COMUNICAÇÕESORAISSELECIONADASCirurgiaCardio-TorácicaCO01SURVIVALAFTERBILATERAL INTERNALMAMMARYARTERY INCORONARYARTERYBYPASSGRAFTING:AREWOMENATRISK?FranciscaA.Saraiva1;NicolasGirerd2;RuiJ.Cerqueira1,3;JoãoP.Ferreira1,2;NoéliaVilas-Boas1;Paulo Pinho1,3; António Barros1; Mário J. Amorim1,3; André P. Lourenço1,4; Adelino F. Leite-Moreira1,31-DepartamentodeCirurgiaeFisiologia,FaculdadedeMedicina,UniversidadedoPorto;2 -INSERM, Centre d’Investigations Cliniques Plurithématique, Université de Lorraine, CHRU deNancy;3-DepartamentodeCirurgiaCardiotorácica,CentroHospitalardeSãoJoão,Porto;4-DepartamentodeAnestesiologia,CentroHospitalardeSãoJoão,PortoBackground: Most observational studies support long-term survival benefit after bilateralinternal mammary artery (BIMA) compared with single internal mammary artery (SIMA)coronaryarterybypassgrafting(CABG)butdataonfemalesisscarce.Introduction:TocomparesurvivalandsafetyofBIMAversusSIMACABGbetweenmalesandfemalesatourtertiarycarecenter.Methods:Single-centerretrospectivecohortincludingconsecutivepatientswithatleast2leftcoronarysystem(LCS)vesseldiseasewhounderwentisolatedCABGwithatleast1IMAconduitandaminimumof2conduitstargetingtheLCSbetween2004and2013.All-causemortalitywastheprimaryoutcome,secondaryoutcomeswerein-hospitalmortalityandreoperationduetosternalwoundcomplications(SWC).Kaplan-Meieranalysisafterinverseprobabilityweightingusingpropensity score (IPW)wasused to compareBIMAand SIMACABGamongst genders.Resultswereconfirmedbysubgroupanalysis.Results:BIMACABGwasperformedin39%outof2424eligibleproceduresandin27%of460females. No differences were found in survival after BIMA and SIMA CABG (median andmaximumfollow-upof5.5and12years,respectively)butastatisticalinteractionwasobservedwithgender(P<0.001).FemaleswhounderwentBIMACABGshowedhighermortality(weightedHRinfemalessubset:3.16;95%CI:1.56–6.29,P=0.001).BIMACABGshowedahigherincidenceofreoperationsduetoSWC(IPWadjustedmodelOR:1.74;95%CI:1.16–2.60)thatweremostlyascribabletomales(weightedORinmales:3.10;95%CI:1.74-5.51,P<0.001).Conclusion:FemalesmayexperiencehighermortalityafterBIMACABGwhichshouldbefurtherexplored.CO02CABG:TOCBPORNOTTOCBP-APROPENSITYSCOREMATCHEDSURVIVALANALYSISPedroMagro1;SérgioBoshoff1;JoséCalquinha1;MiguelSousaUva1;JoséNeves11-HospitalSantaCruzIntroduction:Over thepast3decades twomain strategieshavebeenemployed for surgicalcoronary revascularization (CABG):on-pumpCABGwithcardioplegia (ONCAB)andoff-pumpCABG(OPCAB).Theobjectiveofthisstudyistoevaluatetheshort-termandlong-termsurvivalofthetwostrategies.

Methods: This study consists of 8-year cohort, retrospective single-center analysis with anintention-to-treat design. 2954patients underwentCABG (OPCABn=2123;ONCAB=831) forCAD.Asthesetwogroupswerestatisticallydifferentregardingseveralparameters,apropensityscoremodelwasappliedandamorehomogeneouscohort(n=1441;OPCAB=885;ONCAB=556)wasanalyzed.Univariateanalysis, Kaplan-Meier curves andwhenappropriateamultivariateanalysiswasappliedtotheoverallgroupand6subgroups:2vesseldisease,3vesseldisease,leftstemdisease,diabeticpatients;patientswithcreatininclearancebellow50ml/min;andpatientswithbodymassindexabove30kg/m2.Results: Our study show: No difference in 30-days mortality, long-term survival (mean 71months follow-up), AKY and stroke rates; Higher rates of bypass per patient (2.3% vs 2.8%,p<0,001)andcompleterevascularization(76%vs83%)intheONCABgroup;Fewerre-operationforbleeding(0.8vs3.8%,p<0.001),fewerpeaktroponin>19mg/dl(4.7%vs9.9%,p<0,001),andfewer IABPuse (1.5%vs3.3%,p=0,027) in theOPCABgroup. Sub-groupanalysis showednodifferencebetweenthetwogroupswithexceptionofahigherrateoftroponinpeak>19mg/dladjustedforCADextensionintheleft-mainstemdiseasegroupundergoingONCAB(OR=2,3+-0.8p=0,018)Conclusion: Themajor randomized controlled trials comparing the two strategies show: Nodifferencein30-daysmortality,1-yearsurvival,AKYandstrokerates;Lessre-revascularizationratesandhigherbypassperpatientandbypasspatencywithONCAB.Despitethelargevolumeof evidence generated around both on-pump and off-pump CABG strategies, studies fail todemonstrate clear benefit of either strategy regarding mortality and most commoncomplications.Ourresultsaresimilarof those found inthe literatureasneitherstrategyhasunequivocal superior results. ONCAB shows consistently higher rates of completerevascularizationandhighernumberofgrafts.OPCABshowslessertroponinlevelssuggestiveof less myocardial damage. Major limitations include: analysis not matched for surgeonperformance;cardiacrelatedevents,re-revascularizationneedandgraftpatencynotevaluated;isolateduseoftroponinlevelsforevaluationmyocardialdamage.CO03THEFIRST24ROBOTICSURGERIESOFHOSPITALDALUZFernandoPalmaMartelo1;JoãoEuricoReis1;JoãoSantosSilva1;AnaRitaCosta11-HospitaldaLuzIntroduction: Robotic assisted thoracic surgery (RATS) has been growing all over theworld,presenting itself as an improvement over video-assisted thoracic surgery (VATS). The mainadvantagesaretheprecisionofthemovements,aswellasthethree-dimensionalvisionwiththeconsequentperceptionof thedepthof the surgical field.Thus, technicallymoredifficultprocedures,suchasanatomicsegmentectomiesandbronchoplasticresections,arefacilitated.This surgical approach also improves the quality of mediastinal lymph node dissection,extremelyimportantinlungcancerpatients.Objective:Analysisofthefirst24roboticthoracicsurgeriesperformedatHospitaldaLuzMethods:AllroboticthoracicsurgeriesperformedatHospitaldaLuzfrom2/6/2016tothisdatewereevaluated,concerningdiagnosis,typeofsurgery,chestdrainagetime,hospitalizationtime,morbidityandmortality.Results:Twenty-fourRATSwereperformed,withpatientshavingameanageof60.5(39-76)years, elevenof thembeingmale.All surgerieswereperformedwith3portsof 8mmanda12mmportfortheassistant.Eighteensurgeriesofpulmonaryresection(75%),fivesurgeriesformediastinal lesions (20.8%), and one for intercostal nerve harvest for reinnervation of thebrachialplexus,wereperformed.Inthepulmonarysurgeries,elevenwerelobectomies(61.1%),

fivewereanatomic segmentectomies (27.8%)and twowedge resections (11.1%).Neoplasticdiseasewasthereasonforthesixteenlunganatomicresections,twoformetastaticdiseaseandfourteen for primary lung cancer. In each case, a systemic lymph node dissection wasperformed.Allprocedureswereperformedwithoutintra-orpostoperativecomplications.Meandrainagetimewas3.4days[2-6],andmeanhospitalizationtimewas4.8days[3-8].Therewerenomortalityormajormorbidity.Thereweretwopatientswithprolongedair-leakupto6days.Themorbidityafterdischargewas12.5%,consistingofanapicalpneumothoraxthatresolvedspontaneously, a basal pleural effusion that resolved with outpatient thoracentesis, and arespiratoryinfectiontreatedwithantibiotic.Conclusion:Theoverallevaluationofthistechniqueisstillprecocious,butallowstoaffirmthatanexperiencedsurgeoninvatssurgeryhasafasterlearningcurvewiththisnewapproach.Theinnovationanddevelopmentofnewtechniquesinthoracicsurgeryarefundamentalinordertoallowmoreeffectivetreatments,withlesspainand,whenpossible,lungparenchymasparingsurgeriesinpatientswithearlyneoplasticlungdisease.CirurgiaVasculareEndovascularCO04ARTERIAL VASCULAR COMPLICATIONS IN PERIPHERAL VENOARTERIAL EXTRACORPOREALMEMBRANEOXYGENATIONSUPPORTRita Augusto1; Marisa Passos Silva1; Jacinta Campos1; Andreia Coelho1; Nuno Coelho1; AnaCarolinaSemião1;EvelisePinto1;DanielBrandão1;AlexandraCanedo11-CentroHospitalardeVilaNovadeGaia/EspinhoIntroduction:Extracorporealmembraneoxygenation(ECMO)hasbeenevolvedasalife-savingmeasure for patients requiring emergent support of respiratory and cardiac function.Thefemoralartery is thestandardsite forvascularaccesswhen initiatingadultvenoarterial (VA)ECMO.Cannulation-related complications are a known source of morbidity and it has beenspeculatedthatpatientsundergoingECMOviafemoralarterialcannulationaremorelikelytodevelop peripheral vascular complications (up to 70%). In patients with severe peripheralarterialdisease(PAD)theserisksareevenhigheranditspresencemaybeconsideredarelativecontraindicationforfemoralarterycannulation.Methods:RetrospectiveinstitutionalreviewofpatientsrequiringECMO(January2011-August2017).The primary outcome of this studywas to investigate the prevalence of cannulation-relatedcomplicationsonVAECMOandtodetermineitseffectonpatientmorbimortality.Weevaluated demographics and co-morbidities data.Patients were divided into two groups(complicationspresentVSnotpresent)andstatisticanalysiswasperformedtodeterminetheimpactofdifferentvariablessuchasco-morbidities,cannulationstrategyandtimeonECMOineach group.Operative reportswere reviewed to analyze the surgical procedures implied fortreatingvascularcomplications.Results:Eighty-twopatientsunderwentECMOtherapyduringtheperiodofstudy,56,1%weremalewithameanageof55,8years.ThemediantimeontheECMOdevicewas5,5days.TheVAmode was used in 61 patients, 56 with peripheral cannulation.Femoral arterial access wasestablishedin52patients(73%percutaneously).Vascularcomplicationswereobservedin28,6%of theVA femoral ECMOs:12 acute limb ischemias and3majorhemorrhages.At the timeoffemoral cannulation, distal peripheral catheter (DPC) was placed in 5 patients and nonedeveloped subsequent limb ischemia.For those who developed limb ischemia, severalinterventions were performed: DPC placement in 9 cases, fasciotomy in 4 and 2 major

amputations.Thirtypatientsunderwent arterial cannulasopen surgical removal:8underwentballooncathetertrombectomyand5neededfemoralreconstruction.TherewasanassociationbetweenPAD(p=0,03)andischemiccardiopathy(p=0,02;OR4,5)withthepresentofvascularcomplicationsafterECMOimplantation.VAfemoralECMOmortalitywas69,2%(n=36).VascularcomplicationsafterECMOsupportarenotassociatedwithhighermortalityrates(p>0,05).Conclusion: Cannulation of femoral vessels remains associated with considerable rates ofvascular events (28.6%).PAD and ischemic cardiopathy are associated with vascularcomplications in this formof cannulation.Physicalexaminationand theassessmentofankle-brachial índex before ECMO implantation is therefore recommended.Improved efforts atpreventingthesecomplicationsneedtobedevelopedtoavoidadditionalmorbidityinanalreadycriticalpatientpopulation.CO05SURGICAL TREATMENT OPTIONS OF SUBCLAVIAN ARTERY PSEUDOANEURYSMS: A CASEREPORTANDLITERATUREREVIEWRita Soares Ferreira1; João Monteiro Castro1; Frederico Bastos Gonçalves1; Rodolfo Abreu1;RicardoCorreia1;RuiRodrigues2;CarolinaTorres3;MariaEmíliaFerreira11 - Serviço deAngiologia e CirurgiaVascular, Hospital de SantaMarta, CHLC; 2 - Serviço deCirurgiaCardiotorácica,HospitaldeSantaMarta,CHLC;3-ServiçodeCirurgiaTorácica,HospitalPulidoValente,CHLNIntroduction:Subclavianarterypseudoaneurysmsarerareandoccurmostlyasaconsequenceof an inadvertent arterial puncture during central venous catheterization, endovasculartherapeuticproceduresorafterpenetratingorblunttrauma.Theyusuallyhavealateclinicalpresentation,withpain,swellingorothercompressivesymptoms.Theoptimaltreatmentinthissituationisstillamatterofdebate.Theauthorsdescribeacaseoflatepresentationofsubclavianarterypseudoaneurysmafter transjugularhepaticbiopsyanddiscuss the severaloptions fortreatment.Methods:A41-year-oldwomanwasadmittedinourhospitalduetosymptomaticsubclavianarterypseudoaneurysm.Sheunderwentabiopsy20yearsearlierforanundeterminedfebrilesyndrome.The pseudoaneurysmwas diagnosed during investigation of a right non-pulsatilecervicalmass thatwasassociated tocervicaledemaandHorner’s syndrome.CTArevealedapseudoaneurysmofrightsubclavianarterywith35mmofdiameterandanarteriovenousfistulatojugularveinwhichpresentedwithsignificantenlargement.Additionally,thevertebralvenousplexuswasalsoingurgitated.Thepseudoaneurysmcausedaleftshiftofthethyroid,commoncarotidarteryandtrachea.Thevertebralarteryarised4mmdistaltopseudoaneurysm.Results: After a multidisciplinary evaluation including vascular surgery, neuroradiology andcardiacsurgery,sheunderwentsurgicalexclusionoffalseaneurysmandarteriovenousfistulaviapartialuppersternotomywithcervicotomy.Carewastakentopreservethevertebralartery.Therewasacompleteresolutionofcompressivesymptomsandtherewerenocomplicationsduringthefirstyearoffollowup.Conclusion:Subclavianarterypseudoaneurysmsimposeamajorsurgicalchallenge,especiallywhenoriginatingfromtheproximalthird.Largepseudoaneurysmsmayruptureorproducesignsand symptoms of compression. If intervention is considered necessary, several options areavailable: open surgical resection and vascular reconstruction, endovascular exclusion,stentgraft implantationorultrasound-guidedthrombininjectionhaveallbeendescribed.Thechoice of procedure should be tailored to the patient, based on comorbidities, clinicalpresentation and anatomic characteristics. When compressive symptoms exist, an openapproach is advised. However, because of their location, surgical exposure of the

pseudoaneurysmmaybetechnicallydifficult,requiringasternotomyoraclavicularresectionfor adequate exposure. An endovascular approach demands an adequate landing zone andabsenceofseveretortuosity.Whenarteriovenousfistulaeandenlargementofvertebralveinsare verified, with subsequent increase in venous pressure, there is a risk of cervicalradiculopathy (2-4%). This case report describes an uncommon presentation of subclavianpseudoaneurysmandexemplifiesthecomplexityoftheirtreatment.

CO06COMPARISONBETWEENENDOVASCULARAPPROACHANDAORTO-BIFEMORALBYPASSFORTASCDAORTO-ILIACDISEASEPATIENTSTREATEDBETWEEN2011-2017JoelSousa1;JoãoNeves1;AndréFerreira1;JoséVidoedo2;JoséTeixeira11-HospitaldeS.João,Porto,Portugal;2-CentroHospitalarTâmegaeSousaIntroduction: In the last few years, endovascular approaches have been demonstratingremarkableresultsonthetreatmentofaortoiliacTASCDlesions.However,theresultsremainconflictuousandproperevidenceregardingthebesttreatmentoptionforthisgroupofpatientsisstilllacking.Throughthiswork,weaimtocomparepatency,cost-effectivenessandqualityoflifeinpatientssuccessfullytreatedbythesetwoapproaches.Methods: Patients with TASC D aorto-iliac disease, from two independent Vascular SurgeryCenters, treated either by open surgery and endovascular intervention between 2011-2017,wereretrospectivelyanalyzedandconsecutivelyincluded(n=59).Patientswerethendividedin2groups:OpenGroup(OG),inwhichaorto-bifemoralbypasswasperformed(n=27);andEndoGroup(EG),inwhichanendovascularapproachwaspreferred(n=32).Surgicaldecisionbetweenthesetwoprocedureswasmadeindividuallybythesurgeon,accordingtoclinicalcriteria.Baselinecharacteristics(age,diabetes,smokinghistory,chronickidneydiseaseandrutherfordgradeof ischemia)werealsoevaluated.Qualityof life (QoL)was laterassessedbymeansofthree physical and telephonic validated questionnaires (EQ-5D-5L; peripheral arteryquestionnaire;walkingimpairmentquestionnaire).Results:ThereweresignificantstatisticaldifferencesbetweentheOGandEG,regardingmeanage (62 vs 65 years, p=0,044) and tobacco use (100 vs 75%, p=0,05), but both groupswere

comparablefortheremainingbaselinecharacteristics.Technicalsuccesswasachievedin100%ofthecasesofOG,whileonly in65%was itobtained intheEG(p=0,001).Consequently,re-interventionratewashigherinthelater.Regardinginfectionrate,itwassignificantlyhigherinthe OG (11.1% vs 0%, p=0,05). No differences between groups were found regarding limbsalvage (96,3%vs100%,p>0,05).Cost-analysis revealed thatendovascularproceduresweresignificantlymoreexpensivethanopeninterventions(1053€vs2080€,p=0,001),withsimilarinpatient lengths.Nonetheless, ICUoccupationwas significantly lower in theEG (3,8vs0,05days,p=0,05).NodifferencesbetweengroupswerefoundinthequestionariesofQoL(p>0,05).Conclusion:DespitehigherratesoftechnicalsuccessintheOG,patencyandlimbsalvageseemsquitesimilarbetweenthetwotechniques.Also,endovascularapproachoftheaortoiliacsectorremainssignificantlylessinvasivethantheconventionalalternative.Basedonthis,anddespitethehighersuccessrateofopensurgery,shouldn’twegiveanopportunitytothe“endovascularfirst”approach?CO07OUTCOMESAFTERCATHETERDIRECTTHROMBOLYSISFORACUTELIMBISCHAEMIA–SINGLECENTEREXPERIENCETiagoSoares1;JoãoRochaNeves1;RicardoCastroFerreira1;PedroAlmeida1;PauloDias1;SérgioSampaio1,2;JoséFernandoTeixeira11-CentroHospitalarSãoJoão;2-FaculdadedeMedicinadaUniversidadedoPorto,MEDCIDESPalavras-chave:acutelimbischaemia,catheterdirectedthrombolysis,amputationfreesurvivalIntroduction:Theaimofthisstudyistoevaluatetheoutcomeofcatheterdirectedthrombolysis(CDT)inacutelowerlimbischaemiadependingontheunderlyingetiology.Methods:Retrospectivesinglecenteranalysisofelectronicclinicaldataonpatientswithacutelower limb ischaemia treated with CDT. Between January 2011 and September 2017, 128procedures in 106 patients were included. The etiology of ischaemia was native arterythrombosis in 39 procedures (30,5%), PTFE graft thrombosis in 56 (43,8%), intra-stentthrombosisin11(8,6%),embolyin9(7%),poplitealaneurysmthrombosisin9(7%),veingraftthrombosisin2(1,6%)andpoplitealarteryentrapmentin2(1,6%).Results:Medianfollow-uptimewas14months[range:6-31],duringwhich22%neededfurtherintervention.Theneedforreinterventionwas27,6%innativearterythrombosisgroup,65,2%in PTFE graft thrombosis group, 18,2% in intra- stent thrombosis group. No reinterventionsoccurredneitherinpoplitealaneurysmgrouporembolygroup.Amputationfreesurvivalwas83,3%(SE4,6%)at27monthsandcumulative incidenceofdeathwas10,1%(SE5,2%)at32months,withnodifferencesbetweenthegroups.Conclusion: Intra-arterial thrombolytic therapy achieves good mid-term clinical outcomes,reducingobviatingtheneedtoopensurgicaltreatmentinmanypatients.TheseresultssupportthechoiceforCDTasavalidoptioninacutelimbischaemiaofseveraletiologies.

