Endovascular Aortic Repair

__Abstract__ Endovascular aortic repair is a widespread alternative for a multitude of aortic pathologies, yet tools and understanding are still rapidly advancing. The aim of this thesis is to contribute to current knowledge on risk factors for endovascular aortic repair – exploring the binomial patient-device – to clarify endovascular-specific complications and contribute to a risk-based strategy of postoperative surveillance. In Part One, the authors address controversial issues related to endovascular repa

Aposta na formação

A nossa sociedade vai fazer 18 anos de existência, uma maioridade que também traduz responsabilidade acrescida. Nesta englobamos evidentemente a necessidade de assegurar uma formação continuada de qualidade, abrangente e diversa para os sócios. Para fazer face a este desafio, demos início a um projeto educativo — a Academia SPACV — que visa coordenar as atividades formativas da Direção e Núcleos Temáticos. Os princípios que regem a Academia SPACV são três: qualidade, diversidade e transparência. A qualidade das ações formativas é assegurada pela Direção e Coordenadores dos Núcleos e avaliada pelos formadores e formandos no final de cada evento. Através de newsletter, informaremos os sócios sobre os detalhes destas avaliações. Tentaremos que as iniciativas formativas da Academia sejam abrangentes e úteis para todos, desde o recém-entrado interno de formação específica até ao assistente hospitalar mais experiente que procura atualização em áreas especificas da nossa atividade clínica. Pela primeira vez, em 2018, tivemos um curso de iniciação à Angiologia e Cirurgia Vascular dedicado aos mais novos. Procuramos apoiar os Núcleos em formações dedicadas a temas relevantes da especialidade e associámo-nos à Sociedade Espanhola de Angiologia e Cirurgia Vascular na realização do I Curso Internacional de Atualização em Angiologia e Cirurgia Vascular. Contamos com o imprescindível apoio da indústria, que nos permite concretizar todas estas iniciativas. Não obstante, pautamos todas as formações com isenção e transparência, evitando quaisquer conflitos de interesse. Só desta forma concebemos a formação, dignificamos a nossa Sociedade e servimos os interesses dos nossos doentes. Estamos empenhados, hoje e para o futuro, em oferecer aos associados uma qualidade e diversidade formativa que espelhe os valores que regem a SPACV. Bem hajam, Frederico Bastos Gonçalves Secretário Geral da SPAC

Postimplantation Syndrome after Endovascular Aneurysm Repair

Endovascular aneurysm repair is associated, in a significant proportion of patients, to a systemic inflammatory response denominated postimplantation syndrome (PIS). PIS is characterized by fatigue, fever, and a rise in inflammatory biomarkers after the operation. However, the exact definition is still a matter of debate. There are several proposed definitions for PIS in the literature resulting in significant variability of PIS incidence (ranging from 2% to 100%). The etiology of PIS is not entirely clear. Endograft composition, aortic thrombus, intestinal bacterial translocation, and contrast media may contribute to PIS but the first seems to be the most important determinant. This clinical entity may have clinical consequences in length of hospital stay, readmissions, renal function, cardiovascular events, endoleak rate, and quality of life, but current data are insufficient for definitive conclusions. Despite of absence of stablished treatment for PIS, non-steroid and steroid anti-inflammatory drugs are currently advocated when clinical suspicion arises. Prevention may be achieved with perioperative administration of a steroid drug. Since it may have adverse effects, further knowledge of the real incidence of PIS and its clinical consequences is imperative

An Adjuvant Technique in Endovascular Treatment of Post-Dissection Thoraco-Abdominal Aortic Aneurysms

Introduction: In chronic aortic dissection complicated by aneurysmal degeneration, the absence of spontaneous tears between the true and false lumen at visceral artery level may limit treatment by fenestrated/branched endovascular aneurysm repair (F/BEVAR). The creation of new fenestrations may be required to allow access to the visceral vessels. Technique: In this video, the endovascular treatment of a 70 year old white man with chronic type B aortic dissection complicated by Crawford type II thoraco-abdominal aortic aneurysmal degeneration is presented. The right renal artery had a false lumen origin without nearby visible re-entry tears. He underwent dissection flap fenestration at visceral vessel level using a transjugular intrahepatic portosystemic shunt (TIPS) needle and subsequent dilation with a high pressure balloon. A Zenith TX2 dissection endovascular graft was deployed proximally and extended distally with a Zenith dissection endovascular stent until the fenestration level was reached. In a second stage, a F/BEVAR was performed, with fenestration to the left renal artery and branches to right renal artery, superior mesenteric artery, and coeliac trunk. One year follow up computed tomography angiography showed visceral branch patency and a reduction of the aneurysm sac. Discussion: The chronic dissection flap may be thick and fibrotic, creating a technical challenge for endovascular fenestration. The off label use of a TIPS needle in this procedure created a new fenestration at the desired level and allowed definitive post-dissection treatment of the thoraco-abdominal aneurysm.publishersversionpublishe