EUROPEAN PANOMARA ON VASCULAR SURGERY: RESULTS FROM 5 YEARS OF FEBVS EXAMINATIONS

Introduction: The Fellow of the European Board of Vascular Surgery (FEBVS) examination is a comprehensive exam for Certified Vascular Surgeons or General Surgeons with Vascular Certification. It comprehends a thorough assessment of vascular pathology knowledge, and includes critical analysis of diverse clinical cases and vascular subjects (Clinical Viva), critical review of an academic paper and direct open and endovascular skills examination in independently validated simu- lators. It is, therefore, increasingly seen as a standard of quality for International Vascular Specialists, so that it currently represents the final exam for Vascular Surgery Certification in countries such as Netherlands and Switzerland. Through this work, we aim to perform a critical review on the results of the past ten FEBVS examinations. Methods: A review of the results from the past ten consecutive FEBVS examinations was performed. Data on the results of open technical skills assessment (aortic anastomosis, distal anastomosis and carotid endarterectomy), endovascular technical skills assessment, clinical viva and academic paper analysis were collected. Candidates demographic character- istics were also reviewed. A review on both global and specific failure rates, as well as their behavior throughout the years was performed. Results: Three-hundred consecutive candidates, who have performed their Vascular Training in twenty-six different countries, were assessed in 10 different examinations performed in the last 5 years (2014–2018). Most candidates were male (77,7%), with a mean age of 36 years old. The majority of candidates were from the Netherlands (24,1%), although Germany (13,4%), Spain (12,4%) and the United Kingdom (11,4%) had a significant representation as well. Global failure rate was 28,3%, and 5,3% of the candidates were granted “honours” due to outstanding performance (global score > 90%). 21,2% of the failed candidates repeated the exam, with a global pass rate of 56,1%. Among each of the individual assessments that constitute the exam, failure rate was significantly higher in the academic paper review (24,7%), when comparing to technical open (16%), technical endo (14%) and clinical viva assessments (15,5%). Regarding each of the individual skills evaluated in the open technical section, failure rate was significantly higher in the aortic anastomosis (29,3%), when comparing with distal anastomosis (16%) and carotid endarterectomy (17,6%). More importantly, a progressive increase of failure rate in aortic anastomosis assessment was observed throughout the years (Fig.1), in accordance to the known perception of progressive loss of open aortic skills among young physicians. Portugal represents only 4,2% of all FEBVS candidates, with a pass rate of 100%. Conclusion: The FEBVS examination is a comprehensive exam, that independently assesses both theoretical and technical knowledge. Failure rate is high, although the existence of “honours” confirms a balanced difficulty level. An alarming loss of open aortic skills is noticeable and reinforces the need of simulation training in such territory

GIANT HYPOGASTRIC ARTERY ANEURYSM AFTER PREVIOUS ABDOMINAL AORTIC ANEURYSM EXCLUSION, WITH A HOSTILE ABDOMEN AND ANATOMY

The widespread use of various imaging modalities, allow that hypogastric aneurysms have been increasingly detected. Usually asymptomatic, but once clinical symptoms occur, it must be supposed immediately that the hypogastric aneurysms have ruptured or that is compressing neighboring abdominal structures. We describe a patient with a giant hypogastric aneurysm, after a AAA repair, compressing the ureter and spinal roots, treated by open surgery

Tratamento endovascular de aneurismas saculares isolados da aorta abdominal e da artéria ilíaca – caso clínico

ResumoOs autores apresentam um caso clínico de um doente do sexo masculino, de 72 anos, que apresentava 2 aneurismas abdominais saculares isolados: um aneurisma da artéria ilíaca comum esquerda de 3cm que envolvia a bifurcação ilíaca, corrigido por via endovascular através de embolização com diversos coils da artéria ilíaca interna ipsilateral com a subsequente colocação de uma extensão ilíaca de endoprótese Endurant II (Medtronic Inc, Minneapolis, EUA), e um aneurisma da aorta abdominal de 3,8cm, corrigido com a colocação de uma endoprótese tubular Endurant II.É realizada uma revisão da literatura sobre o nível de evidência do tratamento de aneurismas saculares e das possíveis complicações decorrentes da exclusão de aneurismas da artéria ilíaca, principalmente no diz respeito à embolização da artéria ilíaca interna.AbstractThe authors present a case report of 72 years‐old male patient, who had two isolated saccular abdominal aneurysms, one aneurysm of the left common iliac artery of 3cm of diameter involving the iliac bifurcation, corrected by endovascular embolization with multiple coils of the ipsilateral internal iliac artery with subsequent placement of a iliac extension of an Endurant II stent‐graft (Medtronic Inc, Minneapolis, Minn) and an abdominal aortic aneurysm of 3.8cm, managed by the placement of an Endurant II tubular stent‐graft.A literature review is performed on the level of evidence of the treatment of saccular aneurysms and made reference of the possible complications resulting from the exclusion of iliac artery aneurysms, especially in relation to the internal iliac artery embolization