CO08ENDOVASCULARREMOVALOFFOREIGNBODIESRogerRodrigues1;AlfredoAgostinho1;GabrielAnacleto1;PaulaBranco1;ÓscarGonçalves11-CentroHospitalarUniversitáriodeCoimbraIntroduction: Intravascular or catheter embolization of a foreign body, either by fracture ormigration, is a rare condition, occurring in approximately 1%. This study is focused on themigrationofcatheterssincetheyrepresentthemajorityofcasesofembolization.Wepresentoneofthelargestpublishedseriesofremovalofforeignbodieswithendovasculartechniques.The objective of the present study is to demonstrate the different locations where foreignbodies,inmostcasescatheters,canreach,thetechniqueusedtoremovethemandtheaffectedpopulation.Methods:Thisisa9yearsretrospectivestudyinwhichwereportthecasesofforeignbodiesremovalperformedbyanendovascularapproachbetween2009and2017inourinstitution.Itincludes53patients:28womenand25men.Theaverageagewas58years(rangingfrom15to87years).Thecatheterswereimplantedbyaheterogeneousgroupofprofessionals.Results: Thirty three totally implantable catheters (Implantofix®), sixteenperipheral insertedcentralcatheter,threeGuideWires,oneangioplastyballoonandoneAmplazervascularplugwereextracted.Themostcommonsitesforthelodgingofoneoftheendsoftheintravascularforeign bodies were the right atrium (35,8%) the superior vena cava (11,3%) and the rightventricle (11,3%). In 98,1% of the cases, only one venous accesswas used for extraction offoreignbodies,and in96,2%of thecases the right femoralaccesswasused.The loop-snaretechniquewas used in 45 cases (84,9%) and in 8 cases a basket was the option. Themostcommoncauseofcatheterembolizationwasthedisconnectionbetweenthecatheterandtheportduringthesurgeryforitsremoval,whichoccurredin55,1%ofthecases.Fractureoftotallyimplantablecathetersoccurredin12,2%.Thefractureofaperipheralinsertedcentralcatheterrepresents32,7%ofcasesofembolization.Atrialfibrillation,occurredin8cases.Themortalityrateduringtheprocedurewaszero.Technicalperformancewas100%successful.Conclusion:Percutaneousinterventionforremovalofintravascularforeignbodiesiscurrentlythe best treatment option for patients. It is a minimally invasive, procedure, with lowcomplicationrates.Embolisedmaterialcanbequitesafelyretrieved,andpresentsanattractivealternative to surgical removal of these devices. However, this work should serve as aconsiderationaboutthesafetyoftheremovalofcathetersaswellastheirqualityinordertoreducethistypeofcomplications.CO09INFLUENCEOFINTERHOSPITALTRANSFERONOUTCOMESOFSYMPTOMATICANDRUPTUREDABDOMINALAORTICANEURYSMSNelsonCamacho1; FredericoBastosGonçalves1;GonçaloRodrigues1;AnitaQuintas1; RodolfoAbreu1;RitaFerreira1;JoanaCatarino1;RicardoCorreira1;RitaBento1;MariaEmíliaFerreira11-CentroHospitalardeLisboaCentral,HospitaldeSantaMartaIntroduction: Symptomaticor rupturedabdominalaorticaneurysms (rAAA)maintainsahighmortality index despite technical advances in its treatment. The influence of patients’geographic locationonrAAAoutcomes,whentheruptureoccursorwhentheAAAbecomessymptomatic,hasnotbeenacommonlystudiedissue.Duetothelackofresearchonthismatter,

theimpactofinterhospitaltransferonmortalityisambiguous.Objective:EvaluatetheinfluenceofthegeographiclocationofpatientswithsymptomaticAAAorrAAAonAAAmortality.Methods:RetrospectivereviewofallcasesofsymptomaticAAAandrAAAsubmittedtosurgeryina tertiary institution,between January2011andAugust2017.Themainoutcomewas in-hospitalmortality.Secondaryoutcomeswereadmissiontointensivecareunit(ICU),lengthofICU and hospital stay, type of repair and anesthesia and weekend presentation. Data wassubmittedtounivariableanalysisandlogisticregression.Statisticalsignificancewasconsideredifthepvaluewas<0.05.Results:Duringthedefinedperiodof80months,atotalof135patientswereadmittedwiththediagnosisofsymptomaticorrAAAandsubmittedtosurgery.MostpatientshadarupturedAAA(90.4%,n=122),whilesymptomaticAAArepresentedaminority(9.6%,n=13).Allpatients(91.1%malegender,meanage74±10years)weresubmittedtosurgery,83(61.5%)byendovascularrepairand52(38.5%)byopenrepair,30.4%withlocalanesthesiaandsedation(n=41),allintheendovasculargroup.92patients (68.1%)weretransferredfromotherhospitals,withameandistanceof113±88km.Inthiscohort, in-hospitalmortalitywas31.5%intransferredpatientsand34.9%innottransferredpatients.Subgroupanalysisrevealedthattherewerenosignificantdifferencesbetweentransferredandnottransferredpatients’groupsconcerningmainoutcome(p=0.35),baselinecharacteristics (ageandgender), typeofsurgeryandanesthesia,weekendpresentation, ICU admission, length of ICU and hospital stay. Logistic regression analysisrevealedthatthevariablesassociatedwithmortalitywerefemalegender(oddsratio[OR]2.28;95%confidenceinterval[CI]1.40-3.70;p<0.01),openrepair(OR2.79;95%CI1.68-4.63;p<0.01)andgeneralanesthesia(OR9.16;95%CI2.33-36.06;p<0.01).Conclusion:Our study revealed that transfer of patients for urgent repair of AAA was notassociatedwithan increasedmortality. Thehypothetical increasedmortalitydue to transfermighthavebeencompensatedbyendovasculartreatmentandlocalanesthesiainsomecases.Further studiesmustbecarriedout,particularly comparingendovascularandopen repair inemergencysetting.CO10MEDIANARCUATELIGAMENTSYNDROME–LITERATUREREVIEWANDCASEREPORTNelsonCamacho1;GonçaloAves1;FredericoBastosGonçalves1;RodolfoAbreu1;RitaFerreira1;JoanaCatarino1;RicardoCorreia1;RitaBento1;MariaEmíliaFerreira11-CentroHospitalardeLisboaCentral,HospitaldeSantaMartaIntroduction:Medianarcuateligamentsyndrome(MALS)orDunbarsyndromeisarareclinicalentity characterized by celiac trunk compression by median arcuate ligament and variablegastrointestinal symptoms (postprandial epigastric pain, nausea, weight loss, anorexia anddiarrhea). However, some degree of radiographic compression is observed in 10%-24% ofasymptomaticpatients.Besidestheextrinsicvascularcompression,MALShasamultifactorialetiologyandithasbeensuggestedasaneurogenicdiseaseresultinginalteredsensationandpainfromthesomaticnervesinthesplanchnicplexus.MALSisadiagnosisofexclusion,soothercausesmustbeexcluded.Treatmentoptionsincludereleaseofmedianarcuateligament(open,laparoscopic or robot-assisted) and open vascular reconstruction. Endovascular treatment iscurrently used only as adjuvant procedure after surgical approach, in refractory cases withresidual stenosis of celiac trunk.Objective: To report a case ofMALS and to review currentliterature.Methods:TheauthorsreportaclinicalcaseandpresentaliteraturereviewusingPubMedwiththe terms “median arcuate ligament”, “Dunbar syndrome” and “MALS treatment” asmajor

topics. The bibliography of relevant articles has been checked to identify other significantpapers.Results:A34-year-oldwoman, previously healthy, recurred to aGeneral Practitionerwith arecurrentepigastricpain,exacerbatedbyingestion,withoutrelievingfactors,intheprevious6months. Patient also reported anorexia and unprovokedweight loss of 8Kg over 3months.Physicalexaminationwasnormal.Othergastrointestinalpathologieswereruledout.ComputedTomography Angiography (CTA) abdomen revealed a focal 80% stenosis of the celiac trunk,located8mmfromitsorigininaortaandapost-stenoticenlargementof9mm.An open decompression of the celiac trunk was performed. Through an 8cm mediansupraumbilical laparotomy, supraceliac abdominal aorta was approached. The compressivebandacrosstheceliactrunkwasidentifiedandcut.Furtherdissectionwasperformeduntiltheceliacarterybecamecompletelyexposedanditsbranchesidentified.Thepostoperativeperiodwasuneventfulandthepatientwasdischarged5dayslater,withnormalgastrointestinaltransitand without recurrence of the abdominal pain. 1 month later, the patient remainedasymptomatic.Along-termfollow-upwithannualduplexscanandclinicalevaluationmustbedone, in order to evaluate the need of a revascularization due to persistent stenosis oraneurysmaldegeneration.Conclusion:MALS diagnostic and therapeutic approachmust be patient focused, bearing inmindthemultipleclinicalpresentationandtreatmentoptions.Opensurgicaldecompressionofmedianarcuateligamentisthebaseoftherapy.CO11EMERGENCYNIGHTMARES–RUPTUREOFTYPEIIITHORACOABDOMINALANEURYSMMarinaDias-Neto1;JoséFernandoRamos1;JoãoRochaNeves1;PedroAlmeida1;AugustoRochaESilva1;JoséFernandoTeixeira11-DepartamentodeAngiologiaeCirurgiaVascular,CentroHospitalardeSãoJoãoIntroduction:Theruptureofthoracoabdominalaneurysms(rTAA)representsoneofthemajorchallengestothevascularsurgeon.Recentdevelopmentsintheendovasculararmamentariumandthehighmortalityfromopensurgerymakeendovasculartreatmentanattractiveoption.Devicestobeusedinanemergencyenvironmentshouldbe"off-the-shelf"andinclude,amongothers,EVARsnorkel/chimneyandbranchedendoprosthesis(T-branch,Cook®).Methods:Wedescribethecaseofa70-year-oldpatientwhowasadmittedtotheemergencyroomduecontinuouslowbackpainwith3daysofevolution.Results: The tomographic computer angiography showed a type III thoracoabdominalaneurysm,witha transversemaximumdiameterof75x81mm in the infrarenal aortaandanexuberanthematomaintheleftretroperitoneum,butnoactiveextravasationofthecontrastwasobserved(Figure1).Therewasstillmarkedtortuosityandmoderateiliaccalcification.Itwasdecidedtoplaceabranchedendoprosthesis(34mmdiameteratthetopand18mmatthe bottom). The branched endoprosthesis was extra-corporeally oriented, and introducedthrougharight femoralapproach.The finalpositionwasverifiedwiththedigital subtractionangiographyinanteroposteriorincidence,ensuringthatthedistalborderofeachbranchwas1.5to2cmabovethetargetvesselandthatthestentmarkspresentedthedesiredposition.Aftertheendoprosthesiswasopened,thebranchesarecatheterizedbytheleftaxillaryaccess,however, it was verified that the endoprosthesis had an antero-posteriorly invertedimplantation. Itwaspossible tocatheterize thesuperiormesentericarteryandthe left renalartery (celiac trunk occlusionwas documented intraoperatively); occlusion of the remainingendoprosthesis branches was performed with an Amplatzer. The patient evolved withmultiorgandysfunctionanddiedat24hourspost-operatively.

Conclusion: Implantation of an off-the-shelf branched endoprosthesis requires specificanatomicalcriteriasuchasaorticdiameter>25mmtoallowcatheterizationofthevessels,thepossibility of incorporating each target vessel at a 90o angle in relation to each branch andvisceral arteries with a diameter between 4 and 8 mm. Anatomy review is important tounderstand the lengths and positions of the branches. It should be borne inmind that it ispossiblethatthedevicemighthavetoberotatedduringimplantationtobetteralignthemarksandthatbothincidences(anteroposteriorandprofile)maybeusefulinconfirmingtheposition,somethingthatshouldbethoroughlypursuedtosafeguardacorrectimplantationregardlessoftheinitialstentpositioninyourdeliverysystem.

CO12ENDOVASCULAR SOLUTIONS FOR THORACIC AORTIC ANEURYSMS WITH CHALLENGINGANATOMIESJosé Oliveira-Pinto1; Joel Sousa1; João Rocha-Neves1; Emilio Silva1; Vincent Riambau2; JoséTeixeira11 - Centro Hospitalar de São João; 2 - Department of Vascular Surgery, Hospital Clínic deBarcelona,Barcelona,SpainIntroduction:Thesuitabilityoftheproximalanddistallandingzonesremainsoneofthemainlimitationstothoracicendovascularaorticrepair.Theadventofcustom-madescallopedstentgraftswidenedtheendovascularoptionsinsomechallenginganatomies.Methods: The authors present three cases of thoracic aortic aneurysm (TAA), with threedifferenthostileanatomies,successfullytreatedwithcustom-madescallopedstentgrafts.Results:Case1:Malepatient, 47 yearsold,no relevantmedicalhistory.Angio-CT revealeda54mm post- traumatic TAA, extending distally from the origin of the left subclavian artery.Inadequate sealing in Ishimaru zone 2was evident. The patientwas sequentially treated bymeans of a carotid-subclavian bypass followed by TEVAR with proximal scallop to the leftcommoncarotidartery.Properproximalsealingwasobtained.Case2:Malepatient,76yearsold,diagnosedwitha65mmdiameterTAA, involving theoriginof the left subclavianartery.Presenceofabovinetrunk,andinadequatelandingzonedistallytoit,werenoted.Thepatient

was sequentially treated by means of a carotid-subclavian bypass followed by TEVAR withproximalscalloptothebovinetrunk.PropersealinginIshimaruzone2wasgranted.Case3:Malepatient,77yearsold,multiplecomorbidities.Angio-CTrevealeda59,3mmsaccularaneurysmofthedistalthoracicdescendingaorta,extendingproximallyfromtheoriginoftheceliactrunk.Good collateralizationwas observed after celiac trunk occlusion test. Proper distal sealwasobtainedbymeansofselectiveembolizationoftheceliactrunkfollowedbyTEVARwithdistalscallop to the superiormesenteric artery.All procedureswereuneventful,withno reportedendoleaks,birdbeaks,migrationsorre-interventions.Therearenoreportedcomplicationsat1-yearfollow-up.Conclusion:Custom-made scalloped thoracic stentgrafts are an accessible, reproducible andsafetherapeuticoptionwhendealingwithhostiledescendingthoracicanatomies,andshouldbeconsideredasaminimally-invasiveeffectivesolutioninselectedcases.CO13GIANTRUPTUREDCOMMONILIACARTERYINFECTEDANEURYSMPedro Pinto Sousa1; Sérgio Teixeira2; João Gonçalves2; Carlos Veiga2; Pedro Sá Pinto2; RuiAlmeida21-CentroHospitalarVilaNovadeGaia/Espinho;2-CentroHospitalardoPortoIntroduction:Saccularmycoticaorto-iliacaneurysmsareextremelyrareandwhenpresentedwithruptured,theyareanimportantlife-threateningcondition.Methods:Wepresenta52yearsoldmaletransferredfromanotherHospitalandadmittedtotheemergencyroomwitharupturediliacarteryaneurysm.Results:Hecomplainedofpersistentfeverandabdominaldiscomfortthatswiftlyestablishedashemorrhagic shock. Imagiological studywith angioCT revealed a ruptured left common iliacartery saccular aneurysm with 90mm. The patient was instantaneously and successfullysubmittedtoendoaneurismorraphy,commonandexternaliliacarteryligationandconstructionof an extra anatomic bypass, right to left femoro-femoral bypass. Blood culture revealed aStreptococcus anginosus and the patient received appropriate targeted antibiotics. Post-operativeperiodwasuneventfulandthepatientdischargedtendaysafteradmission.Hehasnowelevenmonthsoffollowupwithnointercurrences.Conclusion:Longtermantibioticsalongwithaggressivesurgicaldebridementof the infectedtissueandvascularrevascularizationwithanextraanatomicbypassremainthemostdefinitivesolution while endovascular aneurysm repair may generally constitute a bridge life-savingprocedureinmycoticinfectedaneurysms.Eventhoughsurgicalapproachcarriesarelativeriskofperioperativemorbidity it isafeasibleanddurablesolutionforextremesituationsliketheoneheredescribed.

CO14INTHECURRENTERAOFENDOVASCULARSURGERY,WHATISTHEROLEOFAXILLOFEMORALBYPASS?Ricardo Correia1; Rita Ferreira1; Ana Garcia1; Frederico Gonçalves1; Rodolfo Abreu1; NelsonCamacho1;JoanaCatarino1;MariaEmíliaFerreira11-HospitaldeSantaMartaIntroduction:Nowadays,axillofemoralbypassisviewedasanend-of-linesolutionforlowerlimbrevascularization,owingtoitsclassicallydescribedpoorlong-termpatency,andrecentadvancesin endovascular options for patientswith complex aortoiliac anatomy not suitable for openreconstruction. There is a marked difference in patient profiles in published series ofaxillofemoralbypass,reflectingchangingproceduresindicationsduetotechnical innovations.Theobjectiveofthisstudy istodeterminethecontemporaryprofileofpatientstreatedwithaxillofemoralbypassandtheiroutcome.Methods:PatientswhounderwentaxillofemoralbypasssurgeryinatertiaryhospitalfromApril2011toSeptember2017were identified.Surgical indication,patency,amputationanddeathrateswererecorded.Patientsweregroupedinaxillounivsaxillobifemoral,1strevascularizationprocedure vs reintervention, andprimary aortoiliac occlusivedisease vs primary aneurysmaldisease,andwerecomparedusingKaplan-Meiersurvivalanalysis.Results:54patientswereincluded.80%underwentanaxillobifemoralbypass.Medianagewas67years;96%weremale.ThemostprevalentcardiovascularriskfactorswereHTA(81%)andhistory of smoking (76%).Primary vascular diseasewas aneurysmal in 24% of patients. Theremaininggrouphadperipheralocclusivearterialdisease.In53%,axillofemoralbypasswasthefirst revascularization performed (naif group).On these, indications for this procedurewereaorto-iliacocclusivedisease(89%)andAAthrombosis(19%).Inpatientspreviouslysubmittedto revascularization (47%), the most common first procedures were aortobifemoral bypass(56%), femoro-femoralbypass(44%)andEVAR(36%). Indicationsforaxillofemoralbypassonthis group were: prosthesis thrombosis (64%), secondary aorto-enteric fistulae (28%) andprosthesisinfection(8%).Primarypatencyofaxillofemoralbypasswas93%at1monthand80%at5years(Graphic1).Differenceswerenotsignificantregardlessthevascularsurgerystatus(naifvsreintervention),butaxillobifemoralbypassandaneurysmaldiseasegroupshadahigherpatency than axillounifemoral bypass and occlusive disease groups, respectively.No patientwith aneurysmal disease required amputation over a 5-year follow-up. In primary occlusivediseasegroup,88%ofpatientswerefree-of-amputationat1monthand83%at5years.Patientswhounderwentthisprocedurehadasurvivalrateof78%at1monthand59%at5years(Graphic2).Nomajordifferencewasrecordedbetweenstudygroups.Conclusion:Axillofemoral bypass, although being an increasingly uncommonprocedure, stillallowsacceptableratesofpatencyandlimbsalvage.Aspatientswithaortoiliacdiseaseusuallyhavemultiplecomorbiditiesandashortlife-expectancy,axillofemoralbypassisattractiveowingtoitslessinvasivecharacter.

