Browsing by Issue Date, starting with "2025-06-11"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
- Diagnosis and Predictors of Post-Implantation Syndrome Following Endovascular Repair of Aortic Aneurysms – a Narrative ReviewPublication . F. Ribeiro, Tiago; Soares Ferreira, Rita; Bento, Rita; Pais, Fábio; Cardoso, Joana; Bastos Gonçalves, Frederico; Amaral, Carlos; Ferreira, Maria EmiliaINTRODUCTION: After endovascular aortic repair (EVAR), many patients develop a systemic inflammatory response called post-implantation syndrome (PIS). AAA and procedure-related characteristics have been linked with increased odds of developing this syndrome. Similarly, some short- and long-term consequences have been associated with PIS. This study aims to review the literature on the diagnosis and predictors of post-implantation after endovascular repair of aortic aneurysms. RESULTS: A non-systematic review of the MEDLINE and Scopus databases was performed using the keywords "abdominal aortic aneurysm," "inflammation," and "endovascular techniques.” No time or language limitations were imposed. Manuscripts were considered irrespective of study design. Articles of interest were analyzed, and the relevant information was organized in tables. RESULTS: PIS is defined as a combination of constitutional symptoms, including fatigue and fever, and elevated inflammatory markers. There are several proposed diagnostic criteria, most including a combination of fever with leukocytosis and/or elevated C-reactive protein (CRP). These result in discrepant rates, as low as 2% and up to 100%. The typical evolution of this syndrome is spontaneous resolution, although pharmacologic measures for symptom relief may be needed. These symptoms often resolve within two weeks; no significant permanent complications remain. Most PIS cases will present up to the first 72 postoperative hours. Endograft material, particularly polyester-based stent grafts, has been consistently linked to increased odds of PIS, up to five-fold, compared to polytetrafluoroethylene (PTFE) grafts. Aneurysm thrombus load (both pre-existing and new-onset) has also been related to an increased odds of PIS. Bacterial translocation, contrast media, and other patient or procedure-related characteristics have not been linked to an increased risk of PIS. CONCLUSION: PIS is a common finding after EVAR. Universal diagnostic criteria for diagnosis are required. Polyester-based stent grafts present the highest risk of developing this syndrome. Aneurysm thrombus load may also relate to this increased risk. The impact of other clinical or anatomical factors remains undetermined.
- Unfractionated Heparin in Ruptured Aortic Aneurysms – Narrative ReviewPublication . F. Ribeiro, Tiago; Correia, Ricardo; Bento, Rita; Pais, Fábio; Soares Ferreira, Rita; Bastos Gonçalves, Frederico; Amaral, Carlos; Ferreira, Maria EmiliaINTRODUCTION: Portuguese estimates point out that nearly 20% of aortic aneurysms are treated in a ruptured setting, with in-hospital mortality reaching up to 50%. Although unfractionated heparin (UFH) is routine during elective surgery, this technical point is debatable when treating ruptured aneurysms. The authors aimed to review the literature on the topic of intraoperative heparinization with UFH within the intraoperative period of ruptured aortic aneurysms. METHODS: A MEDLINE and Scopus database search using the terms “unfractionated heparin," “aortic aneurysm," and “ruptured aortic aneurysm” was performed. No time or language limitations were imposed. The last search was run in July 2023. Manuscripts were considered irrespective of study design. Additional articles of scientific interest for the purpose of this non-systematic review were included by cross-referencing. RESULTS: In the rupture setting, UFH usage rates have widely varied throughout time and geographical sites, and they are reported to be as low as 16%. Overall, the evidence of UFH in clinical practice in this scenario is limited. Notwithstanding, there is some evidence from observational studies of an increased pro-coagulant activity in this clinical scenario, favoring a theoretical physiologic benefit. A prospective, non-randomized study of 131 OSR patients found that patients treated with UFH had improved 30-day survival (84% vs 67%, P=0.001). Non-significant differences in blood product usage were noted. Therefore, societal guideline recommendations about intraoperative UFH in ruptured aortic aneurysms are often missing. CONCLUSION: UFH may potentially reduce death after open repair of rAAA. These findings should be carefully interpreted, as the evidence is scarce and heterogeneous and only portrays open repair.
- Giant Renal Tumor with Inferior Vena Cava Thrombus – a Case ReportPublication . F. Ribeiro, Tiago; Soares Ferreira, Rita; Garcia, Rita; Bento, Rita; Fidalgo, Helena; Ferrito, Fernando; Aragão de Moraisa, José; Ferreira, Maria EmiliaINTRODUCTION: Vascular migration and venous tumor thrombus are infrequent but unique aspects of renal cell carcinoma, and these features have signifcant therapeutic and prognostic implications. We report a case of renal neoplasm with a vena cava tumor thrombus treated with surgical resection and adjuvant chemotherapy. CASE REPORT: A 53-year-old, otherwise healthy woman presented to the emergency department due to macroscopic hematuria and abdominal pain. A large abdominal mass was noted. A computed tomography angiography was performed, and a right renal tumor (105x207mm) with level II inferior vena cava tumor thrombus and local adenopathy was noted. After a multidisciplinary discussion, she was proposed for surgical resection. Through a bilateral subcostal incision (Chevron), a standard right radical nephrectomy and perivascular lymph node excision were performed. The IVC was exposed, and a thrombectomy was performed through a longitudinal cavotomy. Pathology revealed clear renal cell carcinoma and lymph node metastasis. The postoperative period was uneventful. However, the patient developed multiple liver and lung metastases at early follow-up and was treated with chemotherapy. DISCUSSION: Tumor thrombus can extend up to the right atrium and occurs in nearly 10–25% of renal cell carcinoma patients. The natural history of this condition is poor, with a median survival of 5 months and signifcant survival improvements following radical nephrectomy and IVC tumor thrombus removal are observed, with 40- 60% 5-year survival. Surgical treatment should, therefore, be considered in this group of patients. Such operations can be challenging, particularly when thrombus extent is signifcant, and the combination of efforts between oncologists, urologists, and vascular surgeons can improve patient safety and perioperative outcomes with signifcant improvements in overall prognosis.