pt http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000200041&lng=pt&nrm=iso&tlng=pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000200042&lng=pt&nrm=iso&tlng=pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000200044&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Fenestrated and branched endovascular aneurysm repair (f/bEVAR) represents an advanced technique for treating aortic aneurysms that extend to or involve visceral and renal vessels. This technically demanding procedure requires specialised skills and has a steep learning curve. This study aimed to analyse a single-centre 10-year experience with F/BEVAR, focusing on the learning curve effect. Methods: A retrospective analysis was conducted on all f/bEVAR cases performed between 2016 and the present day. Patients without follow-up were excluded. Cases were stratified by study period quartile to account for unequal case distribution over the years. Primary outcomes included technical success (defined as successful incorporation of target vessels), 30-day mortality, major adverse events (MAE), and one-year reintervention rates. Procedural characteristics and outcomes were compared across quartiles. Results: A total of 53 cases were included, with a median age of 71 years, and 49 (92.5%) of the patients were male. Six (11.3%) were symptomatic aneurysms, and one patient presented with a ruptured aneurysm. Twenty-one (39.6%) cases had thoracoabdominal aneurysms, followed by juxta-renal (19 cases, 35.8%). Five patients (9.4%) had a history of aortic dissection. Six patients (11.3%) underwent arch procedures. Most cases (44 cases, 83%) had 4 target vessels incorporated. Thirty-day mortality was 11.3%, and 30-day MAE was 13.2%. When analysing by temporal quartile, the 4th study quartile demonstrated higher proportions of arch procedures, higher numbers of vessels incorporated, increased use of femoral-only access, higher implementation of fusion imaging, and lower 30-day mortality and MAE rates. A proctor was present in 34% of cases, primarily in the first 2 study quartiles. Conclusion: This 10-year experience with f/bEVAR demonstrates a significant learning curve effect. These findings highlight the importance of specialised training, proctorship in early experience, and the value of cumulative institutional expertise in managing complex aortic pathologies with f/bEVAR. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000200050&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Lumbar sympathectomy has historically been a widely used technique in vascular surgery. The advent of minimally invasive approaches capable of definitively interrupting the sympathetic chain at different levels may renew interest in sympathectomy, broadening its scope beyond current indications. This renewed interest could extend its potential benefits to conditions where open surgery is not commonly performed nowadays. This study aims to evaluate the efficacy and safety of radiofrequency neurolysis of the paravertebral sympathetic chain across a range of clinical conditions. Methods: This is a retrospective, single-centre study that included patients who underwent sympathetic chain interruption using percutaneous radiofrequency ablation under local anaesthesia between September 2022 and February 2024. The procedures targeted either the lumbar or the thoracic levels. The indications for the procedure were obstructive arterial disease, complex regional pain syndrome and primary focal hyperhidrosis. Patients underwent re-evaluated during follow-up appointments aimed at monitoring the benefits, complications and adverse effects of surgery. Results: This cohort comprises 23 patients, of whom 83% are female. The average age of the patients is 46.9 ± 17.4 years. The primary indications for lumbar radiofrequency neurolysis of the paravertebral sympathetic chain are plantar hyperhidrosis (n = 8, 35%) and rest ischemic pain (n = 7, 30%). During this period, 49 procedures were performed, with 39 of them at the lumbar level. Most of the patients underwent bilateral procedures (53%). More than 88% of procedures result in clinical improvement for patients, with complete resolution occurring in around 35% of cases. Lumbar radiofrequency neurolysis is associated with no complications. Conclusion: Lumbar radiofrequency neurolysis of the paravertebral sympathetic chain presents as a minimally invasive and safe alternative approach to abolishing sympathetic tone, although it is currently less effective than open surgery. It may potentially be applied to patients formally indicated for lumbar sympathectomy. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000200055&lng=pt&nrm=iso&tlng=pt Abstract Background: Iliofemoral deep vein thrombosis (DVT) involves thrombus formation in the iliac and/or femoral veins and can lead to significant morbidity, including pulmonary embolism and post-thrombotic syndrome (PTS). Traditional anticoagulation remains the standard treatment, but newer endovascular techniques such as catheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), and pharmacomechanical thrombolysis (PMT) are gaining prominence for their potential benefits in clot removal and limb preservation. Objective: This review aims to compare the efficacy and safety of these minimally invasive endovascular modalities in the management of iliofemoral DVT. Methods: A comprehensive literature review was conducted, analysing articles published between June 2019 and June 2024 from PubMed, Lilacs, and Cochrane Library databases. Inclusion criteria comprised clinical studies, systematic reviews, and meta-analyses in English, Portuguese, or Spanish. Data from 50 selected articles were synthesised qualitatively, focusing on treatment success, vessel patency, symptom relief, incidence of PTS, and complications. Results: Both CDT and PMT demonstrated high success rates, with complete thrombus removal in 82% and 72% of cases, respectively. Combined approaches such as pharmacomechanical thrombolysis showed promising short- and medium-term patency and symptom improvement. Studies highlighted reduced PTS severity using advanced techniques like ultrasound-assisted thrombolysis and AngioJet thrombectomy, though long-term data remain limited. Safety profiles revealed low complication rates, primarily minor bleeding, with serious adverse events being infrequent. Conclusion: Endovascular interventions, including CDT and PMT, offer effective, minimally invasive alternatives to anticoagulation in iliofemoral DVT, with advantages in early thrombus removal and limb salvage. Careful patient selection and procedure planning are critical to optimise outcomes, and long-term studies are warranted to further assess durability and complication rates. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000200059&lng=pt&nrm=iso&tlng=pt Abstract Background: Proximal sealing in chronic post-type B dissection aneurysms usually requires a landing zone in zone 1 or 2 of Ishimaru. Classically, this has been addressed through hybrid surgery, which involves surgical cervical debranching and TEVAR. We present a case where a proximal fenestrated TEVAR was used for adequate proximal sealing. Case-report: A 77-year-old male patient with a history of previous uncomplicated type B aortic dissection presented with a post-dissection extent II thoraco-abdominal aortic aneurysm. The maximum aortic diameter was 5.8cm, and all target vessels arose from the true lumen. To achieve an adequate proximal seal, we aimed to use Ishimaru zone 1 as a total seal and zone 2 as an effective seal. For the prevention of spinal cord ischemia, a staged repair was planned. In the first stage, a fenestrated TEVAR custom-made device was used, including a scallop for the innominate artery and left common carotid and a preloaded fenestration for the left subclavian artery, in addition to a distal tapered thoracic component reaching 5cm above the celiac trunk. In the second stage, a custom-made 4-fenestrated device was used in addition to a proximal bridging thoracic component and a distal custom-made bifurcated graft. Both procedures were successful, with postoperative imaging confirming adequate exclusion of the aneurysm and preservation of visceral flow. Conclusion: Custom-made device platforms allow a tailored approach for each patient. The fenestrated TEVAR technique enables proximal sealing in the mid-aortic arch, thereby avoiding the need for surgical cervical debranching. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000200063&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Renal artery stenosis is the leading cause of secondary hypertension. The prevalence of this condition varies, being higher in patients with refractory hypertension and in those with atherosclerotic involvement of other territories. Revascularisation with stenting is the main therapeutic option; however, the benefits regarding the recovery of renal function in patients already on dialysis remain controversial. Case-report: This is a case of a 72-year-old female patient with a history of refractory hypertension and chronic kidney disease, with a single kidney. After multiple hospitalisations due to hypertensive crises and acute pulmonary oedema, she was admitted for worsening renal function requiring dialysis. Diagnostic exams revealed partial aortic thrombosis with critical stenosis of the right renal artery. She underwent angioplasty and stenting of the renal artery, resulting in blood pressure control and discontinuation of dialysis. Two years post-procedure, the patient maintains controlled blood pressure with two medications and stable renal function. Conclusions: Renal revascularisation can be beneficial in patients with renal artery stenosis on dialysis if performed within three months of initiating renal replacement therapy. The decision to revascularise a patient already on dialysis due to renal ischaemia should consider factors such as the duration of dialysis, kidney size, and the presence of residual arterial flow. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000200067&lng=pt&nrm=iso&tlng=pt Abstract Background: Carotid body tumours typically present as an asymptomatic anterior neck mass. However, larger tumours can become symptomatic. Surgical excision is the primary treatment, often preceded by embolisation to reduce tumour haemorrhage and perioperative risks. This case report presents a case of a successful excision of a giant Shamblin III carotid body tumour. Case report: We present a case of a 37-year-old woman, originally from Mozambique, with a decade-long painless, gradually growing pulsatile left cervical swelling and progressive dysphonia and dysphagia to solids. Cervical computed tomography angiography revealed an expansive hypervascular lesion centred in the left carotid space spanning from the left carotid bifurcation to the base of the skull, with approximate dimensions of 11 x 8.1 x 5.5 cm. She had no impairment of cranial nerves but had a tumour-compressed upper airway. Further diagnostic investigations were carried out, and the diagnosis of dopaminergic-producing left Shamblin III carotid body tumour was made. The patient underwent tumour embolisation followed by surgical excision the following day. Under general anaesthesia to safely protect the upper airway until tumour removal, the authors deployed detachable hydrocoils to occlude several ECA branches supplying the tumour. After 24 hours, a multidisciplinary team undertook surgical excision. During the procedure, a peripheral neuromonitoring system was used to minimise the risk of injury to the lower cranial nerves. A regular longitudinal exposure of the carotid vessels was conducted. After proximal control of the common carotid artery, an easily bleeding tumour was medially mobilised to enable internal carotid artery exposure and preservation. Due to the high adhesion of the tumour and complete encasement of the external carotid artery, the authors ligated this artery and reconstructed the CCA bifurcation with an end-to-end common-to-internal carotid anastomosis. She was extubated on postoperative day one and was discharged home after ten days, without neurological deficits. Conclusions: The management of carotid paragangliomas, particularly those classified as Shamblin III, requires a multidisciplinary approach and refined surgical technique to ensure complete tumor removal without compromising essential structures. The combination of preoperative embolization and a well-planned surgical procedure resulted in an excellent outcome for the patient, with no neurological complications. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2025000200071&lng=pt&nrm=iso&tlng=pt Abstract Background: Carotid body tumours typically present as an asymptomatic anterior neck mass. However, larger tumours can become symptomatic. Surgical excision is the primary treatment, often preceded by embolisation to reduce tumour haemorrhage and perioperative risks. This case report presents a case of a successful excision of a giant Shamblin III carotid body tumour. Case report: We present a case of a 37-year-old woman, originally from Mozambique, with a decade-long painless, gradually growing pulsatile left cervical swelling and progressive dysphonia and dysphagia to solids. Cervical computed tomography angiography revealed an expansive hypervascular lesion centred in the left carotid space spanning from the left carotid bifurcation to the base of the skull, with approximate dimensions of 11 x 8.1 x 5.5 cm. She had no impairment of cranial nerves but had a tumour-compressed upper airway. Further diagnostic investigations were carried out, and the diagnosis of dopaminergic-producing left Shamblin III carotid body tumour was made. The patient underwent tumour embolisation followed by surgical excision the following day. Under general anaesthesia to safely protect the upper airway until tumour removal, the authors deployed detachable hydrocoils to occlude several ECA branches supplying the tumour. After 24 hours, a multidisciplinary team undertook surgical excision. During the procedure, a peripheral neuromonitoring system was used to minimise the risk of injury to the lower cranial nerves. A regular longitudinal exposure of the carotid vessels was conducted. After proximal control of the common carotid artery, an easily bleeding tumour was medially mobilised to enable internal carotid artery exposure and preservation. Due to the high adhesion of the tumour and complete encasement of the external carotid artery, the authors ligated this artery and reconstructed the CCA bifurcation with an end-to-end common-to-internal carotid anastomosis. She was extubated on postoperative day one and was discharged home after ten days, without neurological deficits. Conclusions: The management of carotid paragangliomas, particularly those classified as Shamblin III, requires a multidisciplinary approach and refined surgical technique to ensure complete tumor removal without compromising essential structures. The combination of preoperative embolization and a well-planned surgical procedure resulted in an excellent outcome for the patient, with no neurological complications.