COMUNICAÇÕESORAISCirurgiaCardio-TorácicaCO15PULMONARYHYPERTENSIONINVALVULARHEARTDISEASESURGERY:RISKANDPROGNOSISMárcio Madeira1; Sara Ranchordás1; Paulo Oliveira1; Tiago Nolasco1; Marta Marques1; LuísBruges1;JoséCalquinha1;MiguelSousaUva1;MiguelAbecasis1;JoséPedroNeves11-HospitalSantaCruz,CHLOIntroduction: Leftheartdisease is themostcommoncauseofpulmonaryhypertension (PH),andwhenpresent isassociatedwithhighersurgicalrisk.Objectives:AnalyzetheeffectofPHseverity on morbidity, early and late mortality in patients with pulmonary artery systolicpressure(PASP)over30mmHgthatunderwentvalvularheartsurgery.Methods:RetrospectiveobservationalstudyincludingallpatientswithPH,definedasPASP>30mmHg that underwent isolated valvular heart surgery, between 2007 and 2016. Exclusioncriteria were: active endocarditis, congenital heart disease, transcatheter aortic valveimplantation,reoperationsandemergentsurgery.Thestudypopulationincluded607patientswithameanageof69.6yearsandameanPASPof52.5mmHg.Meanfollow-upforall-causemortality was 4.4(0-11) years in 99.7% of patients. MACCE (Major Adverse Cardiac andCerebrovascularevent)wasdefinedasatleastoneofthefollowing:in-hospitalmortality,stroke,post-operativemyocardial infarction, severe arrhythmia ormultiple organ failure. PASPwasevaluatedasacontinuousvariable.Simpleandmultivariablelogisticregressionwasperformedtoevaluatethein-hospitalmortalityandMACCE.Coxregressionwasusedforlongtermfollow-upandone-samplelog-ranktestforcomparisonwithageadjustedgeneralpopulation.Results: The in-hospital mortality was 3.2% and PASP was an independent predictor onunivariableanalysis(OR:1.06;95%CI:1.03-1.09;p<0.001).Onmultivariable logisticregressionPH remains an independent predictor of in-hospital mortality (OR:1.08; 95%CI:1.04-1.12;p<0.001)inadditiontoage(OR:1.08;95%CI:1.01-1.17;p=0.044).MACCEwasobservedin11.4%andPASPwasanindependentpredictoronunivariableanalysis(OR:1.03; 95%CI:1.01- 1.04; p<0.001). On multivariable logistic regression PASP remains anindependentpredictorofMACCE(OR:1.02;95%CI:1.01-1.04;p=0.011)aswellashemodialysis(OR:7.16;95%CI:1.73-29.63;p=0.007).Theindependentpredictorsoflongtermmortalityweremalegender(p=0.011),olderage(p<0.001),higherbodymassindex(p=0.013),urgentsurgery(p=0.027), pulmonary disease (p=0.042) andmore than one valve procedure (p=0.004 for 2valvesandp=0.006for3valves).PASPwasnotanindependentpredictoroflongtermmortality(p=0.142). Compared with an age adjusted general population, patients with PH had asignificantlylowersurvivalrate(p<0.001),moreevident4yearsaftertheprocedure.Conclusions:HigherPASPisariskfactorforin-hospitalmortalityandMACCE,buttherewasnosignificantimpactonlongtermmortality.

CO16RAPIDDEPLOYMENTAORTICVALVESINELDERLYPATIENTS:AGEISNOTJUSTANUMBERTiago Velho1; Hugo Ferreira1; Nuno Guerra1; Catarina Carvalheiro1; André Sena1; NádiaJunqueira1;JoanaSilva1;RicardoFerreira1;JavierGallego1;ÂngeloNobre11-ServiçodeCirurgiaCardiotorácica-HospitaldeSantaMaria,CHLNIntroduction:Aorticvalvestenosis(AS)isthemostcommonvalvularpathologyintheelderly.Surgical aortic valve replacement (AVR) remains the gold-standard of treatment for AS.However,emergingtranscatheteraorticvalvereplacement (TAVR)hasbecomean increasingalternativetosurgery.InarecentsurveyfromtheEuropeanSocietyofCardiology,9,4%ofthephysiciansstatedthatagewasthemainreasontoproposeforaTAVRinsteadofsurgery.Methods: We performed a single-center retrospective study including 353 patients (149patientsover80years-old,comparedto204patientsbetween60-69years-old)consecutivelysubmittedtoAVRbetweenJanuary1,2013,andDecember31,2016,tocomparetheresultsofbothgroupsinAVRsurgeryandhowwecanimprovesurgeryoutcomeinolderpatients.Results: The demographic and clinical characteristics between the two groupswere similar.Therewerenosignificantdifferencesinsurvivalbetweenthetwogroupsat30days(96,57%60-69yovs.96,64%>80yo),12months(89,57%60-69yovs.93,51%>80yo)and24months(85,92%60-69yo vs. 87,62% >80yo). The postoperative complication rates were similar in the twogroups,excludingtherateofpost-operativeatrialfibrillation,higherinthe>80years-oldgroup(29,06%vs.17,28%,p=0,0147).ICUandaveragehospitallengthofstaywassimilarbetweenthetwogroups(p>0,05).Inallpatients,EuroscoreIIwasdirectlycorrelatedtointensivecareunitlengthofstay(p=0,0044).Inallpatients,extracorporealcirculationandaorticcross-clamptimeswere directly correlated to invasive ventilation time (p=0,0254 and p=0,0101) and to post-operativebleeding(p=0,0002andp=0,0015).However,inthesubgroupanalysis,aorticcross-clamp timewasdirectly correlated to ventilation time (p=0,0397) and to intensive careunitlengthofstay(p=0,0493)inthe>80yopatients,butthatwasnotverifiedinthe60-69yopatients(p=0,0942,p=0,3801,respectively).Conclusion: Survival rates are similar between the two groups, with similar post-operativecomplications. Post-operative atrial fibrillation and the use of blood andbloodproducts aremorecommoninpatientsover80years-old.Inolderpatients,lowerperiodsofextracorporealcirculationandaorticcross-clampmuchbeachievedtoreduceinvasiveventilationtime,post-operativebleedingandICUandhospital lengthofstay, improvingpost-operativerecovery. Ithasbeenshownthatrapiddeploymentaorticvalvesreduceextracorcoporealcirculationandaortic cross-clamp times, so theiruse inelderlypatientsmust improvesurgery recoveryandoutcome.CO17HEART TRANSPLANTATION: EARLY RESULTS OF TWO DIFFERENT REGIMES OFIMMUNOSUPPRESSIONCarlosBranco1;DavidPrieto1;AndréAntunes1;ManuelBatista1;ManuelJAntunes11-CCT-CHUCIntroduction: The management of induction and maintenance immunosuppression therapyafterhearttransplantation(HT)remainsacontroversial issue.Thedosageandthetiminghasbeenachangingtarget.Weaimedatevaluatethe incidenceofacutecellularrejection(ACR)[≥1Rgrade],majorinfectionandsurvivalinfirstyearafterHTinpatientsreceivingtwodifferent

inductionimmunosuppressionregimesandwithareductioninintensityoftriplemaintenanceimmunosuppressiondose.Methods: From November-2003 to June-2016, 317 patients were submitted to HT. Afterexcludingthosewithpediatricage(n=8),thosewithpreviousrenalorhepatictransplantation(n=2), those submitted to retransplantation (n=2), patients with early death withoutendomiocardialbiopsy(n=10)andthoseinatransitionmaintenanceregime(n=26),thestudypopulation resulted in 269 patients. These patients were divided in two groups: patientsreceivingthepreviousregimeoftwodosesofbasiliximab(groupA,n=211)andthosereceivingasingledoseofbasiliximab(groupB,n=58).Allthepatientsweretreatedwithamaintenancestandardtripleimmunosuppressiveregimenofcorticosteroids,aninhibitorofcalcineurinandmycophenolatemofetilbutmoreimmunosuppressiveloadingroupA.Results: Mean age of the recipients (group A vs. group B) was 54.6±10.6vs.55.0±9.8 years(p=0.808); 77.3%vs.75.9%weremale (p=0.861); 28.4%vs.28.1%werediabetic (p=0.957); andischemic etiology was present in 39.8%vs 41.0% of the patients (p=0.798), respectively. Nodifferenceswerefound,atfirstyear,betweenthetwogroupsconcerningglobalACRincidence(55.0%vs.56.9%,p=0.882,respectively)butmajorACR(≥2Rgrade)wasslightlysuperioringroupB (16.6%vs.27.6%, p=0.080, respectively). Time-free from major ACR at 3rd, 6th and 12thmonths was, respectively 91.0±2.0%vs.84.5%±4.8%; 86.7±2.3%vs.74.1±5.7%; and83.4±2.6%vs.72.4±5.9%(p=0.048).Time-freefrommajorinfectionat3rd,6thand12thmonthswas,respectively89.6±2.1%vs.82.8±5.0%;87.7±2.3%vs.79.3±5.3%;and84.4±2.5%vs.79.3±5.3%(p=0.253). No differences were found concerning survival at 3rd, 6th and 12th months(94.3±1.6%vs.94.8±2.9%; 92.4±1.8%vs.93.1±3.3%; and 90.0±2.1%vs.91.4±3.7%, (p=0.771)respectively).Conclusion: with this study, we verified that lowering doses of induction andmaintenancetherapy was responsible for increase cases of major ACR at first year of heart transplant.However, no differences were found concerning the incidence ofmajor infection and earlysurvival.Hence,effectiveimmunosuppressioninductionregimencanapparentlybedonesafelywithasingledoseregimewithoutcompromisingsurvivalatfirstyearafterHT.CO18TWOYEARSOFEXPERIENCEINTHEIMPLANTATIONOFHEARTMATEIIIVítorMendes1;CandidoCerca1;MoniqueCrosset1;MatthiasKirsch11-CentreHospitalierUniversitaireVaudois-LausanneIntroduction: Left ventricular assist devices as long-termmechanical circulatory support areincreasinglyusedasanoptionformedicallyrefractoryadvancedheartfailure.HeartmateIIIisoneofthealternativedevicesforcirculatorysupport inthosepatients.Objectives:AnalyzeatwoyearsHeartmateIIIimplantationProgram.Methods: FromNovember2015 toAugust2017,Heartmate IIIwas implanted in16patientswithchronicend-stageheartfailure,in81%(n=13)asabridgetotransplantand19%(n=3)asdestination therapy. We did a review off demographic, clinical and surgical data, and weanalyzed the overall survival using the Kaplan-Meier method, excluding patients who weretransplanted.Results:Heartmate IIIwas implanted in16malepatients (100%)withage55.8±11.1 years(limits 38-74 years) and body surface area 2.0 ± 0.19m2. The baseline hemodynamic datarevealedacardiacindex2.1±0.4l/min/m2andaleftventricularejectionfractionof20.7±7.3%. Ischemic cardiomyopathywas themost common etiology in this chronic heart failurepopulation(n=9;56%).Sevenpatients(44%)wereclassifiedINTERMACS4;five(31%)inprofile2; three (19%) in profile 3 and one (6%) in profile 1. The implantation of the devices was

performedunderCardiopulmonaryBypass(78.6±25.7min),and25%ofthepatients(n=4)hadright ventricular dysfunction, requiring postoperative temporary right ventricle support. Ascomplications, 6patients (38%)manifestedbleeding requiring surgery and2 (12%) reportedgastrointestinalbleeding,4(25%)developeddrivelineinfection,3ofthemweretreated(18%)withconservativetherapyand in1patient(6%)withdrivelinetransposition.Duringthetotalfollow-uptime(19months),threepatients(18%)weretransplanted;twodeathsoccuredduetopulmonaryembolismandischemicstrokerespectively;verifiedbytheKaplanMeiermethod,anoverallsurvivalrateof92.9±6.9%,stablefrom6monthsafterimplantation.Conclusion: The 6months survival rate of 92.9%proves the efficacy of this therapy for ourpatientsandallof themwere INTERMACSprofils lower than4.Despite thesmallnumberofpatients enrolled and the follow-up duration limiting our study, we demonstrated the firstexperienceofourcenterinthetreatmentofhigh-riskpopulation.Inconclusion,weshowthattheHeartmateIIIwasconsistentinlowINTERMACSprofilepatients.CO19FREEDOM SOLO VERSUS TRIFECTA BIOPROSTHESES: CLINICAL AND HEMODYNAMICEVALUATIONAFTERPROPENSITYSCOREMATCHINGRuiJ.Cerqueira1,2;RenataMelo1;SoraiaMoreira1;FranciscaA.Saraiva1;MartaAndrade1,2;ElsonSalgueiro1,2;JorgeAlmeida1,2;MárioJ.Amorim1,2;PauloPinho1,2;AndréP.Lourenço1,3;AdelinoF.Leite-Moreira1,21-DepartamentodeCirurgiaeFisiologia,FaculdadedeMedicina,UniversidadedoPorto;2 -Departamento de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto; 3 -DepartamentodeAnestesiologia,CentroHospitalardeSãoJoão,PortoIntroduction: To compare stentless Freedom Solo and stented Trifecta aortic bioprosthesesregardinghemodynamicprofile,leftventricularmassregression,earlyandlatepostoperativeoutcomesandsurvival.Methods: Longitudinal cohort study of consecutive patients undergoing aortic valvereplacement (from 2009 to 2016)with either Freedom Solo or Trifecta at one centre. Localdatabases andnational recordswerequeried. Postoperative echocardiography (3-6months)was obtained for hemodynamic profile (mean transprosthetic gradient and effective orificearea)and leftventriclemassdetermination.Afterpropensityscorematching (21covariates),Kaplan-Meier analysis and cumulative incidence analysis were performed for survival andcombined outcome of structural valve deterioration and endocarditis, respectively.Hemodynamics and left ventricle mass regression were assessed by a mixed-effects modelincludingpropensityscoreasacovariate.Results: From a total sample of 397 Freedom Solo and 525 Trifecta patientswith amedianfollow-uptimeof4.0(2.2-6.0)and2.4(1.4-3.7)years,respectively,amatchedsampleof329pairswasobtained.Well-balancedmatchedgroups showednodifference in survival (hazardratio=1.04, 95% confidence interval=0.69-1.56) or cumulative hazards of combined outcome(subhazardratio=0.54,95%confidenceinterval=0.21-1.39).AlthoughTrifectashowedimprovedhemodynamicprofilecomparedtoFreedomSolo,nodifferenceswere found in leftventriclemassregression.Conclusion:TrifectahasaslightlyimprovedhemodynamicprofilecomparedtoFreedomSolobut this does not translate into differences in the extent ofmass regression, postoperativeoutcomes or survival, which were good and comparable for both bioprostheses. Long-termfollow-upisneededforcomparisonswitholdermodelsofbioprostheses.

CO20ISOLATEDTRICUSPIDVALVESURGERY:REPAIRVERSUSREPLACEMENTManuelaSilva1;RuiCerejo1;PedroCoelho1;FragataJosé11-HospitaldeSantaMarta,CentroHospitalarLisboaCentralIntroduction:Isolatedtricuspidvalvesurgery(ITVS)isanuncommonprocedurewithfewstudiespublished.WereportourseriesofITVSandcomparesurgicaloutcomesandmortalityinpatientsundergoingvalverepair(TVR)versusreplacement(TVRep).Methods:RetrospectivestudyincludingallpatientswhounderwentITVS(n=34)betweenJuly2008andJune2017,dividedintwogroupsaccordingtotypeofprocedure:TVR20patientsandTVRep 14 patients. We reviewed preoperative characteristics and analysed operative data,outcomesandmortalityinbothgroups.Results:Thirty-fourpatientsunderwentITVS,meanage58,1±15,9years,50%femaleandmeanBMI 26,1kg/m2. TVRwas performed in 58,8%and TVRep in 41,2%of patients. Patients hadsimilardemographicandbaselinecharacteristics,except forpreviouscardiac surgery (TVRep78,6%vs.TVR35,%,p<0,05).MeanlogisticEuroSCOREwas10,1%forTVRepand6,6%forTVR(p<0,05).Etiologieswerefunctionalinsufficiency(68%),endocarditis(18%),degenerative(9%),rheumatic(3%)andcongenital(3%).TVRwasthepreferredsurgicalapproach.Ringannuloplastywas performed for all TVR and bioprosthesis was used for all TVRep. Postoperativecomplicationswere:needfortransfusionalsupport(76,5%), inotropicsupportlongerthan48hours (38,2%), prolonged invasive ventilation over 24 hours (35,3%), new onset of atrialfibrillation(11,8%),duplicationorpostoperativecreatinineover2mg/dl(8,8%),dialysis(8,8%),stroke(5,9%),intra-aorticballoonpump(5,9%),permanentpacemakerimplantation(2,9%)andsepsis (2,9%).TVRepwasassociatedwithsuperior lengthof surgery (TVRep291vs.TVR186minutes),longerICUstay(TVRep17,1vs.TVR2,8days),longerhospitalstay(TVRep37,1vs.TVR11,7 days), prolonged invasive ventilation (TVRep 71,4% vs.TVR 10%) and longer inotropicsupport(TVRep78,6%vs.TVR10%)(p<0,05).Overall30-dayand1-yearmortalitywere8,8%and17,6%,respectively.Typeofprocedurewasnotassociatedto30-daymortality(TVRep14,3%vs.TVR5%,p<0,05),butTVRepwasassociatedwithhigher1-yearmortality(TVRep35,7%vs.TVR5%,p<0,05).Conclusions:TVRshowedbetteroutcomes,withlesspostoperativecomplicationsandmortalitythanTVRep.Thisdifferencecannotbelinkedtotypeofpathology,althoughpatientsinthelattergroupmaybeassociatedtogreatercomplexity,withhigherriskandwereoftenreoperations.CO21AORTIC VALVE REPLACEMENT WITH PERCEVAL® BIOPROSTHESIS: INITIAL SINGLE-CENTEREXPERIENCEDiogo Rijo1; Sara Simões Costa1; João Pedro Monteiro1; Fátima Neves1; Luís Vouga1; PauloNeves1;PauloPonce1;MiguelGuerra1,21-CentroHospitalarVilaNovadeGaia/Espinho;2-ServiçodeCirurgiaeFisiologiadaFaculdadedeMedicinadoPortoIntroduction:Aorticvalvereplacement(AVR)isthegoldstandardforthetreatmentofsevereor symptomatic aortic valve stenosis. Less invasive procedures have been developed as analternativetotheconventionaltechniqueoffullsternotomyapproachwithstentedprosthesis.ThePerceval®aorticvalve(LivaNova,Milan,Italy)isasuturelessbioprosthesis,ofwhichseveral

reports have shown promising results in terms of mortality, morbidity and hemodynamicperformance,especiallywithalessinvasiveapproach.Methods: Between March 2016 and September 2017, 43 patients underwent AVR withPerceval®bioprosthesis.Themeanagewas74.3±6.8years,24(55.8%)patientswerefemale,andthemeanEuroSCOREIIwas4.1±0.6.ConcomitantprocedureswereCABG(n=11;25.6%),mitralvalvesurgery(n=2;4.7%)andtricuspidvalvesurgery(n=1;2.4%).Results:IsolatedAVRwereperformedin31patients(72%),withalessinvasiveapproachin29cases(67%),ofwhich20patientswithupperministernotomyand9patientswithrightanteriormini-thoracotomy. Cardiopulmonary bypass and cross- clamp times were 69.8±26.6 and49.2±18.1 minutes for isolated AVR and 106.1±32.6 and 82.9±24.9 minutes for combinedprocedures,respectively.Preoperativepeakandmeangradientswere81.6±24.8and49.7±16.1mmHg, decreasing to 22.4±10.2 and 11.9±5.8 mmHg, respectively, during follow up (mean9.1±6.0months).Themeaneffectiveorificeareaimprovedfrom0.77±0.18to1.83±0.45cm2,andmeanleftventricularejectionfractionfrom55.0±10.0to55.2±8.4%;meanleftventricularmassdecreasedfrom221.6±55.7to180.2±42.4g/m2.Trivialparavalvularleakageoccurredin2patients, without clinical relevance. Five patients (11.6%) needed pacemaker implantationbecause complete heart-block before discharge (in 4 patients postdilationmodellingwasn’tperformed).In-hospitalmortalitywas9.3%(n=4),allnon-valverelated(meanEuroSCOREIIof9.15±4.0).Conclusion: AVR with the Perceval bioprosthesis is associated with lowmortality rates andexcellent hemodynamic performance. Sutureless technology may reduce operative times,especiallyincombinedprocedures,makingminimallyinvasiveAVRmoreeasilyreproducible.CO22ARTERIALSWITCH:HOWTOPREDICTREOPERATIONCarolinaRodrigues1;RuiCerejo11-HospitaldeSantaMartaIntroduction:Jatenesurgeryorarterialswitchisperformedatourinstitutionsince1989.Itismandatorytosubmitourresultstoanevaluationthatallowustoidentifythemaincausesofreoperation and, more importantly, to determine what variables predict the need ofreoperation.Methods: In this retrospective analysis were included all the 91 patients with d-TGA whounderwentanarterialswitchoperationatSantaMartaHospitalbetween1999and2016.Results:Meanfollow-upwas6years(range1-21years).71%ofthepatientshadsimpleTGAand29%hadcomplexTGA.Theneedofreoperationwas21%(n=19).Pulmonaryarterystenosiswasthemain(47%)indicationforreoperation.Theoverallcumulativemortalitywas 9.9%. The gender (P= 0.8), diagnosis (simple or complex TGA) (P= 0,5) or theexistence of previous surgeries(P=0.9)were unable to predict the need of reoperation. Thepresenceofcoronarypatternsanomalieswastheonlyvariablereachingstatisticalsignificance(P<0.05),bothinunivariateandmultivariateanalysis.Conclusion:Inourseries,themainindicationforreoperationafterarterialswitchoperationwaspulmonaryarterystenosisandtheonlypredictivevariablewasthepresenceofcoronaryanomalies.

