Inês Antunes

Institutional Impact of EVAR's Incorporation in the Treatment of Abdominal Aortic Aneurysm: a 12 Years' Experience Analysis.

Introduction Endovascular aneurysm repair (EVAR) was introduced as a less aggressive treatment of abdominal aortic aneurysms (AAA) for patients ineligible for open repair (OR). Objective To analyze EVARs incorporation impact in the treatment of infra-renal abdominal aortic aneurysms in our institution. Methods A retrospective study of the patients with diagnostic of infra-renal AAA treated between December 2001 and December 2013 was performed. The choice between EVAR and OR was based on surgeons experience, considering patient clinical risk and aneurysms anatomical features. Patients treated by EVAR and by OR were analyzed. In each group, patients and aneurysms characteristics, surgical and anesthesia times, cost, transfusion rate, intraoperative complications, hospital stay, mortality and re-intervention rates and survival curves were evaluated. Results The mean age, all forms of heart disease and chronic renal failure were more common in EVAR group. Blood transfusion, surgical and anesthesia times and mean hospital stay were higher for OR. Intraoperative complications rate was higher for endovascular aneurysm repair, overall during hospitalization complication rate was higher for open repair. The average cost in endovascular aneurysm repair was 1448.3€ higher. Re-interventions rates within 30 days and late re-intervention were 4.1% and 11.7% for endovascular aneurysm repair versus 13.7% and 10.6% for open repair. Conclusions Two different groups were treated by two different techniques. The individualized treatment choice allows to achieve a mortality of 2.7%. Age ≥80 years influences survival curve in OR group and ASA ≥IV in EVAR group. We believe EVARs incorporation improved the results of OR itself. Patients with more comorbidities were treated by endovascular aneurysm repair, decreasing those excluded from treatment. Late reinterventions were similar for both techniques.

Radiocephalic Fistula Recovery Using the Brachial Vein and Forearm Basilic Vein: A Case Series and Literature Review: RC-AVF Recovery Using Different Veins

Vascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC‐AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC‐AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC‐AVF problems. One patient had fistula thrombosis 5 months after the procedure, while for the other patient, the fistula continues to work without problems. Literature describes only a few cases using the forearm basilic vein or the brachial vein for fistula recovery. This procedure increased the patency of fistulas. This approach has been proven to be a good solution for solving outflow problems using the superficial or deep veins, increasing fistula patency and avoiding the need to place a central venous catheter and all the related complications.

Internal Carotid Artery Tortuosity as a Rare Cause of Dysphagia: Case Report and Literature Review

Abnormalities in the morphology of internal carotid artery are commonly identified but their natural history is not well known. Rarely, vascular abnormalities can cause mass effect causing dysphagia. We report the case of a patient presenting with long-standing dysphagia and choking during swallowing of solid food caused by an internal carotid artery tortuosity undergoing surgical treatment at our institution and we review the available literature.

Impact of Endovascular Aortic Aneurysm Repair in a Renal Transplantation Program.

BACKGROUND An increasing number of abdominal aortic aneurysms (AAAs) may occur in renal failure patients waiting for kidney transplantation because of sharing atherosclerotic risk factors. There is increasing possibility to diagnose an AAA in this group, where treatment has some particularities. After aneurysm treatment these patients remain candidates to kidney transplantation. Similarly, there is an increasing possibility to diagnose AAA in kidney transplantation recipients. Our aim is to present our experience and review the published literature. METHODS We studied the patients who underwent endovascular aneurysm repair (EVAR) and were later submitted to kidney transplantation, and the patients who underwent kidney transplantation and were later diagnosed with AAA and treated by EVAR. RESULTS Our experience with renal transplantation began in 1987 and with EVAR in 2001. We performed EVAR in 3 kidney transplantation recipients, without complications as endoleaks or loss of the transplanted kidney. We performed kidney transplantation in 2 patients who underwent EVAR. CONCLUSIONS As patients waiting for kidney transplantation wait for several months to years, necessity to treat the aortic aneurysm is sometimes imperative. EVAR is the preferred method in this high-risk group with the particularity of necessity to preserve the internal/external iliac arteries to allow anastomosis between renal artery of the transplanted kidney and recipients iliac artery. Ensuring this, kidney transplantation remains possible and we did not detect differences in comparison with a regular procedure. Kidney transplantation recipients have some particularities as immunosuppressive therapy; in this group, EVAR was recognized as less aggressive and with less impact in renal function.