ENDOVASCULAR ANEURYSM REPAIR: CURRENT STATUS ON DEVICE SPECIFICATIONS AND OUTCOMES

Introduction: Since its first introduction in 1991, endovascular aneurysm repair (EVAR) became the preferred modality for abdominal aortic aneurysms (AAA) repair. Several devices have been launched over the years addressing progressively more complex anatomies. The aim of this review is to provide an update on current endografts and compare their results. Methods: MEDLINE databases were searched for endografts features and respective outcomes. Results: Currently, a significant variety of grafts is approved for clinical use, targeting different anatomic properties. There are presently six CE and FDA approved devices: Zenith®, AFX®, C3 EXCLUDER®, Endurant® II, Ovation® and Aorfix™; while six more have only the CE mark: Anaconda™, E-vita ABDOMINAL XT®, E-tegra®, Incraft®, TREOVANCE® and Altura™. Also, there are four fenestrated and branched endografts available for treating thoracoabdominal aneurysms: Zenith® Fenestrated, Fenestrated Anaconda™, Zenith® p-Branch® and Zenith® t-Branch®. The Endurant II and Treovance stent grafts can accommodate neck lengths ≥10 mm; Aorfix and Anaconda are more liberal regarding neck angulation, extending of infrarenal neck angulation up to 90º. Finally, Zenith, C3 Excluder, Ovation and Incraft stent grafts can be used with distal fixation length ≥10 mm. Conclusion: New-generation endografts perform better than the older ones, especially in challenging anatomies. Mid-term outcomes between contemporary stent-grafts seem to be similar for most of the outcomes. However, no randomized controlled trials exist comparing different contemporary stent grafts, making conclusions difficult to accomplish. Longterm follow-up reviews are required to assertively take assumptions about different stent grafts performance

ANEURISMA DA VEIA POPLÍTEA – A PROPÓSITO DE UM CASO CLÍNICO

Os aneurismas da veia poplítea são entidades raras, porém com potencial de causar complicações tromboembólicas graves, como o tromboembolismo pulmonar. A grande maioria são detectados no contexto da doença tromboembólica, apenas alguns são detectados incidentalmente ou por outro tipo de sintomatologia. Os aneurismas sintomáticos da veia poplítea deverão ser tratados cirurgicamente, devido ao alto risco de recorrência de embolia pulmonar, mesmo em doentes hipocoagulados. Os autores descrevem o caso de um doente com aneurisma sacular da veia poplítea esquerda, causando sintomas compressivos locais e com trombo endoluminal, que foi corrigido cirurgicamente com sucesso

Abdominal compartment syndrome after endovascular treatment of ruptured abdominal aortic aneurysm: a topical review

INTRODUCTION Abdominal compartment syndrome (ACS), defined as intra-abdominal pressure (IAP) greater than 20 mm Hg that is associated with new organ dysfunction/failure, represents na uncommon but hazardous complication after endovascular aneurysm repair for ruptured abdominal aortic aneurysms (r-EVAR). The aim of this review is to overview incidence, mortality and potential benefit of expedite treatment of ACS. METHODS Pubmed databases were searched in order to find publications reporting incidence associated mortality of ACS after r-EVAR. Articles published before 2002 and non-human data was not included. RESULTS Among larger studies (n>100) ACS incidence ranged between 6.9 to 20%, with significant heterogeneity among included studies. Significant heterogeneity was also find regarding in-hospital mortality, ranging between 30 to 83%. One study revealed that need for decompressive laparotomy carried a significan greater risk of in-hospital mortality (odds ratio [OR], 5.91; 95% confidence interval [CI], 3.62-9.62;P<.001). Medical treatment options for reducing IAP represent the first step whenever intra-abdominal pressure > 12mmHg. When the latter reveal innefective, decompressive laparotomy is mandatory to avoid multi-organ failure. No studies comparing effectiveness of decompressive laparotomy exist in the literature as this represents a rescuing measure

SCORES DE MORTALIDADE PRÉ-OPERATÓRIA NOS ANEURISMAS EM ROTURA — REVISÃO BIBLIOGRÁGICA

A rotura de Aneurisma da Aorta Abdominal representa um evento associado a elevada taxa de mortalidade, longos tempos de internamento em unidades de cuidados intensivos e elevados custos para os serviços de saúde. A mortalidade após correção de aneurismas em rotura varia de acordo com o estado clínico e reserva fisiológica do doente na altura do evento. Por forma a estratificar quais os fatores de risco que mais influenciam a mortalidade neste grupo de doentes, assim como perceber quais os melhores candidatos a cirurgia, vários scores foram publicados nos últimos anos, com dezenas de variáveis analisadas. De entre os 5 scores mais relevantes encontram-se: Glasgow Aneurysm Score, Vancouver Scoring System, Hardman Index, Edinburgh Rupture Aneurysm Score (ERAS) e Vascular Study Group of New England (VSGNE). Esta revisão pretende, portanto, sumariar os mais importantes achados de cada score assim como proporcionar uma análise crítica dos mesmos