CO23FROZEN ELEPHANT TRUNK WITH E-VITA OPEN HYBRID PROSTHESIS FOR SURGICALCORRECTIONOFMULTISEGMENTALTHORACICAORTICPATHOLOGY:REVIEWOFRESULTSAntónioCruzTomás1;ÁlvaroLaranjeiraSantos1;JorgePinheiroSantos1;DanielaVarela-Afonso1;JoséFragata11-HospitaldeSantaMartaIntroduction:TheFrozenElephantTrunk(FET)surgeryallowscorrectionofascending,archandproximaldescendingaorticpathology,usingahybridprosthesisatthesametime.Itisacomplexinterventionandrequiresamultidisciplinaryteamthat,besidesschedulingandperformingthesurgery, accompanies the patient (pt) throughout the postoperative period. Objectives: Toreviewshortandmediumtermclinicalresultswiththistechnique.Methods:BetweenJanuary2010andSeptember2017,weoperated34patients(pts)usingFET.Thesurgerywasperformedundercardiopulmonarybypass(CPB)withcardio-circulatoryarrestindeephypothermia,alwayswithbilateralantegradeselectivecerebralprotectionandundernoninvasive neuromonitorization. Antegrade and retrograde, hematic, cold, intermittentcardioplegia was used. All patients were followed in our outpatient clinic with imagingtechniques.Results:Themeanageoftheptswas62.8±11.5years,16males.Themeanfollow-upperiodwas 18.7 ± 16.1months. Diagnoses were: chronic type A dissection 9 pts, ascending aorticaneurysmanddistalarch9pts,pseudoaneurysm1pt,mega-aortasyndrome11pts.Noptwasoperatedinacutesituation.Sevenpts(20.6%)werereoperationsandin4pts(11.8%)associatedcardiacprocedureswererequired.Theleftsubclavianwasconservedin24pts(70.6%).CPB, aortic clamping and distal ischemia mean times were, respectively; 260, 149 and 54minutes.Hospitalmortalityoccurredinfivepts(14.7%),3ofwhichatthebeginningoftheseries,due to mesenteric ischemia. The hospital morbidity consisted of: ventilator-associatedpneumonia3pts(8.8%),stroke2pts(5.9%),perioperativeinfarction1pt(2.9%)andparaplegia1pt (2.9%).Sevenpts (20.6%)required9endovascularre-interventions(TEVAR) inthedistaldescendingaortaandintwooftheseanabdominalfenestratedendoprosthesiswasimplantedby the vascular team. Three pts presented early type IIB endoleaks, which resolvedspontaneouslyinfollow-upCT.Amongtheotherstherewerenoendoleaksandtheexpectedinvolution of the aneurysmal sac and positive remodeling of the aorta was observed. Allsurvivorsareclinicallystable,asymptomatic,inclassNYHAI.Conclusion:Theoverallresultsareinlinewiththeliterature.Mesentericischaemiaistheleadingcauseofin-hospitaldeath.FETisasafeandeffectiveintervention.Theexpandablesegmentofthehybridprosthesisisanexcellentlandingzonetocompletetheprocedure,whennecessary,withthesecondstageTEVAR.Survivorsacquireanexcellentqualityoflifeinthemediumterm.Clinicalfollow-upandlifelongimagingtechniquesaremandatory.CO24CAROTIDSTENOSISINCARDIACSURGERYPATIENTSPedroPintoSousa1;GabrielaTeixeira2;JoãoGonçalves2;CarlosVeiga2;PedroSáPinto2;PedroBrandão1;AlexandraCanedo1;LuisVouga1;RuiAlmeida21-CentroHospitalarVilaNovadeGaia/Espinho;2-CentroHospitalardoPortoIntroduction: Ischemic stroke is a potential perioperative complication after an open heartsurgery(OHS).Whetheracarotidstenosisorocclusionisassociatedwithanincreasedriskof

perioperativestrokeinpatientsorjustariskfactorhasbeenaconcernofintensedebateintheliterature.Methods: We retrospectively analyzed patients submitted to OHS between January andDecember2016withknownasymptomaticcarotiddisease.The data from 85 consecutive patients undergoing coronary artery bypass grafting, valvereplacement,orbothwascollected.Thefinaleventsregisteredwerestroke,acutemyocardialinfarctordeath.Ouraimwastoassesswhetherthepresenceofcarotidstenosisprecludedahigherrateofstrokeaftercardiacsurgery.Results:70maleand15femalepatients,withamediumageof74(min45,max84)yearswereanalyzed.45(53%)patientsweresubmittedtobypassgrafting,21(25%)tovalvereplacementand19(22%)toboth.Ofthesepatients,42(49%)hadunilateralsignificantcarotidstenosisequalorgreaterthan50%,12(14%)hadbilateralsignificantstenosisand20(24%)hadastenosisequalor greater than70%. 2(2%) patients had a previous history of neurologic event. In the peri-operativeperiod,3patients(3,5%)developedtransientischemicattack(TIA)orstroke,3(3,5%)acardiaceventand6(7%)patientsdied (3due toacardiaceventand2due toaneurologicevent). Two (67%) of the neurologic events occurred in the corresponding side of anhemodynamic carotid stenosis although both this patients had also significant aortic archcalcificationandatrial fibrillation.Noneof thepatients thatdevelopedpost-operativeTIAorstrokehadpreviouslyaneurologicevent.Conclusion: Some studies reported an average stroke incidence around 1.9%following OHS.Despitecarotidstenosis,otherriskfactorsshouldbetakenintoconsiderationbeforeconsideringOHS such as advanced age, prior stroke/TIA, unstable angina, predicted prolonged time forcardiopulmonary bypass, severe aortic arch disease and atrial fibrillation. In our studiedpopulation twoof thepost-operativeneurologic events occurred in patientswith significantbilateralstenosis,onesidebetween50-69%andtheotherside70-99%.Accordingtothenewguidelines“ManagementofAtheroscleroticCarotidandVertebralArteryDisease:2017ClinicalPracticeGuidelinesoftheEuropeanSocietyforVascularSurgery”stagedorsynchronouscarotidinterventionmaybeconsideredforOHSpatientswithbilateralasymptomatic70-99%carotidstenosis,ora70-99%stenosiswithcontralateralocclusion.Ourresultsmaysuggestthatasub-groupofpatientswithbilateralsignificant(>50%)carotidstenosismaybenefitfromstagedorsynchronouscarotidintervention.CO25CARDIACCATHETERIZATIONAFTERCABGWITHBIMAGRAFTING:INDEPENDENTPREDICTORSANDMID-TERMBYPASSVIABILITYFranciscaA.Saraiva1;MartaTavares-Silva1,4;RuiJ.Cerqueira1,2;MárioJ.Amorim1,2;AnaFilipaFerreira1;PauloPinho1,2;AndréP.Lourenço1,3;AdelinoF.Leite-Moreira1,21-DepartamentodeCirurgiaeFisiologia,FaculdadedeMedicina,UniversidadedoPorto;2 -Departamento de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto; 3 -DepartamentodeAnestesiologia,CentroHospitalardeSãoJoão,Porto;4 -DepartamentodeCardiologia,CentroHospitalardeSãoJoãoIntroduction:Coronaryarterybypassgraft(CABG)patencyisanimportantvariable,butrarelystudiedasthemainoutcome.Thebestuseofbilateralinternalmammaryartery(BIMA)graftingregardingconfigurationtypeorcombinationwithsaphenousveingraft(SVG)isstilldebated.Purpose:TofindindependentpredictorsforneedofcardiaccatheterizationandforsignificantlesionsinCABGfollow-up.Methods:RetrospectivecohortincludingallpatientswhounderwentisolatedCABGwithBIMAgraftsbetween2004and2013inatertiarycenter.Preoperative,surgicalandpostoperativedata

were collected through clinical files and informatics databases. Kaplan-Meier curves, Coxregressionandlogisticregressionwereusedtofindpredictorsfortheneedofcatheterizationand for significantangiographic lesionsafterCABG.Secondaryend-points studiedweremid-termsurvivalandneedofre-revascularizationeithersurgicallyorpercutaneously.Results:Weincluded1030patientsinthisanalysis.Medianfollow-uptimewas5.5yearsand150(15%)patientswerere-catheterizedinthatperiod.Mostoftheseprocedureswasduetoischemia suspicion (74%) and 61 (41%) were positive for significant angiographic lesions ofconduits(IMA:3.2%andSVG:3.8%,p=0.488).Inmultivariateanalysis,SVGusewasfoundasanindependentpredictorofcardiaccatheterizationonfollow-up(HR:1.610,CI95%:1.038-2.499,p=0.034).On theother side, independent predictors of graft lesionswere younger age (OR:0.951,CI95%:0.921-0.982,p=0.002),femalegender(OR:2.231,CI95%:1.038-4.794,p=0.040),arterialhypertension(OR:1.968,CI95%:1.022-3.791,p=0.043)and3-vesseldisease(OR:2.820,CI 95%: 1.155-6.885, p=0.023). Among the patientswith significant angiographic lesions, 48underwentrepeatrevascularization(44PCIe4CABG).Arterialhypertensionandyoungeragewereindependentpredictorsofre-revascularization.Conclusion:InBIMApatientstheadditionofSVGpredictstheneedofcatheterization;howeverprevalenceofsignificantangiographiclesionswassimilarinIMAandSVG.Ourresultssuggestthatarterialhypertensionisanindependentpredictorofgraftpatencyandre-revascularizationrate.CO26TEVAR–APRIMARYORADJUNCTPROCEDUREHELPFULINTHESURGICALCORRECTIONOFCOMPLEXPATHOLOGYOFTHETHORACICAORTAAntónio Cruz Tomás1; Álvaro Laranjeira Santos1; Jorge Pinheiro Santos1; Daniela Varela-Afonso1;JoséFragata11-HospitaldeSantaMartaIntroduction: Thoracic Endovascular Aortic Repair (TEVAR) made possible the treatment ofaorticdiseasethatpreviouslycouldonlybeapproachedopenly,associatedwithaconsiderablemorbidityandmortality.However,italsobringsnewchallengesinfluencingpatientselection-favourable landingzone,goodperipheralaccess,propensity forendoleak (EL) - that requiresrigorousclinicalandimagingfollow-up.Objective:ReviewallpatientsthatunderwentTEVARinourDepartmentandassessmorbidityandmortality.Methods: From November 2007 to September 2017, 57 TEVAR were performed in ourDepartmentto52patients.AllpatientsperformedpostoperativeCTangiographywithin30daysafter surgery. Follow-upwas carried in ourOutpatient Clinicwith annual imaging. StatisticalanalysiswasperformedwithSPSSTM22(©IBM).Results:Patients’meanagewas65.6±10.3yearsand69.2%weremale(n=36).Meanfollow-upwas48.1±34.1months.Themostfrequentsurgicalindicationwasthoracicaorticaneurysm(42.1%), followed by chronic type B aortic dissection (35.1%), pseudoaneurysm (10.5%),reinterventionbyEL(7.0%),penetratingaorticulcer(3.5%)andtraumaticdissectionoftheaorta(1.8%).Surgerywaselectivein87.7%ofcasesandpartofadualstagestrategyin17.3%.In-hospital mortality was 3.9%. Survival at 1, 2 and 5 years was 87.9%, 85.6% and 71.5%,respectively. Reported complications were: need for endovascular reintervention 7.7%;complicationoffemoralaccess7.7%;andcerebellarinfarction1.9%.Throughoutfollow-up,noELwasdetected in56.1%ofpatients.Therewasan incidenceofearlyEL in38.4%,ofwhich45.0%hadspontaneousresolution,documentedinsubsequentCTscans.Themostfrequentwastype IA (42.9%) thatwasalso theonewith thehighest spontaneous resolution rate (62.5%).MeantimetodiagnosisoflateELwas36.9±21.4monthsandoccurredin11.5%ofpatients,the

mostfrequentbeingtypeIA(50.0%);therewasnospontaneousresolutionobserved.InallcasesofreinterventionduetoELagoodsurgicalresultwasobtained.Conclusion:TEVARisaprocedurewithlowmorbidityandmortality,goodlong-termoutcomeandarelatively lowincidenceofEL.MostpatientsdonothaveELduringtheirfollow-upandhaveanexcellentsurvival.ThemostfrequentearlyEListypeIAandabouthalfresolveinthefollowingmonths.Althoughrare,lateELdidnotpresentspontaneousresolution.ThetreatmentofELcaneasilybeachievedwithnewinterventionandexcellentresult.CO27POSTOPERATIVE ATRIAL FIBRILLATION AFTER CORONARY ARTERY BYPASS GRAFTINGSURGERYAna Filipa Ferreira1; Francisca A. Saraiva1; Raquel Moreira1; Rui J. Cerqueira1,2; Mário J.Amorim1,2;PauloPinho1,2;AndréP.Lourenço1,3;AdelinoF.Leite-Moreira1,21-DepartamentodeCirurgiaeFisiologia,FaculdadedeMedicina,UniversidadedoPorto;2 -Departamento de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto; 3 -DepartamentodeAnestesiologia,CentroHospitalardeSãoJoão,PortoIntroduction:Postoperativeatrialfibrillation(PoAF)isthemostcommonarrhythmiafollowingcardiacsurgery,whichincreasethepatient’smorbidityandmortality.Purpose:Theaimofthisstudywastoevaluatenewonsetofatrialfibrillation(AF)afterisolatedcoronaryarterybypassgrafting(CABG)surgery,itsclinicalandsurgicalpredictors,anditsimpactinimmediateandlong-termoutcomes.Methods: Retrospective study including all CABG surgeries performed in a tertiary centre,between2004and2011.PatientswithdocumentedepisodesofAForpacing rhythmbeforecardiac surgerywereexcluded.Preoperative, surgical andpostoperativedatawere collectedthroughclinicalfilesandinformaticsdatabases.Qui-squaretestsandindependentt-testswereused to compare categorical and continuous data, respectively, between patients with andwithoutPoAF.Amultivariate logistic regressionmodelwasusedto identify independentriskfactorsofPoAF.TodeterminetheeffectofPoAFinlong-termsurvival,weusedKaplan-Meiercurves,LogRanktestandmultivariateCoxregression(maximumfollow-uptime:13years).Results:Weincluded2511patients,meanageof63±10years,78.7%beingmale.PoAFoccurredin450patients (18.0%), 3±3days after surgery, themajoritypharmacologically cardiovertedwith amiodarone (96.2%). These patientswere older (67±9 vs. 62±10 years, p<0.001),morefrequentlyobese(27.8%vs.22.9%,p=0.026),hypertensive(76.7%vs.69.7%,p=0.003)andhadlowerpreoperativecreatinineclearance(CC)values(73.2±27.4vs.81.4±28.3ml/min,p<0.001),longer cardiopulmonary bypass time (60.0% vs. 54.8%, p=0.043) compared with patientswithout PoAF. Inmultivariate analysis, older age (OR: 1.035, 95% CI: 1.015-1.056, p=0.001),lowerpreoperativeCCvalues (OR:0.992,95%CI:0.985-0.999,p=0.032)and larger leftatrialdiameter(OR:1.058,95%CI:1.024-1.093,p=0.001)weredeterminedasindependentpredictorsofPoAF.Thesepatientsalsorevealedlongerhospitalizationtime(8[4to193]vs.6[4to114]days, p<0.001) and higher hospital mortality (2.9% vs. 0.8%, p<0.001). Regarding long-termsurvival,patientswithPoAFshowedlowercumulativesurvivalthanpatientswithoutAFevents(52% vs. 66%, p<0.001). PoAF was also found as an independent predictor of mortality inmultivariateCoxregression(HR:1.394,95%CI:1.147-1.695,p=0.001).Conclusion:PoAFincidenceafterCABGsurgerywas18%.Olderage,lowerCCvaluesandlargerleftatrialdiameterweresettledasPoAFindependentpredictors.Additionally,theoccurrenceof this arrhythmia was independently associated with lower long-term survival, after CABGsurgery.

CO28BILATERALINTERNALTHORACICARTERYGRAFTINGINPATIENTSWITHDIABETESMELLITUSAnaBraga1;PedroMagro1;MiguelSousaUva1;MiguelAbecasis1;JoséPedroNeves11-HospitaldeSantaCruzIntroduction:Bilateralinternalthoracicartery(BITA)graftinginpatientswithdiabetesmellitusiscontroversialduetoahigherriskforsternalinfection.Thepurposeofthisstudyistocomparethe ratesofmediastinitisaswellasmortality ratesofBITAgrafting to thatof single internalthoracicartery(SITA)graftingandsaphenousveingraftsinpatientswithdiabetes.Methods: Between2007and2015all consecutivediabeticpatientswithmultivesseldiseasewhounderwentprimarycoronaryarterybypassgraftsurgerywithBITAwerecomparedwithpatientswhounderwent coronaryarterybypassgraft surgerywithSITAand saphenousveingrafts(thecontrolgroup).Patientssubmittedtosinglegraftswereexcludedfromtheanalysis.Propensityscorematchingwasusedtoaccountfordifferencesbetweengroupsinpreoperativecharacteristics.Thefrequencyofperi-operativemediastinitiswascomparedbetweenBITAandcontrol group. Mortality rates between were compared between groups at 1-month post-surgeryand2-yearpost-surgery.Results: A total of 1005 patients were included in our sample in which 188 (19%) patientsperformedBITAgrafting.BITApatientswereyounger(BITAgroupmeanage60.0yearsvscontrolgroup 69.9 years; p<0.001), less often female (BITA group 11.7% vs control group 28.2%;p<0.001), and less often insulin treated (BITA group 9.6% vs control group 18.8%; p=0.002)comparedtothecontrolgroup.Allothercharacteristicswerenotstatisticallydifferentbetweengroups, namely CCS, NYHA score, three vessel coronary artery disease, left main disease,previous myocardial infarction, hypertension, COPD and body mass index. After propensityscorematching,344patientswereincludedintheanalysis,138intheBITAgroupand206inthecontrolgroup.Inthisanalysisbothgroupswerenotstatisticallydifferentineverycharacteristicevaluated including age, sex and insulin-treateddiabetic patients. The rateof peri-operativemediastinitis in matched groups was comparable (BITA group 2.3% vs control group 1.5;p=0.605). Mortality rates were comparable between groups at 1-month post-surgery (BITAgroup1.4%vscontrolgroup0.5%;p=0.346)and2-yearpost-surgery(BITAgroup3%vscontrolgroup2%;p=0.557).Conclusion: The findings of this sample suggest that the short and mid-term outcomes ofpatientswithdiabetesandmultivesseldiseasewhoundergoBITAgrafting is similar toothergrafting procedures. BITA grafting in diabetic patients seems to be safe in terms of sternalwound problems. Longer term follow-up is required to determine BITA grafting survivalimprovement.CO29DAVIDOPERATIONINTHEBICUSPIDAORTICVALVEPOPULATIONPedroMagro1;MartaMarques1;MiguelAbecasis11-HospitaldeSantaCruzIntroduction: Bicuspidaortic valve (BAV) is the singlemost commoncardiac congenitalmal-formationwithaprevalenceof1-2%. It is frequentlyassociatedwithaorticdisease includingannularectasia. Increasingevidencesuggests thatvalve-sparing root re-implantationsurgerycombined with primary aortic valve repair can be performed with goodmidterm results inpatientswithBAV.

