First Population-Based Screening of Abdominal Aortic Aneurysm in Portugal.

BACKGROUND: The incidence of abdominal aortic aneurysm (AAA) repairs in Portugal is one of the lowest mentioned in the literature. This phenomenon can be justified either by a low prevalence of the disease or by its low detection rate. To date, the prevalence of the pathology is unknown. The objective of the study was to estimate the prevalence of AAA and its associated risk factors, in men aged ≥65 years and to evaluate the population's disease awareness. METHODS: All males aged ≥65 years registered in a Portuguese primary health care unit were invited to participate. The abdominal aorta was measured by ultrasound (inner to inner method). Concomitant risk factors and patient's AAA awareness were also assessed. An aortic diameter >30 mm was considered aneurysmatic. RESULTS: Nine hundred thirty-three patients were invited for the screening. Of these, 715 participated in the study (participation rate of 76.6%). The AAA prevalence in this sample was 2.1%. Eighty-five percent of the evaluated patients had never heard of the disease before. The mean age of the assessed population was 72.3 years; Multiple logistic regression analysis showed a positive association between AAA and history of smoking (odds ratio [OR] 8.8, P = 0.037) and history of dyslipidemia (OR 9.6, P = 0.035). A negative association was found between diabetes and AAA (OR 0.33, P = 0.045). CONCLUSIONS: The found prevalence shows that a significant number of potentially fatal AAAs remains to be diagnosed in Portugal. These results highlight the need for an effective program of AAA detection in Portugal. The lack of awareness in the Portuguese population for this pathology should also prompt reflexion.

Strategies to prevent TEVAR-related spinal cord ischemia.

Spinal cord ischemia remains the Achilles' heel of thoracic and thoracoabdominal diseases management. Great improvements in morbidity and mortality have been obtained with the endovascular approach TEVAR (Thoracic Endovascular Aortic Repair) but this devastating complication continues to severely affect the quality of life, even if the primary success of the procedure - dissection/aneurysm exclusion - has been achieved. Several strategies to deal with this complication have been published in the literature over the time. Knowledge and technology have been evolving from identification of the risk factors associated with spinal cord ischemia, including lessons learned from open surgery, and from developments in the collateral network concept for spinal cord perfusion. In this comprehensive review, the authors cover several topics from the traditional measures comprising haemodynamic control, cerebrospinal drainage and neuroprotective drugs, to the staged-procedures approach, the emerging MISACE (minimally invasive selective segmental artery coil-embolization) and innovative neurologic monitoring such as NIRS (near-infrared spectroscopy) of the collateral network.

[Pelvic congestion syndrome - A clinical report]. / Síndrome de Congestão Pélvica - A Propósito de um Caso Clínico.

Pelvic congestion syndrome is a common disorder that occurs mainly in young multiparous women. It is characterized by a variable combination of chronic (up to 6 months) not cyclical pain, dyspareunia, dysmenorrhea, urinary symptoms and constipation, that may be associated to perineal and lower limbs varicose veins, with pelvic origin. We report the clinical case of a 26 year-old female, G0P0, with lower limbs varicose veins. During the investigation of chronic pelvic pain associated to pelvic heaviness and dyspareunia, a MR was performed and pelvic varicose veins were diagnosed. Findings were confirmed by venography. Imaging findings and symptoms severity mandated treatment and we proceeded to left ovaric vein embolization. Therapeutic success was then reached and patient remains asymptomatic 10 months after treatment.

[Occlusion of peripheral bypass--changing of an institutional paradigm]. / OCLUSÃO DE BYPASS PERIFÉRICO. MUDANÇA DE PARADIGMA INSTITUCIONAL.

OBJECTIVES: Compare the results of surgical thrombectomy (ST) and catheter directed thrombolysis (CDT) in the treatment of acute ischemia due to peripheral prosthetic bypass occlusion. METHODS: Retrospective single center analysis of the electronic clinical data on two groups of patients with acute lower limb ischemia due to prosthetic bypass occlusion: in one ST was performed (data collected between June-2006 ahd September-2011) and the other was treated with CDT Qui2 test (categorical variables) and independent samples t test (continuous variables) were used for comparisons between groups. The Kaplan-Meier method was used to estimate rates of freedom from reintervention and limb salvage, with the Log Rank test used for comparisons. RESULTS: Twenty-six bypass were included in the ST group and 11 bypass were included in the CDT group. There were no statistically significan differences between groups regarding gender age and type of occluded bypass. The median time for freedom from reintervention was 275 days for the CDT group and three days for the ST group (p = 0.0029 when comparing survival curves). The median time for limb salvage was 468 days for the CDT group and 17 days for the ST group (p = 0.03 when comparing survival curves). CONCLUSION: These results support the choice for CDT as the local first line therapy for acute ischemia due to bypass occlusion, despite the limitations arising from the sample size. The results of ST need to be urgently addressed.

[Restenosis and Progression of Contra-Lateral Disease after Carotid Endarterectomy. A prospective study]. / Reestenose e Evolução da Doença Contra-Lateral Após Endarterectomia Carotídea. Estudo Prospectivo.

OBJECTIVES: Estimate the frequency and risk factors of restenosis after carotid endarterectomy, contralateral carotid disease development, neurologic symptoms (ipsi or contralateral) and new endarterectomy (ipsi or contralateral) in patients who underwent previously endarterectomy. METHODS: Retrospective single center analysis of the electronic clinical data and of duplex ultrasound results of 293 consecutive patients who underwent carotid endarterectomy between 2002 and 2008. The study included risk factors, procedure and patient's characteristics. All outcomes, since time-dependent, were estimated by the Kaplan-Meier method. The association between outcomes and risk factors was evaluated with the Log Rang test. RESULTS: The proportion of patients with restenosis/occlusion during follow up was 16% (EP=0,04), at 8,5 years. The rate of patients with restenosis was much higher in patients that underwent direct closure when compared to all other (16% Vs 2% at 3,4 years; P=0,02). At 9 years, 26% (EP=0,05) of the patients without previous contralateral internal carotid artery stenosis showed progression of the disease. CONCLUSION: Findings during duplex ultrasound follow up in patients who underwent carotid endarterectomy reach a somewhat unexpected high frequency. However, most of these changes do not mean hemodynamic or clinical significance. Direct arterial closure was associated with higher restenosis frequency. The disease progression in contralateral side occurred in a considerable proportion of cases, in particular in those patients who had already hemodynamically significant stenosis. These findings emphasize the potential benefits of duplex ultrasound follow up in patients who undergo carotid endarterectomy.

[Post Traumatic Pseudoaneurysm of the Hepatic Artery - Clinical report]. / Aneurisma da Artéria Hepática Comum Pós-Traumatismo - Caso Clínico.

Hepatic artery aneurysms are a rare condition that can be fatal if rupture happens. Often, they are incidentally identified in routine imaging. Intervention is indicated when symptomatic, if they reach 2cm or more of size, in patients presenting with multiple hepatic artery aneurysms and in all pseudoaneurysms. We describe the case of a 57 year-old female, to whom a post-traumatic hepatic artery aneurysm was diagnosed. Open surgical repair was successfully accomplished.

[Atrial myxoma: a histologically benign tumor with potentially serious manifestations]. / Mixoma auricular: um tumor histologicamente benigno com manifestações potencialmente graves.

Atrial myxoma is the most prevalent primary heart tumor. Although it is considered histologically benign, it may course with serious complications. We report the clinical case of a 35 years old man, previously asymptomatic, admitted due to an acute ischemia of the lower limbs, consequence of an embolic complication of a left atrial myxoma. We conclude with a brief review of the literature on the topic.