Methods:OurobjectiveistocomparetheshortandlongtermresultsofDavidprocedureinBAVpatientswithaorticrootectasia.Retrospectiveanalysisofourinstitution’sdatabaseretrieved42 patients with aortic annular ectasia who underwent valve-sparing root re-implantationsurgerywithDavidtechnicfrom2007to2015.Thiscohortincluded11patientswithBAVand31with tricuspidaorticvalve (TAV).Pre, intraandpost-operativevariablesof these twogroupswere statistically analyzed using univariate analysis. Continuous variables are expressed asmeans+-standard deviation. Categorical variables are expressed as percentages. Univariateanalysiswas performedusing students t-test for continuous variables and x2 for categoricalvariables. Long-term survival and freedom from re-intervention was analyzed using Kaplan-Meiercurves.Results:Follow-upwasachievedin100%ofcaseswithanaveragefollow-upof60months.Meanageofthestudiedpopulationwas50years.ComorbiditiesanddemographicsweresimilarintheBAVandTAVgroupswiththeexceptionofayoungeroperativeageintheBAVgroup(p=0,028).Meancardiopulmonarybypasstimeandmeanischemictimewas162’and133’respectively.Combinedprocedureswereperformedin3(7,1%)ofpatients.TheBAVgroupshowedlongercardio-pulmonarybypasseaorticcross-clamptimes(p=0,024;p=0,022)andauniversalneedforaorticplasty.Short-termresultsandcomplicationsweresimilarinthetwogroupswiththeexception of a higher need for pacemaker implantation in the BAV group (p<0,001). Post-operativeresultsincludingin-hospitalmortality,stroke,AMI,pre-dischargeechocardiographicevaluationandlong-termsurvivalandfreedomfromre-interventionweresimilarbetweenthetwogroups.Conclusion: Our experience reinforces the idea that, however challenging, the aortic valvesparing re-implantationprocedure in thesettingofBAV,hasacceptableshortand long-termresults,similartothoseobservedinTAVpatients.ThepitfallsofthissettingaretheuniversalneedforaorticvalveplastyandhigherriskforAVblock.Amoresignificantcohortofpatients;echocardiographic long-term evaluation and long-term comparison with the gold-standardtechnic(Bentallprocedure)mayfurtherclarifythebenefitsofthisapproachinBAVpatients.CO30CLINICAL UTILITY OF FRAILTY SCALES FOR THE PREDICTION OF POSTOPERATIVECOMPLICATIONS:SYSTEMATICREVIEWANDMETA-ANALYSISVâniaRocha1,2,3;FilipeMarmelo1,2;AdelinoLeite-Moreira1,2;DanielMoreira-Gonçalves1,2,4,51-DepartamentodeCirurgiaeFisiologia;2-FMUP;3-HospitaldeSãoMartinho;4-CIAFEL;5-FAEUPIntroduction:Frailtycanbedefinedasabiologicalsyndromeofreducedreserveandresistanceto stressful events. Evidence suggests that this syndrome is linked to adverse outcomes invarious surgical populations. Several instruments have been developed to measure frailty,howeverthereisnoconsensusaboutwhichoneisthemostusefulinthesurgicalpopulation.Therefore,thisstudyaimstoevaluatetheutilityofdifferentfrailtyscalesinthepredictionofpostoperativecomplicationsinoldersurgicalpopulation.Methods:Thisreviewandmeta-analysisassemblesprospectivecohortstudiesreportingfrailtyandpostoperativeoutcomes.SearcheswereperformedinPubMed/Medline,Scielo,CochraneLibraryandScienceDirectdatabases.StatisticalanalyseswasperformedusingReviewManagersoftwareandthepooledOddsRattioswascalculated.Results: A total of 15 articles were included in the present review. Frailty was significantlyassociatedwithpostoperativecomplications(OR=2.53,95%CI:2.07-3.10;p<0.00001),mortalityuntil30days(OR=3.49,95%CI:2.40-5.09,p<0.00001)andhigher1-yearmortality(OR=2.90,95%CI:1.99-4.24,p<0.00001),andwithhospital lengthofstay>5daysor>14days (OR=2.78,

95%CI:1.45-5.30,p=0.002andOR=2.40(95%CI:1.08-5.36,p=0.03,respectively).Inaddition,ourmeta-analysisshowedthatfrailtyisasignificantpredictorofrenalfailure(OR=5.03,95%CI:1.74-14.54, p=0.003), neurological complications (OR= 3.41, 95% CI: 1.08-10.73, p=0.04),respiratorycomplications(OR=9.21(95%CI:2.35-36.02,p=0.001),woundinfection(OR=2.85(95%CI:1.65-4.94,p=0.0002)andsepsis(OR=3.84(95%CI:1.37-10.71,p=0.01).Conclusion:Overall,frailtysignificantlyincreasestheriskfordevelopingadverseoutcomesaftersurgery,soearlydetectionoffrailtymaybeawindowofopportunityforinterventionandakeyfactor for improving clinical outcomes. Moreover, future studies are required for thestandardizationofthefrailtyscalesused.CO31LONG-TERM OUTCOMES IN OCTOGENARIANS FOLLOWING ISOLATED AORTIC VALVEREPLACEMENTSaraSimõesCosta1;DiogoRijo1;JoãoPedroMonteiro1;DanielMartins1;NelsonSantosPaulo1;LuisVouga1;MiguelGuerra1,21-ServiçodeCirurgiaCardiotorácica,CentroHopsitalardeVilaNovadeGaia/Espinho,EPE;2-DepartamentodeCirurgiaeFisiologia,FaculdadedeMedicinadaUniversidadedoPortoIntroduction: Isolated aortic valve replacement (AVR) in elderly patients is associated withincreased operative risk, due to higher prevalence of associated risk factors and othercomorbidities,makingoutcomepredictionessential.Inpatientswithsymptomaticsevereaorticdisease, advancedage is often a reason for a transcatheter rather than surgical aortic valvereplacement. In the era of TAVI, there has been renewed interest in the outcomes ofconventionalAVRforhighand intermediateriskpatients.Thisstudyevaluates theshortandlong-termoutcomesofelectiveAVRinelderlypatients.Methods:BetweenJuly2011andMay2015,100patients,aged80yearsorolder,underwentelectiveAVRinourunit.Thenotesofthesepatientswereretrospectivelyreviewedandfollow-upinformationwasobtainedfromtheircardiologistsandgeneralpractitioners.Theaverageagewas82.8±2.3years,53.0%werefemale,96.0%hadsevereaorticvalvestenosisandtheirmeanEuroSCOREIIwas4.1±3.2(intermediaterisk).Preoperatively,35.0%ofpatientswereinNYHAclassIIIorIV.StatisticalanalysesweredoneusingIBMSPSSversion24.Results: Median UCI and hospital stay was 2.0±3.7 and 7.0±9.5 days, respectively. Post-operatively, 2patients required insertionof apermanentpacemaker,3patients sufferedanischemicstrokewithoutsequelae,3requiredtemporaryrenalreplacementtherapy,7requiredresternotomy for bleeding, 3 had sternal wound infections. No myocardial infarction wasobserved.In-hospitalmortalitywas4.0%,whichwasinaccordancewiththemeanEuroSCOREII(4.1±3.2,p>0.05).One-year survivalwas85.0%, three-year survivalwas81.4%and five-yearsurvivalwas59.4%.Atfollow-up,96.0%ofpatientswereNewYorkHeartAssociation(NYHA)Class I or II and 2 late endocarditis occurred and were medically treated. Structural valvedeteriorationwasobservedin2patientsat3yearsfollow-up.Conclusion: The outcome after AVR in octogenarians is satisfactory; the operative risk isacceptable and might even be reduced with an individual approach to perioperativemanagement in high-risk patients. Patient age should not be the primary exclusion forconventionalcardiacsurgeryforaorticvalvedisease.

CO32CARDIACSURGERY,WITHSYNCHRONOUSCAROTIDANGIOPLASTY,OUREXPERIENCECarlosPinto1;MarcoCosta2;HilarioOliveira2;ManuelJAntunes11-CentrodeCirurgiaCardiotoracica,CHUC;2-Cardiologia,poloHG,CHUCIntroduction: The identification of carotid stenosis in patients proposed for coronary arterybypassgrafting,provesthatatherosclerosisisasystemicdisease.Inpatientswithcarotiddiseaseandinneedofcardiacsurgery,therearestillquestionsaboutthebestmethodoftreatment-medical,surgicalorpercutaneous,thedegreeofstenosisconsideredforinterventionandthebesttimefortreatment(pre,periorpostoperativeheartsurgery).Thesurgicaltreatmentofthecarotidstenosisiscurrentlythegoldstandard.However,percutaneoustreatmenthasexpandeditsindications.Itisourgoaltopresenttheinitialresultsofourexperienceintheimplementationof a synchronous strategy for the treatment of percutaneous carotid disease treatment,followedbycardiacsurgery.Methods:Between July/2013andAugust/2017,37patientswereeligible for thisprocedure.Demographic,perioperativeandpostoperativedatawerecollectedtoevaluatetheincidenceofcerebrovascularcomplications(severestroke,deathduetostroke,transientischemicstroke),cardiaccomplications(acutemyocardialinfarction(AMI)),orrenalimpairment.Results: Themajority of patients (83.7%) weremale, with amean age of 74 years (51-90).Coronary artery disease was the most prevalent surgical indication (59%). Hypertension,dyslipidemia,andsmoking,inthisorderofmagnitude,werethemostprevalentriskfactors.Onepatienthaddocumentedpreviousstroke.Theefficacyofcarotidangioplastywas97.3%,asinonepatient itwas impossibleduetotechnicalreasons. Insixpatients,thecarotidprocedurewasassociatedwithpercutaneoustreatmentofcoronarydisease.Theintervalbetweenbothprocedureswas1hour,inaverage.In-hospitalmortalitywas5,4%(2patients)and1AMIwasdocumented.Renalinjuryandatrialfibrillationwerethemostcommoncomplications,foundin27%and19%,respectively.Themeanfollow-uptimewas523days(50-1525days).Twodeathsweredocumentedduringfollow-up.Nore-stenosiswasfound.Conclusion: The approach presented here (percutaneous treatment of carotid stenosis,concomitanttreatmentofcoronarydiseaseandproximitybetweenprocedures)isfeasibleandeffective in reducing the riskof cerebrovascular complications inpatients inneedof cardiacsurgery. Long-term follow-up results, associated with permeability studies, may boost thistechniqueforclinicalacceptance,withchangesinguidelines,inthissetofpatients.CO33SEVERE INTRAOPERATIVECOMPLICATIONSDURINGVATSANATOMICALRESSECTIONSANDTHEIR SURGICAL RESOLUTION INA PORTUGUESE THORACIC SURGERY CENTRE – A 9-YEARREVIEW.João Eurico Reis1; Ana Rita Costa1; Manuel Godinho1; João Santos Silva1; Rita Barata1; IvanBravio1;FernandoMartelo1;PauloCalvinho1;JoséFragata11-HospitaldeSantaMartaIntroduction: Many studies have demonstrated that video-assisted thoracoscopic surgery(VATS)isnotonlyfeasibleandsafebutisactuallytheapproachchosenforanincreasingnumberof pulmonary anatomic resections. There are however few studies reporting on severeintraoperative complications during VATS anatomical ressections and their resolution.Objective:Our aim is to analyse the incidenceof severe intraoperative complicationsduring

VATS anatomical ressections, at our department, in the past nine years, and describe theirtechnicalresolutionduringthesurgery.Methods:Weperformed the retrospective analysis of thepatients submitted to lobectomy,bilobectomyorsegmentectomybyVATSorVATSconvertedtothoracotomyatHospitaldeSantaMarta,betweenMay2008andSeptember2017.Severeintraoperativecomplicationsweredefinedasaneventthatresultsinalifethreateningsituation or an injury to a proximal airway, blood vessel or organ that would lead to anunplannedadditionalanatomicalresection.Results:A totalof151patientswere submitted toanatomical ressections,90,7% (n=137)ofthemforaprimarylungcancer,otherindicationsweremetastaticdisease6%(n=9)andbenigndisease in 3,3% (n=5). The surgery was a lobectomy in 94% of the cases (n=142), asegmentectomy in5% (n=8),andonebilobectomy.Theconversion rate to thoracotomywas12%(n=18),mostofwhichwerefortechnical/oncologicalreasons(n=11),and7othersweretocontrol bleeding. Four (2,6%) severe intraoperative complications were identified. Three ofthem(2%)wereerroneoustransectionsofbronchovascularstructures(leftmainbronchus,leftmain pulmonary artery andboth left pulmonary veins); andonewas amembranous airwayinjuryproximaltothestapleline.Therewerenointraoperativedeaths.Thethreepatientswitherroneousbronchovascular transectionwereconvertedtothoracotomyandthebronchialorvascular re-anastomosis was performed, therefore avoiding a left pneumonectomy. In thepatientwiththemembranousairwayinjury,thebronchoplasticsuturewasperformedbyVATS.All four patients were primary lung cancer patients. In all these cases the patients weredischargedaliveandwellandareundergoingtheirfollow-upprogramwithnosignsofdiseaserecurrence.Conclusion:Albeitrare,severecomplicationsduringVATSLobectomycanoccurbutwhentheyhappenthethoracicsurgeonhastobereadytosolvethemwiththeminimalrepercussionforthepatient.CO34THREE-YEAR EXPERIENCE ON 477 PATIENTS UNDERGOING UNIPORTAL VIDEO- ASSISTEDTHORACOSCOPICSURGERYSusanaLareiro1;PedroFernandes1;LuisVouga1;JoséMiranda1;MiguelGuerra1,21-ServiçodeCirurgiaCardiotorácica,CentroHopsitalardeVilaNovadeGaia/Espinho,EPE;2-DepartamentodeCirurgiaeFisiologia,FaculdadedeMedicinadaUniversidadedoPortoIntroduction:Uniportal video-assisted thoracic surgery (VATS) techniquehasbeendescribedbothfordiagnosticandtherapeuticindications.OutcomesafteruniportalVATShaveneverbeenreportedinPortugueselargeseries.WereviewthesafetyandefficiencyofourinitialexperiencewithuniportalVATS.Methods: In a retrospective study of prospectively collected data, 477 uniportal VATSprocedureswereanalyzedbetweenJune2014andJune2017.Allprocedureswereperformedwithout rib spreading. Patients' demographic data, preoperative and postoperativemanagementaswellasresultswereanalyzed.Results:Themeanageofpatientswas47,9years(range,10to86),and155(32,5%)patientswere female. The uniportal VATS procedures included 156 (32,7%) anatomical major lungresections, 80 (16,8%) one or multiple wedge resections, 172 (36,1%) blebectomies and/orpleurectomies,24(5%)mediastinallesions,16(3,3%)empyemadrainageanddecorticationsandotherindicationsin29(6,1%)cases.MedianoperativeimeandsurgicaldrainageforuniportalVATSforanatomicalmajorlungresectionswas95minutes(range,40to245)and100ml(range,0to650),respectively.Conversiontoeither2or3portVATSormini-thoracotomywasnecessary

in7.1%ofthesurgeries,oftenduetoadhesions,incompletelungcollapseorbleeding.Thechestdrainwasremovedafteramedianof3days(range,0to34).Medianhospitalstaywas3days(range,1to41).Postoperativecomplicationratewas12,4%mainlyduetoprolongedairleak8,4%(n=40).Therewasnoperioperativemortality.Conclusion:UniportalVATSisafeasibleandsafetechniqueforvariousindicationsinthoracicsurgery.Theperioperativeresultsarepromising.Excellentresultswithminimalmorbidityandshort hospital stay are amongst its strong points. It can be performed by thoracic surgeonsexperiencedinthepostero-lateralthoracotomyapproach.CO35UNIPORTAL VIDEO-ASSISTED THORACOSCOPIC SURGERY - THE NEW PARADIGM IN THESURGICALTREATMENTOFLUNGCANCERPedroFernandes1;SusanaLareiro1;LuísVouga1;MiguelGuerra1;JoséMiranda11-DepartmentofCardiothoracicSurgery,CentroHospitalardeVilaNovadeGaia/Espinho,EPE,PortugalIntroduction:Theprogressivedevelopmentandimprovementofminimallyinvasiveapproachesin the field of thoracic surgery allowed to establish video-assisted thoracoscopic (VATS)anatomiclungresectionsasthepresenttechniqueofchoiceinthetreatmentofearlystagelungcancer.Methods: Thepurposeof this studywas to evaluate the surgical outcomesof patientswhoperformeduniportalVATSanatomiclungresectionsforthetreatmentofprimarylungcancer.The patients’ demographics, approach and type of surgery, postoperative morbidity andmortalityandoverallsurvivalwereanalyzed.Results: From December 2013 through September 2017, 173 patients underwent uniportalVATSanatomiclungresectionsforthetreatmentoflungcancer.Surgerywasperformedin92maleand81femalewithameanageof63.5years(range19-83years).Allsurgeriesbeganbyasingle-portVATSapproach,beingnecessarytoaddanextraportin9surgeriesandconversionto mini-thoracotomy in 10 procedures (conversion rate of 5.8%) due to bleeding and/ortechnicaldifficulties.All kindsof anatomic lung resectionwereperformed:154 lobectomies,whichrepresents89.0%oftheprocedures(93upperlobectomies,12middlelobectomiesand49lowerlobectomies),10bilobectomies(5.8%)and9anatomicsegmentectomies(5.2%).Meanlymphnodestationsdissectedwas2.48stations(range1-8stations).Themeansurgicaltimewas 112.2minutes (range 40-245minutes) andmean intra-operative drainagewas 155.6ml(range 0-1400ml).Median hospitalization timewas 5 days (range 2-28 days). Therewas nooperativeor30-daysmortalityandthemaincomplicationobservedwaspersistentairleakagein38patients(22.0%).Non-small-celllungcancer(NSCLC)wasthemainhistologictypeofcancer(n=149;86.1%), followedbycarcinoidtumours (n=20;11.6%)andotherhistologic type(n=4;2.3%).Themeanfollow-uptimewas15months(range0-45months)andtheoverallsurvivalwas94.5%.Conclusion: We believe that uniportal VATS anatomic lung resection with systematiclymphadenectomy is technically safe and feasible and it is an alternative approach tothoracotomyorconventionalthoracoscopicinthetreatmentoflungcancer.Thisapproachhasdemonstratedtobereproducible,comprisingalltheadvantagesofaminimalinvasivesurgery,withoutjeopardizingtheefficiencyoftheoncologictreatment.Therefore,wesuggestthatthistechnique could have a broader implementation and development in all national surgicalcenters. The issues of patient acceptability, cosmetic and oncologic results, and cost-effectivenessremaintobedeterminedinthefuturethroughoutmulti-institutionrandomizedcontrolledtrialsandlong-termfollow-up.

CO36MAJORCOMPLICATIONSOFVIDEOMEDIASTINOSCOPYANDTHEIRRESOLUTION–A5YEAREXPERIENCEAnaRitaCosta1; JoãoSilva1; JoãoEurico1;ManuelGodinho1;RitaBarata1; IvanBravio2;PauloCalvinho1;JoséFragata11-HospitaldeSantaMarta;2-IPOLisboaIntroduction:Videomediastinoscopyisaninvasiveprocedureformediastinalassessment,withlow rates of morbidity and mortality. Despite the low risk of complications, they can bepotentiallylethalifnotimmediatelycontrolled.Objective:Thegoalofthisstudyistoanalysetheoverallincidenceofcomplicationsofvideomediastinoscopies,performedinthelast5yearsatourdepartment,aswellastheirresolutionandoutcomes.Methods:Aretrospectivereviewofallvideomediastinoscopiesperformedatasingleinstitutionduringa5-yearperiodwasperformed.Majorcomplicationsweredefinedas life-threateningevents.Results: During the study period, from July 2012 to July 2017, were performed 160mediastinoscopies,67werediagnosticand93forstaging.Therewere3majorcomplications(1.87%), of which a severe haemorrhage from a bronchial artery, a tracheal rupture, and amassivehaemorrhagefromaninnominatearterylaceration.Inthis3cases,thediagnosiswerelungcancerin2patientsandlymphomaintheotherone.Therewerenointraoperativedeaths.Onepatientdiedinthepostoperativeperiodduetomediastinitisanddiseaseprogression.Thepatientwhosufferedinnominatearterylaceration,hadastrokeduetodissectionoftherightcarotidartery.Duringfollow-up,onepatientdiedfromprogressionofoncologicdisease,andtheotheroneisalive4yearslater.Conclusion:Althoughmediastinoscopyhasalowrateofcomplications,thesecanbepotentiallylethalandthethoracicsurgeonshouldbeabletoresolvethemrapidly.Duetothescarcityofpublicationsonthissubject,itisimportanttodescribepotentialcomplicationsofthissurgicalprocedureandtheirclinicalresolution.CO37SURGICALTREATMENTOFCOMPLICATIONS55YEARSAFTEREXTRAPERIOSTEALLUCITEBALLPLOMBAGEFORPULMONARYTUBERCULOSISTelmaCalado1;MagdaAlvoeiro1;DanielCabral1;MarianaAntunes1;FranciscoFélix11-HospitalPulidoValente-CHLNIntroduction:Inthe1930-50s,beforetheintroductionofantimicrobialdrugsanddevelopmentoftechniquesofpulmonaryresssection,collapsetherapywasthemainstreamoftreatmentforcavitary pulmonary tuberculosis. The methods to achieve the collapse included artificialpneumothoraxwithairrefills,phrenicnervecrush,thoracoplastyandextrapleuralplombage.Theplombage involvescreatingacavitysurgicallyundertheribs intheupperchestwallandfilling the space with inert material, such fat, paraffin wax, rubber ballons, oil andmethyl-methacrylate(Lucite)balls.ThetheorybehindPlombagetreatmentisthatcollapseofthelungpromotedehealingprocessandlimitthespreadoftuberculousinfectiontootherareasofthelung. However, with time, the presence of these materials for a prolonged period of timeresultedincomplications,suchaserosionofmajorvessels,respiratoryinsufficiency,infectionandmigration.

Methods:Wepresentaclinicalcaseofonepatientpresentedwithalatecomplicationofluciteballplombageafter55years.Results:An78-year-oldmanwithahistoryofpulmonarytuberculosistreatedwithplombagein1962,ischemicheartdisease,hypertensionanddiabetesmellitus,wasadmittedtohospitalforaxillaryswellingandpleurocutaneousfistula.Thex-rayofthechestandcomputedtomographyshowed the apex of the left hemithorax filledwithmultiple lucite balls, each approximately2,5cmindiameter,andextrusionofaballintotheaxillaryfistuluoustract.Inthiscontext,thepatient complied with multiple antibiotic regimens without success. So, the patient wassubmittedtosurgicalextractionof21luciteballs,pleurocutaneousdrainageandthoracoplasty(7ribsandthetipofthescapulawasremove).Theculturesturnedouttobenegativeandthepatientmadeanuneventfulrecoverywithdischargeonthe19thpostoperativeday.Pathologicexamination revealed active chronic inflammatory process and negative microorganismscreening.Conclusion:Despitetherapiddeclineincollapsetherapysincetheappearanceofantitubercularchemotherapy, thereare still suchelderlypatientswho remainasymptomaticwhile carryingresidualplombagematerial.Thereisnoneedforroutineablationofanythismaterial,howeverifanyforeignmaterialbecamesasourceofcomplicationshouldbeextractedwithoutdelay.Asthenumberoflivingpatientstreatedbyplombageisattenuatingrapidly,fewerandfewerwillbe seen in the future, and no one is likely to accumulate considerable experiencewith thisproblem.CO38UNUSUALBEHAVIOROFALUNGINFLAMMATORYMYOFIBROBLASTICTUMOR:CASEREPORTCristinaRodrigues1;DanielCabral1;TeresaAlmodovar2;AnalisaRibeiro3;DiogoDelgado4;LeonorMota5;SamuelMendes1;MagdaAlvoeiro1;CarolinaTorres1;TelmaCalado1;MarianaAntunes1;FranciscoFélix11-ServiçodeCirurgiaTorácica,CentroHospitalardeLisboaNorte;2-ServiçodePneumologia,InstitutoPortuguêsdeOncologiadeLisboaFranciscoGentil;3-ServiçodeAnatomiaPatológica,Centro Hospitalar de Lisboa Norte; 4 - Serviço de Radioterapia, Centro Hospitalar de LisboaNorte;5-ServiçodePneumologia,CentroHospitalardeLisboaNorteIntroduction: 55 years old, male patient. History of heavy smoking (65 UMA) and COPD.Admittedtohospitalduetoaleftpneumonia.ThoracicCTandPET-Scan,showedleftlowerlobemassmeasuring92x89mm(SUVmax49).Severalmediastinalnodegroupspresentedincreaseduptake of FDG. A fiberoptic bronchoscopy was performed. Citology of the bronchoalveolarlavagesuggestedasquamouscarcinoma.EBUSofnodestations4R,4Le7withoutevidenceofmalignancy.Methods: The case was taken to a multidisciplinary meeting staged as IIIA (T3N2M0).Neoadjuvanttherapy(fourcyclescysplatineandgemcitabine)wasdecidedbasedonstation5,suspected disease. A left lower lobectomy was performed after a cervical mediastinoscopyexcludedmetastasisofnodestations4Rand4L.Histologyofthespecimenwascompatiblewithinflammatorymyofibroblastictumor(IMT).Nolymphnodeinvolvementwasreported. ItwasrestagedasIIB(ypT3N0M0).Results:Threemonthsaftersurgeryonedenovonoduleinthelingulawith12,7ofSUVmaxwasreported.ThenodulewasremovedconfirmingaIMTmetastasis.FourmonthsafterthenoduleressectionaCTshowednewlungandlivernodules.AtotaloclusionoftheleftmainbronchuswasdocumentedandbronchoscopicdebulkingoftheendobronchialmassagainrevealedIMT.Paliativeradiotherapywasdecidedinthemultidisciplinargrouptargetingtheleftmainbronchus(fivesessionsofradiotherapyonadoseof20Gyin4Gydailyfractions).Tenmonthsaftersurgery

duetotheonsetofbackpain,aCTrevealedasacrumlesionwhoseneedlebiopsywassuspiciousformultiplemyeloma.Thepatientwasreferredtoanotheroncologicalcenterwherepreviousnon-surgical cases had been sent in the past. The patient is now proposed for histologyreassessmentanddiscussionbythehematologyandpneumologymedicalteams.Conclusion:Inflammatorymyofibrobastictumorsareconsideredbenignorlow-grademalignanttumors.Thesizeofthetumour(cut-offof3cm)andsecuresurgicalresectionwithfreemarginsarethemajordeterminantsforrecurrenceandsurvival.Therearesomecasesreportedintheliteratureofdistantmetastasisandsarcomatoustransformationaftermultiplerecurrences.Inourpatient,thelesionwasbiggerthan3cmandheunderwentacompleteresection.Nothingcouldforeseethisaggressivemetastaticbehavior,especiallywhentherecurrencedidnotshowasarcomatoustransformation.CO39UNIPORTALVATSLOBECTOMY:SUBXIPHOIDAPPROACHCatarinaCarvalheiro1;JavierGallego-Poveda1;DiegoGonzalez-Rivas2,3;JorgeCruz11 - FundaçãoChampalimaud;2 - ShanghaiPulmonaryHospital;3 -UCTMICoruñaUniversityHospitalIntroduction: Interest in uniportal video-assisted thoracic surgery (VATS) is rapidly growingworldwidebecauseitrepresentsthesurgicalapproachtothelungwiththeleastpossibletraumaandinrecentyearsthesubxiphoidapproachhasbeenusedinthefieldofthoracicsurgeryasitis associatedwith lesser pain because there is no intercostal nerve damage and it providesexcellent cosmetic outcomes. This technique was recently introduced for major pulmonaryresectionsandevenbilateralapproachesinselectedpatients.Methods:Wepresentacaseofa66yearsoldmale,formersmoker(45unitpackyear)whohadathoraxCT(computorizedtomography)scanforworseningcomplaintsofcoughwithsputumproduction. The CT scan revealed a right upper lobe nodule (16x14mm) with ground glassdensity and fissure retraction. The pulmonary function tests showed mild bronchial andbronchiolarobstruction. Itwasdecidedtoundergosurgicaltreatment.Thesurgicalapproachwasasubxiphoiduniportallungresection.Results:Thepatientwaspositionedinaleftlateralpositionwith60degreesofinclination.Thesurgeonandscrubnursewerelocatedinfrontofthepatientandtheassistantintheoppositeside. A 3cmmidline vertical incisionwasmade below the sterno-costal triangle. The rectusabdominiswas divided and the xiphoid processwas partially resected. The right pleurawasopenedbyfingerdissection.Thepericardialfattytissuewasremovedandasofttissueretractorwasplaced.A10-mm,30-degreesvideocameraanddoublearticulatedinstrumentscombinedwithseveralspecificlongerVATSinstrumentswereusedthroughthesamesubxiphoidincision.Itwas performed a wedge resection and after the diagnosis of adenocarcinoma in theintraoperativehistological examination, thepatient underwent a right upper lobectomyandcompletemediastinallymphadenectomybythesameapproach.Thepost-operativeperiodwasuneventful,thechesttubewasremovedinthethirdpostoperativeday.Thepaincontrolwasexcellent, with a maximum of pain grade 1 in the Visual Analogue Scale.The patient wasdischargedinthefourthpostoperativeday.Conclusion:ThesubxiphoidapproachisavariantofuniportalVATSapproachwithoutopeningthe intercostal space with its striking advantages in terms of pain control and cosmetics inselectedpatients.However,thistechniquehasyetsomelimitationssuchasthecontrolofmajorbleeding and theperformanceof a completeoncologic lymphnodedissection related to itssurgicalcomplexityexpectedinemergingtechniques.Furtherstudiesarenecessarytocertifythefeasibility,safetyandbenefitsofthisapproach.

CO40BILATERAL RECURRENT SPONTANEOUS PNEUMOTHORAX AS A LATE CONSEQUENCE OFOESOPHAGEALSURGERY:CASEREPORTCristinaRodrigues1;DanielCabral1;LeonorMota1;AntónioBettencourt11-HospitalLusiadas,LisboaIntroduction:Wereportacaseofapatientwithrecurrentbilateralspontaneouspneumothoraxpresumablyoriginatinginaleftbulla.Methods:A68yearoldmale,wasadmittedtotheemergencydepartmentwithshortnessofbreathandbilateralchestpain.Hehadhadoesophagealcancerresection2yearsbefore,withaposteriormediastinalreconstructionusingagastrictube.Afterwardshehadtobeoperatedtwiceforhiatalhernia.Results: Bilateral chest tubes were inserted, with complete resolution in 72 hours. He wasreadmitted 20 days later,with a bilateral recurrence. A pneumologistwas called upon. Thethoracic CT scan revealed large bulla in the left upper lobe. There was no evidence ofpneumomediastinumormediastinalfluidcollections.Communicationbetweenthetwopleurawassuspected.Afterdiscussionwiththesurgeonresponsibleforthepreviousinterventionsonlythe left chestwas drainedwith bilateral lung expansion after suction. A left VATS approachrevealedapartiallyadherentleftlung,initsmediastinalface.Inflatedbullacouldbepartiallyobservedfirmlygluedtotheuppermediastinum.Aleakcouldnotbedemonstratedwithintheleftthorax.Duetothefirmadhesionsofapresumablynonrupturedbulatothephrenicnerve,adecisionwasmadenottodissectit.Apleurectomywasperformed.Inthe3daysthatfollowed,the fistula persisted and increased, in spite of lung expansion. A left thoracotomywas thenperformed.Thefullextentoftheanteriormediastinalfaceofthenleft lungwasdissectedbyopeningthebullathatwerepartiallyleftonthemediastinalpleura.ResectionwasmadeusingtristapleendoGIAstaplers®.Theposteriormediastinumwasmanuallydissectedfreeuptothepresumedgastric tube location.At theendofsurgery,nomajorair leaksweredocumented.Communicationwith the right pleura could not be located, not evenwith the aid of a 30ocamera,butalargeamountoffluid(1000cc)missing,wasrecoveredafterturningthepatient.Thepostoperativeperiodwasprolongeduttothe16thday,byasmallbutpersistentairleak.Conclusion:Althoughnovisualproofofcommunicationbetweenthetwopleuralcavitiescouldbefound,thecontroloftherightpneumotoraxbycontralateraldrainage,theresolutionofthecaseby left pleurectomyandbulla resectionbackup this theory. This is anunique case, notpreviouslyreported,resolvedbyamultidisciplinarydiscussionofallthespecialistsinvolvedinthetreatment.

CO41SURGICALTREATMENTFORELDERLYPATIENTSWITHLUNGCANCERTelmaCalado1;MarianaAntunes1;DanielCabral1;MagdaAlvoeiro1;FranciscoFélix11-HospitalPulidoValente-CHLNIntroduction:Non-smallcelllungcancerisaverycommondiseaseintheelderlypopulationanditsincidenceinthisparticularpopulationisexpectedtoincreasefurther,becauseoftheageingoftheWesternpopulation.Pulmonaryresectionisoftennotrecommendedintheelderly,eventhoughtheyhavenomedicalcontraindicationstosurgery.Suchpatientsarepostulatedtohavealimitedlifeexpectancy,therateofcomplicationsandperioperativedeathisconsideredtobe

higher than younger population. However, decision making is extremely difficult, since thisgroupinunder-representedinclinicaltrials.Methods:Thisstudyaimtodoaretrospectiveanalysisofcomorbidity,surgicalproceduresandpos-operativecomplicationsforsurgeryinpatientsolderthan70yearsofagewhounderwentapulmonaryresectionforlungcancer.WeanalysedtheclinicalrecordsofallpatientswithNon-smallcelllungcancersubmittedtosurgeryduringtheperiod2012to2016inourdepartmentanddividethemin2groups:elderlygroup(morethan70yearsold)andgroupcontrol.Results:Inthefiveyearsstudyperiod,ourdepartmentperformedpulmonaryresectionin601patientswithNSCLC,ofwhom209(34,8%)were70yearsandolder.Themeanagewas74,6yearsoldintheelderlygroupand58,6inthecontrolgroup.Preoperativecomorbiditiessuchascardiac and previous neoplasic diseases were more frequent in the elderly group, and thepercentageofsmokerswashigherinthecontrolgroup(80,1%vs61,7%).Asegmentarorwedgeresectionwasperformedmorefrequentfortheelderlygroup(16,7%)thaninthecontrolgroup(6,6%), whereas pneumonectomies and lobectomies were performed more frequently. Theratioofpos-operativecomplications,especiallycardiaccomplications,washigherintheelderlypatients (12,9% vs 8,2%), however, there was no significant difference in prevalence ofpulmonary/respiratory complications, such pulmonary leakage, pneumonia or empyemabetweenthe2groups.Therewasnooperativeorhospitaldeathinanyofthegroups.Conclusion:AdvancedagealoneisnotacontraindicationtosurgicalresectiononNSCLC.Elderlypatients should be offered the best treatment possible, considering surgical risk on anindividualizedbasis,andkeepinginmindthatsurgeryoffersthebestresultswhenthediseaseisresectable.CO42WHATABOUTHAVINGAHYDROPNEUMOTHORAXEVERYMONTH?SaraLopes1;JoãoMaciel1;PedroCabralBastos1;PauloPinho11-CentroHospitalarSãoJoãoIntroduction:Endometriosisisapathological,benign,inflammatoryconditioncharacterizedbythepresenceofendometrialglandsandstromaoutsidetheuterinecavity,typicallyinthepelvis.In rare conditions, this estrogen-dependent disease may be extrapelvic, presenting with avarietyofsymptoms,includingThoracicEndometriosis.Methods:A37year-oldwomanpresentedwithher third righthydropneumothorax in threemonths.Hermedicalhistoryincludedinfertility,anovarianmass(instudy),biliarydiskinesiaandproteinCdeficiency.TheCTshowedablebintherightinferiorlobeandapleuraleffusion.Adetailedclinicalhistoryrevealedatemporalrelationshipofthehydropneumothoraxesandhermenses.Results:Sheunderwentavideothoracoscopy:thereweremacroscopictissuealterationsallovertheparietalandvisceralpleura.Weperformedabiopsyofoneofthosespots(oftheparietalpleura)andanatypicalresectionoftheapexoftheapicalsegmentoftheright inferior lobe,wheretheblebwas.Atalcpleurodesiswasalsoperformed.Thepatientwasdischargedatday1andiscurrentlyunderregularfollow-upinambulatory,withnorecurrentpneumothoraxesfortwomonths.ThehistopathologywascompatiblewithapleuralEndometriosis.Conclusion: Thoracic endometriosis is a clinical diagnosis, although the histopathologicconfirmationispreferred(butnotnecessary):itshouldbesuspectedinreproductiveagewomenwhopresentwithhemothorax,pneumothorax,hemoptysis,chestorscapularpain,lungnodulesordiaphragmaticruptureperimenstrually,especiallyright-sided.Mostcommonlyitpresentsascatamenial pneumothorax and/or hemothorax. Those with high clinical suspicion and/orimaging supportive of the diagnosis, should undergo an interventional procedure

(thoracoscopy),bothfordiagnoseandmanagement.Primarytreatmentischesttubedrainage.Preventionof recurrence canbemedical (hormonal suppression)or surgical (lung resection,pleurectomy,pleurodesis).CO43MAJOR HEMORRHAGE DURINGMEDIASTINOSCOPY: DO YOU PANIC OR DO YOU HAVE APROTOCOL?FilipaMadeira1;CortesaoJoana1;RitaPancas1;TeresaPaiva11-CentroHospitalareUniversitáriodeCoimbraIntroduction:Althoughuncommon,majorvesselhemorrhageisthemostfearedcomplicationof mediastinoscopy. Our goal was to determine the optimal management strategy and todevelopasimpleandaccessibleprotocolforoptimizingcareinthesesituations.Methods: Data collection after reviewing the relevant literature. A literature review wasconductedusingthefollowingdatabases:PubMed,Medline,EmbaseandScienceDirect.Results:theprotocolconsistsofthreedistinctparts-initialchecklist,considerationsinminorbleedingandperformanceinmajorbleeding.Inthislastsectionweproposeaninitialapproachbasedmainlyonfluidresuscitationandimmediatesurgicalcorrectioniftheformerhasnotbeensuccessful.Conclusion: Mediastinoscopy continues to be an important and effective diagnostic tool.However,itcancauseimportantiatrogeniclesionswhichtheanesthesiologistandsurgicalteammustbepreparedtodiagnoseearlyandtreatproperly.CirurgiaVasculareEndovascularCO44AMNIOTIC MEMBRANE IN THE TREATMENT OF VARICOSE VARICOSE ULCERS A CENTEREXPERIENCERocha-Neves1;AndreFerreira1;JoelSousa2;MarinaDias-Neto3;LuisGamas2;IsabelVilaça2;JoséTeixeira21-FaculdadedemedicinadauniversidadedoPorto-Departamentodebiomedicina-unidadedeAnatomia;2-CentroHospitalarSãoJoão,EPE-serviçodeAngiologiaeCirurgiaVascular;3-FaculdadedemedicinadauniversidadedoPorto-DepartamentodeCirurgiaeFisiologiaIntroduction:Amnioticmembrane(AM)isanoptionasacoverinvaricoselegulcers,promotingepithelization.Anti-inflammatoryandanalgesicproprietiesaredescribed,aswellashighlevelsofgrowthfactorsandangiogenesis.Thecostsareinferiortosurgicalplasty.TheaimofthisworkistodescribetheresultsofAMinthetreatmentofvaricouslegulcersinagroupofpatientsrefractorytothebestmedicaltreatment.Methods: A pilot prospective trial was conducted. Thirteen patients were selected for thetreatmentwithAMfromanoutpatientclinic.Theinclusioncriteriaincluded:ulcerareainferiorto100cm2,ulcersizevariationinferiorto30%in the last month, duration superior to 2 years and refractory to best medical treatmentincluding compressive therapy. The exclusion criteria were ABI>0,8m active infection, boneexposure, severemyopathy of the low limb and acute decompensation of systemic chronic

disease.Thefirstfivecaseswereappliedontheenfermary(meanstay3days),thelast8patientswereappliedintheoutpatientclinic.Afterthetreatmentbehavioralreinforcementwasmade.Results:Themeansampleagewas56YO(50-71),70%werefemale,30%werediabetic,andpost-thromboticsyndromewaspresentin54%(7),onlyonepatientwasanactivesmoker.After2yearsarecurrencewasobservedin23%(3)cases.Conclusion:AMiseffective in thetreatmentofvaricoseulcersunresponsivetobestmedicaltreatment.CO45WHICHANEURYSMCHARACTERISTICSPREDICTEVARNONSUCESS?PedroPintoSousa1;PedroBrandão1;AlexandraCanedo11-CentroHospitalarVilaNovadeGaia/EspinhoIntroduction:Hostileanatomiccharacteristicsinpatientsundergoingendovascularabdominalaortic aneurysm repair (EVAR) may lead to technical nonsuccess of the procedure, latecomplications, reintervention or death. The authors analyzed anatomical abdominal aorticaneurysm specific considerations so as technical endoprosthesis implantation and correlatethemwithendoleakdevelopmentandpostoperativesurvival.Methods: Authors retrospectively reviewed all consecutive, elective, EVAR’s that occurredbetween2010and2016,withavailabledata,atoneinstitutionforabdominal,infrarenal,aorticaneurysms.ThepatientscomorbiditieswereregisteredandpreoperativeCTscanwasanalyzedconsidering theproximal zone (diameter, length, presenceof thrombusor calcification), thedistal zone (length and diameter), aortic aneurysm (maximum diameter, angulation, axisdeviation, mural thrombus and patency of the inferior mesenteric artery and the lumbararteries) and concomitant iliac aneurysm or peripheral occlusive disease. Outcomes wereendoleakdevelopmentanddeath.Results:Weanalyzed56patients,54(96%)malewithamediumageof78(min61,max89)years.Duringamedium3,4yearsoffollowup,12(21%)patientsdevelopedendoleak(10typeII and 2 type I) and 18 (32%) died. The adjusted analysis showed a statistically significantassociationbetweenaneurysmangulation(p=0,046),patencyoftheinferiormesentericarteryand the lumbar arteries (p=0,044) and aneurysm diameter (p=0,009) with endoleakdevelopment. Notice that 40% of the aneurysms that impaired a significant axis deviationdevelopedendoleak.AllexceptoneendoleakwerediagnosedwithinthefirstyearafterEVAR.None of the deaths that occurred during the follow up period were correlated to postintervention aneurysm enlargement or rupture. Howeverwe found a statistically significantassociationbetweenpatencyoftheinferiormesentericarteryandthelumbararteries(p=0,042)andearlydeathduringthefirstyearafterEVAR.Conclusion: Even though many aneurysm are suitable for EVAR, unfavorable aneurysmmorphologiccharacteristicsandpredictablecomplicatedendograftplacementshouldbetakenintoconsideration.Forsuchclinicalcases,asurgicalapproachshouldbeconsidered.WebelievethatcurrentrecommendationsforfollowupwithangioCTonlyat1and12monthsduringthefirst year following EVAR is a good practice conduction sincemost of endoleaks developedduringtheseperiod.IfneitherendoleaknoraneurysmenlargementisdocumentedduringfirstyearafterEVAR,colourduplexultrasonographyisagoodalternativeforannualpostoperativesurveillance.

CO46RENALAUTOTRANSPLANTATION-THESOLUTIONFORDIFFERENTPATHOLOGIESPedroPintoSousa1;RuiMachado2;PedroSáPinto2;RuiAlmeida21-CentroHospitalarVilaNovadeGaia/Espinho;2-CentroHospitalardoPortoIntroduction:Renalautotransplantation(RA) isasafeandeffectiveproceduretoreconstructthe urinary tract which first successful surgery was performed by Hardy in 1963. Themainindications reported for performing RA generally includes renovascular disease, ureteralpathologiesandneoplasticdisease.RAmaybealsousefulas the last recourse inpreventingkidneylossinhighlyselectedpatients,especiallywhenconventionalmethodshavefailed.Methods:TheauthorspretendtodescribefourtotaldifferentsituationswheretheRAwasthekeysolutionforthepathologyinitiallypresented.Results:1-52yearsoldmalewithaprevioushistoryofrightnephrectomythatoccurredduringan exacerbation of his basal Chron disease so as left ureter cutaneostomie, presentedwithrepetitiveurinarytractinfectionsthatledtorenalfunctionimpairment;2-57yearsoldfemalewiththediagnosisofrenalarteryaneurysmwhilebeingstudiedasapotentialrenaldonor;3-49 years old male admitted in the emergency room after a penetrating trauma whichconditionedbowelandureterallesionswithpostoperativeconsecutiveandrecurrentperitonealinfections that compounded a necessity for a left ureter cutaneostomie, that the patientaccuratelyrefused;4-24yearsoldfemalewiththediagnosisofNutcrackersyndromeidentifiedafterbeingstudiedregardingrepetitiveurgencyadmissionswithfrankhematuria.Everypatientwas submitted to RA. The intervention and postoperative course were uneventful. Weperformedanultrasoundevaluationon thedayaftereachprocedure toattestnormal renalperfusion.Conclusion:TheRAwererealizedinthetwopatientswithureterallesionsbecausetherewasnoviablealternativebutkidneyloss.TheothertwoclinicalcasesweretreatedwithRAbecausetheyconcernedacomplexrenovasculardisease(onearterialandtheothervenous).Despitetheexistence of an endovascular option for these patients, long term followup studies are stilllacking. The RA is a viable option in specific situations for kidney salvage. The recentdevelopmentoflaparoscopicnephrectomysignificantlydecreasedthesurgicalhostilitytothepatientandpromotedtheRAvalueonthetreatmentofcomplexvascularpathologies,traumaticdiseaseandspecificmedicalsituations.Itrepresentsacrediblealternativewithattestedresultsalready described in the literature thus requiring a vast Institutional experience withconventionalrenaltransplantation.CO47ABDOMINALAORTICANEURYSMINWOMEN:RETROSPECTIVEANALYSISOFTHECASESTHATUNDERGOSURGICALREPAIRBárbaraPereira1;AndréMarinho1;RogerRodrigues1;MárioMoreira1;MafaldaCorreia1;PedroLima2;JoanaSilva1;JoãoAlegrio1;ÓscarGonçalves11-CHUC;2-239400400Introduction:Theprevalenceofinfra-renalaorticabdominalaneurysms(AAA)isabout3to4timeshigherinmen,witharecommendationI1aforscreeningmen>65y.Althougwomenonlyrepresente20%ofthetotalAAAstheyhaveasignificanthigherrupturerate–threefoldhigher– and a worse outcome after ruptured AAA repair. Screening is not consensual but can berecommended forwomen>65ywhohave smokedorhavea familyhistoryofAAA.Against

screening is the fact that theAAA inwomenhavenotonlya lower incidencebutalsoa latepresentation(>80y)butreferenceshavebeenmadetothefactthatsmokingbecamepopularmorethan30yearsafterthanmenandsotheeffectsjustnowcanstarttobeseen.Methods:Aretrospectivereviewwasmadetoallwomenwithaninfra-renalAAAwhoundergoasurgicaltreatment,electiveorurgent,inthepast7years(January2010–August2017)inourhospital.Informationwasobtainedthroughtheclinicalprocess.Itwasmadeanevaluationofthedemographicinformationandanatomicfeatures.Results:15caseswerereviewed,4electiveand11rupturedsurgicalrepairs.Themeanagewas74andonly4womenweremorethan80yearsold,withaminiumageof57.Morethanhalfthepatientswerepreviouslydiagnosiswithhypertensionbutonly30%hadhighcholesterol.Onlyone was a known smoker. None had a diagnosis of cardiac disease. One had a sintomaticcerebrovasculardisease.Withintheelectivecases,allopenrepair,theintra-hospitalarmortalitywaszerowithameanstayof7,5days.Therupturedcases,1endovascular,hadaperioperativemortalityof50%Themeanaorticdiametreatrupturewaslessthan6cm.Conclusion:DatasupportstheevidenceofthemorbidityofarupturedAAAandthehighintra-hospitalarmortalityinwomen.Earlydetectionandelectiverepairshouldbeconsidered.Sex-specificresearchisneededtoprovidethebestmedicaltreatment.CO48INSTITUTIONALPROTOCOLFORPREVENTIONOFTEVAR-RELATEDSPINALCORDISCHEMIA-THEFIRST9CASESMarinaDias-Neto1;PedroReis2;LeonorMendes2;MargaridaRodrigues2;CristinaAmaral2;GraçaAfonso2;JoséFernandoTeixeira11-DepartamentodeAngiologiaeCirurgiaVascular,CentroHospitalardeSãoJoão;2-ServiçodeAnestesiologia,CentroHospitalardeSãoJoãoIntroduction:Spinalcordischemia(SCI)isafearedcomplicationafterendovascularcorrectionofthoracicaorticdiseases(TEVAR).TheguidelinesoftheEuropeanSocietyforVascularSurgeryrecommend prophylactic lumbar drainage (LD) of cerebrospinal fluid in high-risk patientsundergoingTEVAR.Ourinstitutionalprotocolconsidersashigh-riskpatientsas:coverageoftheoriginoftheAdamkiewiczartery(T9-T12),aorticcoverage>15cm,involvementofcollaterals(treated or untreated abdominal aortic aneurysm, left subclavian artery revascularization orbilateralocclusionoftheinternaliliacarteries)andsymptomaticSCI.TheobjectiveofthestudywastodemonstratetheefficacyandsafetyofLDinpreventingortreatingSCIafterTEVAR.Methods:PatientssubmittedtoLDintheperioperativeperiodofTEVARundertheinstitutionalprotocol,betweenMay2015andApril2017,wereprospectively included.PrimaryOutcome:prevention and/or reversal of neurological symptoms (efficacy). Secondary Outcome:complicationsrelatedtothetechnique(safety).Results:Weincluded8patientswiththoracoabdominalaneurysmsand1patientwithtypeBaorticdissection,aged63-75years.Eightinterventionswereelectiveandonewasurgent.TheLDcatheterwasplacedbeforesurgeryin8casesandinthepostoperativeperiodin1caseduetosymptomatologyofSCIthatrevertedafterliquordrainage.Ofthoseplacedpre-operatively,2hadsymptomsofSCI inthepostoperativeperiod,whichalleviatedwithincreaseddrainageand hemodynamic and hemoglobin optimization. The patient undergoing urgent TEVAR forrupturedthoracoabdominalaneurysmevolvedwithmultiorgandysfunctionanddeath24hoursaftersurgery.Therewerenoothercomplications.Conclusion:Inthisinitialexperience,theinstitutionalprotocolwithLDplacementprovedtobesafeandeffectiveinpreventingandtreatingSCIafterTEVAR.

CO49ANEURYSMSOFTHEUPPERLIMB:REVIEWOFANEXPERIENCEMafaldaCorreia1;LuísAntunes1;ÓscarGonçalves11-ServiçodeAngiologiaeCirurgiaVasculardoCentroHospitalareUniversitáriodeCoimbraIntroduction:Truearterialaneurysmsoftheupperlimbarerareandtheirtreatmentisintendedto avoid complications as distal embolization or compression of surrounding neurovascularstructures.Thepurposeofthisstudy istoreviewtheexperience inthesurgicaltreatmentoftruearterialaneurysmsoftheupperlimb.Methods: Retrospective study of patients with true arterial aneurysms of the upper limbsurgicallytreatedbetweenJanuary2007andAugust2017.Ninepatientswere identifiedanddata was collected regarding sex, age, past medical history, aneurysm’s aetiology, surgicalprocedure,complicationsandtheneedforre-intervention.Results:Fromatotalofninepatients,sevenweremaleandtwowerefemale,withagesbetween29and68yearsold(mediumageof55,5).Oneofthepatientshadsurgerytwicebecauseoftwoaneurysmsoftheupperlimb.Fromatotalof10cases,twoweresubclavian,onewasaxillaryandsevenwerebrachialaneurysms.Threeofthemhaddegenerative/idiopathicaetiology,onewasassociatedtoacervicalribandsixoccurredinthesettingofarteriovenousfistulaorkidneygraft.Threepatientshademergentsurgeryandtheothershadelectivesurgery.Allofthemweresubmitted to aneurysmectomy. As 30-day complications, therewere two haematomas, onecompartmentsyndromeandtwoearlygraftocclusions.Fourpatientsneededre-intervention.Duringthefollow-upperiod,allthegraftsinitiallypreservedwerepatent.Therewerenofurtherknowncomplicationsoramputationprocedures.Oneofthepatientswhohademergentsurgeryandpresentedwithfingerparesisremainedwithhypomotilityafterthesurgery.Conclusion:Truearterialaneurysmsoftheupperlimbareuncommon.Inthisreviewmostofthe aneurysms were found in patients with haemodialysis vascular access or kidney grafts.Despitetheneedforearlyre-interventioninsomecases,thesurgicaltreatmentoftruearterialaneurysmsoftheupperlimbisalowmorbidityprocedure.

COMUNICAÇÕESORAISBREVESCirurgiaCardio-TorácicaCO50ENDOTHELIALFUNCTIONANDVASCULARPROPERTIESINSEVEREAORTICSTENOSISBEFOREANDAFTERAORTICVALVEREPLACEMENTSURGERYRenataMelo1;FranciscaA.Saraiva1;AnaFilipaFerreira1;SoraiaMoreira1;RaquelMoreira1;RuiJ. Cerqueira1,2; Mário J. Amorim1,2; Paulo Pinho1,2; André P. Lourenço1,2,3; Adelino F. Leite-Moreira1,21-DepartamentodeCirurgiaeFisiologia,FaculdadedeMedicinadaUniversidadedoPorto;2-DepartamentodeCirurgiaCardiotorácicadoCentroHospitalarSãoJoão;3-DepartamentodeAnestesiologiadoCentroHospitalarSãoJoãoIntroduction: The degenerative process that results in aortic valve stenosis (AS) haspathophysiologicalfeaturessimilartotheatheroscleroticprocess.Wethereforehypothesizedthat, as in atherosclerosis, endothelial and vascular dysfunction couldbe apathophysiologicfeatureofAS.Aim:Toevaluateendothelialfunctionbeforeandafteraorticvalvereplacement(AVR)surgeryinpatientswithsevereAS.TocorrelateendothelialfunctionwithseverityofASandclinicalprofile.Methods: Two noninvasive methods were used to evaluate endothelial function (ReactiveHyperemiaIndex(RHI)measurewithEndoPATTM2000system)andvascularproperties(carotid-femoralPulseWaveVelocity(PWV)measuredbyComplior®Analyse)in13patientswithsevereASundergoingAVR.Samplewascollectedbyconvenienceinasingle-centerbetweenFebruaryandJulyof2017.Pre-operative,surgicalandpost-operativedatawerecollectedthroughclinicalfilesandinformaticsdatabases.PWV,RHI,AugmentationIndex(AI)wereassessedatthedayofsurgeryand2.4±1.2monthspost-operatively.Meantransvalvulargradients(MTG),aorticvalvearea(AVA)andleftventricularfunctionwereevaluatedbytransthoracicechocardiographyat3.4±1.6monthsoffollow-up.Wilcoxonorpairedt-testswereusedtocomparepre-andpost-operative values of continuous variables. Spearman correlations (rho) were done to findassociationsbetweenendothelial/vascularfunctionparametersandclinicaldata.Results:Inoursample,meanagewas70±8yearsand69%werefemales.Arterialhypertensionwaspresentin11(85%)patients,diabetesin3(23%)andpre-operativeNYHAfunctionalclass≥IIIin4(31%).Nopatientwascurrentlysmokerandonly2hadprevioushistoryofsmoking.Nosignificant changes were observed between pre- and post-operative endothelial/vascularfunctionvalues.PWV(m/s),AI(%)andRHIbeforeandafterAVRsurgerywere:10.5(6.1to16)vs.9.4(4.7to21.6),p=0.701;33%[-24to54]vs.23%[0to47],p=0.116and1.83(1.08to3.13)vs.1.71(1.06to3.12),p=0.638,respectively.Wefoundasignificantinversecorrelationbetweenpre-operativeAVAandAI(rho=-0.652,p=0.016)andapositivecorrelationbetweenageandpost-operativePWV(rho=0.639,p=0.019).Pre-andpost-operativeMTGandAVAwere54±5mmHgand0.7±0.1cm2vs.12±4mmHgand2.0±0.5cm2,respectively(p<0.001).Conclusion: Considering small sample size, no differences were found in indices ofendothelial/vascularfunctionbeforeandafterAVRsurgeryduetoAS.However,itseemsthatendothelialdysfunctionisassociatedwithseverityofASassessedbyAVA.

CO51PREDICTORSOFACUTEKIDNEYINJURYINTHEPOSTOPERATIVEPERIODOFCARDIACSURGERYASSOCIATEDWITHCARDIOPULMONARYBYPASSRaquelMoreira1;TiagoJacinto1;PauloNeves2;LuísVouga2;CristinaBaeta11 - Escola Superior de Saúde do Politécnico do Porto; 2 - CentroHospitalar de VilaNova deGaia/EspinhoIntroduction:Acutekidneyinjury(AKI)inthepostoperativeperiodofcardiacsurgeryoccursin1 to 30% of the patients, mainly caused by ischemia secondary to renal hypoperfusion.Cardiopulmonary bypass (CPB) has a deleterious effect on renal function, constituting anaggression to the patient's homeostasis. Aim: To evaluate the incidence of AKI in thepostoperativeperiodofcardiacsurgeryinpatientswithoutpreoperativerenalinsufficiencywhounderwentcardiacsurgerywithCPB,andexploretheassociationbetweenincidenceofAKIandpredictorsrelatedtoCPB.Methods:Observational,retrospective,cross-sectionalstudy.Participantsweredividedintwogroups,thosewhodevelopedAKIinthepostoperativeperiodandthosewhodidnotdevelopAKI. KDIGO Clinical Practice Guideline for Acute Kidney Injury classification was used tocharacterizeAKI.Thepreoperativevariablesanalysedwereanthropometricdata,cardiovascularriskfactorsandbloodparameters.Thetypeofsurgery,intraoperativevariablesrelatedtoCPBandpostoperativecreatininevariationwerealsoanalysed.Theassociationbetweenvariableswasstudiedusingbinarylogisticregression.Results: Of the 329 patients included, 62 (18.8%), developed AKI. There were statisticallysignificantdifferencesbetweenthegroupsinage(p<0.001),CPBtime(p=0.011),diuresisduringCPB(p=0.038)andmannitolandfurosemideadministrationduringCPB(respectively,p=0.032andp=0.013).Odds ratio showeda significantpositiveassociationbetweenAKIandage (OR(95%)-1.08 (1.04-1.11)), CPB time (OR (95%)-1.01 (1.00-1.01)), mannitol and furosemideadministrationduringCPB (respectively,OR (95%)-2.29 (1.08-4.89) andOR (95%)-2.54 (1.21-5.30)).Conclusions: This study shows that a significant number of patients developed AKI in thepostoperativeperiodofcardiacsurgeryandthisincidencewasinfluencedbyfactorsrelatedtoCPB.CO52SIMPLIFIED TECHNIQUE FORAORTIC ARCHREPLACEMENT IN PATIENTSATHIGHRISK FORFROZENELEPHANTTRUNKÁlvaroLaranjeiraSantos1;AntónioCruzTomás1;JorgePinheiroSantos1;DanielaVarela-Afonso1;JoséFragata11-HospitaldeSantaMartaIntroduction: Surgical approach of multisegmental pathology of the thoracic aorta, namelyaorticarch/descendingaortaischallenging.TheFrozenElephantTrunk(FET)hasgoodresults,withacceptablerisk.However,inthesubgroupofpatients(pts)olderthan75yearsandwithimportantcomorbidities,thesurgicalriskisveryhigh.Objectives:Reviewshort-termresultsofthisoriginal,simplifiedandpotentiallyhybridtechniquedevelopedinourDepartmentforthissubgroupofpatients.Methods:FromJanuary2016toSeptember2017,10ptswereoperatedwiththistechnique-meanage70.2±15.3years,7males.Thediagnoseswere:6ptswithaneurysmaldiseaseand4

ptswithaorticdissection.Fourptshadpreviouscardiacsurgery.Thesurgicalconceptconsistsof3keypoints:1)Useofapatient-tailoredgraft,builtinaback-table,toreplacetheascendingaortaandarch,withside-branchesproximallyanastomosedtoreroutethesupra-aorticvessels,allowingaproximal,longLandingZoneforeventualTEVAR.2)Debranchingofthesupra-aorticvessels.3)Maintainbilateralanterogradeselectivecerebralperfusion.Allptswereoperatedoncardiopulmonarybypass(CPB)withaperiodofhypothermic(24oC)cardiocirculatoryarrestfortheopendistalanastomosis.Preservationoftheleftsubclavianarterydependedonparaplegiarisk andwas individually assessedpreoperatively. In a second stage, a TEVARwas electivelydeployedin2patients.Allpatientswerefollowedinourclinicandimagingclinicat6monthsandannuallyaftersurgery.Results:MeanCPB,aorticcrossclampingandvisceralischemiawere,respectively,196,120and44 minutes. One pt died in- hospital due to bowel ischemia. Four pts had respiratorycomplications requiring prolonged ventilation. The mean ICU and hospital stay was,respectively,7,8and23,6days.Themeanfollow-upwas15.2monthsandthreeptsdiedduringthisfollow-up.Oneptwasre-hospitalizedwithdeepsternalwoundinfection.Ofthesurvivors,one had a stroke at 6 months postoperatively and the remainder are asymptomatic. Thepostoperativeperiodof the2pts submitted toTEVARwasuneventful; todate, they remainsurgicallystable,withoutneedingre-intervention.Conclusion:ThetechniqueiseffectiveandavoidstheburdenofFET.Theshort-termresultsareencouragingbut,inthelong-term,theyshouldbeevaluatedtodeterminetheirroleamongarchinterventions, specially their value in relation to recent pure endovascular techniques withfenestrated or branched endoprosthesis. Long ICU and hospital stay points towards theimplementationofmeasuresandprotocolstoimprovethem.CO53ROSSSURGERY:OUREXPERIENCECarolinaRodrigues1;RuiCerejo11-HospitaldeSantaMartaIntroduction:AtSantaMartaHospital,RossSurgerywasperformedforthefirsttimein1999.Seventeen years later, it is mandatory to evaluate the mid and long-term results of ourexperience,aswellasprospectthefutureofthisprocedure.Methods: BetweenMarch 1999 and June 2016, 23Ross procedureswereperformed at ourinstitution. We did a retrospective analysis of the patient’s data, results of the surgery,complications,freedomfromreoperationandmortality.Results:Themajority(36,4%)ofthepatientshadaorticstenosis,22,7%hadaorticregurgitationand27,3%hadaorticstenosisandregurgitation.Sub-valvularstenosiswaspresentin13,6%ofpatients.Themeanfollow-upis12years.Eightypercent(n=16)ofthesurvivorsareinclassIofNYHA,withtheremaining20%(n=4)inclassII.Inourseries,81%ofthepatientsarefreefromreoperation. The overall cumulative mortality was 9%. There was no operative mortality.Conclusion:Rosssurgeryhasspecificindicationsandinthisgroupofpatientstheadvantagesareundeniableandtheresults,accordingtoourseriesarepositiveandencouraging.

CO54TRIFECTABIOPROTHESISFORAORTICVALVEREPLACEMENT:OUREXPERIENCEJoãoPedroMonteiro1;DiogoRijo1;SaraSimõesCosta1;RodolfoPereira1;RicardoFerraz1;MiguelGuerra11-CentroHospitalarVilaNovadeGaia/EspinhoIntroduction:Bioprosthesisareincreasinglyusedforaorticvalvereplacement(AVR),asaresultof increasing elderly patients, as well as, continuous improvements in durability andhemodynamicperformanceofpericardialprosthesis.TheTrifectaaorticprosthesisisalatest-generationtrileafletstentedpericardialvalvedesignedforsupra-annularplacementintheaorticposition.ThisstudyestablishesthesafetyandearlyclinicalandhemodynamicperformanceoftheTrifectavalve.Methods:We retrospectivelyanalyzed thedataof373 consecutivepatients thatunderwentsurgicalimplantationofthepericardialstentedaorticprosthesis(Trifectavalve;StJudeMedical,StPaul,Minn)atourinstitutionfromMarch2014(firstimplant)toMarch2017(3years).Pre-operative, operative and post-operative parameters and clinical outcomes, as well as,echocardiographydatawereevaluated.Results:Themeanagewas73,96years±51,176(47,18%)patientsweremale,meanbodymassindex of 28,14 ± 12 and 75 (20,11%) were 380-years old. Concomitant procedures wereperformed in 123 (32,98%) patients. Isolated AVR was undertaken through conventionalsternotomy (62,5%), partial sternotomy (35%) or anterior right minithoracotomy (2,5%).Prosthesissizes implantedwere:19mm(n=37),21mm(n=138),23mm(n=196)and25mm(n=2).Theoverallfollow-upincluded669latepatient-years.Early(≤30day)mortalityoccurredin20patients(5.36%),andtherewere4(1.07%) late(≥31days)deathsyieldinga linearizedmortalityrateof2.98%perlatepatient-year.ForisolatedAVR,mortalityoccurredin12(3.22%)patients. The incidence of new onset atrial fibrillation/flutter was of 28.95% (n=108). Fivepatientshadnecessity for implantationofpostoperativepermanentpacemaker (1,34%),andfourmediastinitis/sternaldehiscence(1.07%)andthirtyninecasesofmajorbleedingrequiredsurgery(10.46%).Therewere2earlythromboembolicevents,including1(0,27%)strokeand1(0,27%) systemic embolic event. There were no instances of early valve thrombosis,endocarditis,orclinicallysignificanthaemolysis.Therewerenolatethromboemboliceventsorvalvestructuraldeterioration. Intotal,therewas1 latevalveexplantduetoanendocarditis.Overall, freedom from valve explant was 99,77% per late patient-year. At postoperativeechocardiography,averagemeangradientsacrossallvalvesizeswas10.63mmHg.Meanfollow-upwas4±2months.Nosevereaorticregurgitationwasobserved.Conclusion:ThepresentsystematicreviewdemonstratedthatAVRwiththisprosthesisprovidedexcellent early safety and hemodynamic outcomes with acceptable mean gradients;nevertheless, their timing, pathological characteristics, and clinical presentation mandatecontinuedfollow-up.

CO55CORONARYALLOGRAFTVASCULOPATHYAFTERCARDIACTRANSPLANTATION:PREVALENCE,PROGNOSTICANDRISKFACTORSAndréAntunes1;DavidPrieto1;CarlosPinto1;CarlosBranco1;PedroCorreia1;ManuelBatista1;ManuelAntunes11-ServiçodeCirurgiaCardiotorácicadoCentroHospitalareUniversitáriodeCoimbraIntroduction: Coronary allograft vasculopathy (CAV) is still a serious long-term complicationaftercardiactransplantation.Purpose:ToevaluatetheprevalenceofCAVinasingleinstitution,itsimpactonsurvivalandtoexploreassociatedriskfactors.Methods: FromNovember-2003 through June-2016,316patientswere submitted tocardiactransplantation.Afterexcludingthosewithpaediatricage(n=8),thosewithpreviousrenalorhepatic transplantation (n=2) and those who didn’t survive the first year after cardiactransplantation(n=40),thestudypopulationresultedin266patients.Fortytwopatients(15.8%)withCAV,diagnosedbyanew>50%coronaryarterystenosis inanyvesselduring follow-up,werecomparedwithanon-CAVgroup.Results:Bothgroupssharedesamemedianage(54+10years).RecipientmalesexpredominatedintheCAVgroup(93%vs.74%),asdidischemicetiology(52%vs.37%).Althoughnotreachingstatistical significance, CAV patients also had more dyslipidemia (60% vs. 50%), history ofsmoking(52%vs.44%)andperipheralvasculardisease(45%vs.29%).Theincidenceofcelularacuterejection1RismorefrequentinCAVgroup(69%vs.60%)suchas2Ror3R(29%vs.27%).Prolongeduseofinotropicsupportandmechanicalassistanceaftercardiactransplantationwerecomparablebetweenbothgroups.Thesurvivalofthispatients,whoweresubmittedtocardiactransplantationandhadlivedatleast1year,betweenCAVandnon-CAVgroupwascomparableat5-year(91%vs.85%),buttendedtobelowerforCAVpatientsin10-yearinterval(52%vs.73%).Conclusion: This data confirms CAV as a common long-term complication following cardiactransplantation.Althoughshorttomid-termsurvivalseemsnottobeaffectedbyCAV,long-termsurvivalappearslower,hencealongerfollow-upisneeded.CO56ASCENDINGAORTAANEURYSMSINOCTOGENARIANSJorgePinheiroSantos1;ÁlvaroLaranjeira1;AntónioCruzTomás1;DanielaVarela-Afonso1;JoséFragata11-HospitaldeSantaMarta,CentroHospitalardeLisboaCentralIntroduction:Olderage isoften regardedasa relative contraindication foropen surgery foraorticaneurysms.Theseindividualsoftenhaveagreatercomorbidityburdenthatpredisposethemfordevelopmentofpostoperativecomplications.Theaimofourstudyistoevaluatethesurgicaloutcomesofselectedoctogenariansafteropenaorticsurgery.Methods:Weperformedaretrospectiveobservationalstudy.Wecollecteddatafrompatientsoperated on by our team between January of 2012 to September of 2017.We performedunivariatelogisticregressionandsurvivalanalysistoconstructKaplanMeiersurvivalcurves.Results:Weanalyseddata from430patients, and31patients fulfilled the inclusion criteria.67.7% of the patients were male. The mean age was 81.5 ± 1.8 years. The preoperativecomorbiditieswerehypertension(83.9%),aorticvalvedisease(54.8%),dyslipidaemia(48.4%),

renalimpairment(9.7%),type2diabetesmellitus(9.7%)andCOPD(3.2%).Asfortheproceduresperformedthemajoritywasaorticvalvereplacementandgraftinterposition(48.4%)followedby graft interposition (35.5%), ascending aorta and arch replacement (9.7%) and graftinterpositionandcombinedCABG(6.5%).16.1%oftheprocedureswerereoperationsand6.5%wereperformedasurgent.In-hospitalmortalitywas9.4%and1-yearsurvivalwas77.4%.Themeansurvivaltimeaftersurgerywas736.4±530.3days.Asforcomplications,22.6%developedrespiratory complications, 6.5% had infectious complications and 3.2 developed renal andcentralnervous systemcomplications.Olderagewasnot related toearly (p=0.266)or latemortality(p=0.779).TherewasnoassociationbetweenolderageandlongerICUstay(p=0.781)ortotalhospitalstay(p=0.985).Conclusions: Highly selected octogenarians benefit from surgery, having a similar rate ofpostoperativecomplicationsandsurvival,asdescribedintheliterature.CO57DIAGNOSTICCHALLENGESINCHRONICCONSTRICTIVEPERICARDITISAnaBraga1;AfonsoOliveira1;KevinDomingues2;MariaJoãoAndrade1;MiguelAbecasis1;JoséPedroNeves11-HospitaldeSantaCruz;2-HospitaldeSantaremIntroduction: Chronic constrictive pericarditis (CCP) is a disease that has multiple possiblecausesand isassociatedwithvariableclinical findings,dependingon its severity. Itdevelopsinsidiously,andinmanycases,particularlyindevelopedcountries,noantecedentdiagnosiscanbefound.Thesecasesaretermedidiopathic.Tuberculosisistheleadingcauseofconstrictivepericarditisindevelopingnationsbutrepresentsonlyasmallminorityindevelopedcountries.Methods: Here the authors describe two different case reportswhere tuberculosiswas theprobablecauseofCCP.Results:A21-year-oldmanborninCapeVerdelivinginEuropefor4yearsanda24-year-oldmanborninGuinéBissauwerebothadmittedduetointenseprecordialpainandsyncopeafterexertion. Interestingly both had fatigability, dyspnea, chest discomfort and palpitations onexertion, as well as progressive involuntary weight loss and decubitus cough. On physicalexamination they had tachycardia, jaundice, cachexia, elevated jugular venous pressure,hepatomegalyandascites.BothelectrocardiogramsshowedprominentPwavesandchestX-rayshowed bilateral pulmonary interstitial infiltrates and enlargement of the right cavities.Analytically, elevated bilirubin, leukopenia and thrombocytopenia was also found in both.Echocardiographyrevealedfindings,inbothcases,compatiblewithCCPincludinglesscommonsigns as annulus reversus and annulus paradoxus. Thoraco-abdomino-pelvic CT from bothpatients revealed chronic liver disease with congestion, pleural effusion, pericardialcalcifications,ascitesandmassivemediastinalandabdominaladenopathies.BloodculturesandIGRAtestwerenegative.However,giventhepresumptivediagnosisoftuberculosis(TB),anti-TBtherapywasstarted.Despitethediagnosisof“end-stage”CCPwithveryhighoperativeriskmultidisciplinary team decided after informed consent, to perform total anteriorpericardiectomy, that occurred without complications. Pericardial and mediastinal biopsies,pericardial/pleural fluid cultures/immune-phenotyping were inconclusive. Anti- tuberculosistherapywasmaintained. After surgery, the patients had a remarkable clinical improvement(NYHAI)thatpersistedin6-monthfollow-up.Conclusion:Thesetwocasereportsillustratethatdespitethemarkedlyelevatedoperativeriskofpericardiectomyin“end-stage”formsofdiseaseafterpatientsinformedconsentmustbeaconsideredoption.Theotherpointtoconsideristhat,despiterare,tuberculosisstillisapossiblediagnosistoconsiderinCCPinPortugal.

CO58CARDIACFIBROELASTOMA:10-YEAREXPERIENCEJorge Pinheiro Santos1; Nuno Banazol1; António Cruz Tomás1; Daniela Varela-Afonso1; JoséFragata11-HospitaldeSantaMarta,CentroHospitalardeLisboaCentralIntroduction: Papillary fibroelastoma is one of the most common types of primary cardiactumour.Thoughararepathology,itsimportancerelatestoitsformofpresentation,withstrokeandsuddendeath,andthequestionsregardingitsmanagement.Objectives: to review the casuistic of cardiac tumours in our service, in special the papillaryfibroelastomas.Methods:clinicalcaseseriesoverviewingtheperiodfrom1stJanuary2008to30thSeptember2017.Weanalysedallpatientssubmittedtocardiacsurgeryduetocardiacmassesortumoursandverifiedallthepathologyresultstoconfirmthediagnosis.Results:Intheperiodselected,around6500surgerieswereperformed.Ofthose,59patientswere operated on due to cardiac tumours. 81.4% were myxomas, 13.6% were papillaryfibroelastomas,3.4%werecardiacsarcomasand1.7%weremetastasis.Ofthepatientsthathadpapillaryfibroelastomas(n=8),5weremale,andthemeanagewas51.5±16.2years.62.5%(n=5)hadoriginintheaorticvalveand37.5%(n=3)inthemitralvalve.Regardingpresentation,3 patients presented with stroke, 2 patients had episodes of syncope and 3 patients wereasymptomatic.Aftersurgery,allpatientsremainedasymptomaticandtherewasnoevidenceofrecurrence.Attheendoffollow-upallpatientswerealive.Conclusion:Althoughararepathology,papillaryfibroelastomasremainimportantduetotheirpotential for embolization and cardiac chamber obstruction, therefore should be primarilytreatedwithsurgery.

CO59IGG4DISEASEANDSLEROSINGAORTITISBrunoFernandes1;RuiAnacleto2;LinaCarvalho31 - Department of Pathological Anatomy, CHUC; 2 - Department of Cardiothoracic Surgery,CHUC;3-InstituteofPathologicalAnatomyandMolecularPathologyofFMUC,CHUCIntroduction: IgG4-related disease (IgG4-RD) is an immune-mediated fibro-inflammatoryconditionwithunknownetiologythatcanaffectvariousorgans.Althoughitsprevalenceisstillunknown,itappearstobemorefrequentinadultmales.Cardiovascularmanifestationsarerareand can include idiopathic retroperitoneal periaortic fibrosis, inflammatory aortic aneurism,inflammatory periarteritis and inflammatory pericarditis. Vascular involvement is a well-recognized feature and large vessel commitment, especially the aorta, can be the onlymanifestationofthedisease.Thegoldstandarddiagnosisishistological.Methods:A47-year-oldmanpresentedruptureoftwoaorticaneurysms:onethoracicandoneabdominal,andunderwentsurgicalcorrection.Asegmentoftheaortaarterywallmeasuring3x2x0.5cm,exhibitedsmoothintimateandwhitevinousadventitia,mediumtunicwaswhite,throughfirmtissuewithlossofelasticity.Results: Inadditiontoheterogenouscollagenationwithdestructionoftheelasticnetworkoftheaorticmediaetunica,therewasfibrindepositionandneutrophiloverlap.Lymphoidfollicleswithreactivegerminatecenterswerealongthetunicamediaandadventitia,withoutphenotypeofendothelitisandabsenceofeithermacrophagesandLangerhanscells(CD1a).PlasmocytesshowedimmunopositivitytoIgG4,withheterogeneousandwelldefinedlocalization,supportingthediagnosisof igG4Disease.Serological studies showednegativity forvasculitis,hereditaryconnective tissue diseases were not component of the clinical set and normal serum IgG4concentrationwasdetermined.Conclusion: Few cases of involvement of large vessels by IgG4-RD have been reported inliterature.SerumIgG4concentrationmaybenormalinonethirdofpatients.Inthiscase,IgG4immunostaining was crucial for the diagnosis of IgG4-RD aortitis, together with the hyalinedestructionofthetunicamedia(ESP2015/Aagaimy2013).ThereisstillnoclinicalknowledgeforthetreatmentandmonitoringoftheinvolvementoflargevesselsbyIgG4-RD.CO60ASCENDINGAORTAANEURYSMSOVER70MMJorgePinheiroSantos1;ÁlvaroLaranjeira1;AntónioCruzTomás1;DanielaVarela-Afonso1;JoséFragata11-HospitaldeSantaMarta,CentroHospitalardeLisboaCentralIntroduction: Current guidelines suggest that patients with aortic diameter over 55-60mmshouldundergo ascending aorta replacement, dependingon associated valvepathology andothercomorbidities.Studiesshowthattheriskofaorticruptureover60mmisover30%.Eventhough, we still receive in our practice patients that present with aneurysms of greaterdimensions.Theaimofourstudy istoevaluatethesurgicaloutcomesofpatientspresentingwithascendingaortawithdiameterlargerthan70mm.Methods:Weperformedaretrospectiveobservationalstudy.Wecollecteddatafrompatientsoperated on by our team between January of 2012 to September of 2017.We performedunivariatelogisticregressionandsurvivalanalysistoconstructKaplanMeiersurvivalcurves.

Results:Weanalyseddata from430patients, and31patients fulfilled the inclusion criteria.64.5% of the patients were male. The mean age was 67.9 ± 12.9 years. The preoperativecomorbiditieswerehypertension(64.5%),dyslipidaemia(45.2%),aorticvalvedisease(35.4%),renal impairment (9.7%)andCOPD (3.2%). Theaveragediameterwas82.3±18.6mm,withvaluesrangingfrom70to160millimeters.Asfortheproceduresperformedthemajoritywasinterposition of prosthetic graft (45.2%), followed by aortic valve replacement and graftinterposition(35.5%),FrozenElephantTrunk(12.9%),tubeinterpositionandcombinedCABG(3.2%)andaorticrootreplacementwithgraftinterposition(3.2%).9.7%oftheprocedureswerereoperationsand9.7%wereperformedasurgent. In-hospitalmortalitywas3.2%and1-yearsurvival was 83.9%. The mean survival time after surgery was 1135.9 ± 777.1 days. As forcomplications,29%developedrespiratorycomplications,9.7%hadcardiaccomplications,6.5%had central nervous system complications and 3.2% developed renal and vascularcomplications.Greaterdiameterwasnotassociatedwithearly(p=0.929)orlatemortality(p=0.987).Conclusions:Theseresultsshowthatpatientswithaneurysmsgreaterthan70mmcanbesafelyoperatedon,withnoincreaseincomplicationsinthepostoperativeperiodorgreatermortality.CO61ELECTIVE 2ND STAGE TEVAR TO COMPLETE FROZEN ELEPHANT TRUNK IN THE SURGICALCORRECTIONOFCOMPLEXMULTISEGMENTALPATHOLOGYOFTHETHORACICAORTAÁlvaroLaranjeiraSantos1;AntónioCruzTomás1;DanielaVarela-Afonso1;JorgePinheiroSantos1;JoséFragata11-HospitaldeSantaMartaIntroduction:Classicalconventionalsurgerytotreatmulti-segmentalthoracicaorticdiseaseintwooperativestages,sternotomyandleftthoracotomy,isassociatedwithsignificantmortalityandcomplications.TheFrozenElephantTrunk(FET)associatedwithanendovascularprocedure(TEVAR) allows an extensible and simplified surgical approach of the descending andthoracoabdominalaortawithoutincreasingtherisk.Methods: Retrospective study of 8 patients (pts), 5males,mean age 67.5 ± 4.2 years,withascendingandarchdiseaseassociatedwithdescendingaorticdisease(chronicdissection2pts,aneurysmaldisease6pts),treatedbetweenJanuary2014andSeptember2017.AllsurvivorsareperiodicallyfollowedupinouroutpatientclinicwithCTorMRIangiography.Results:Theaveragefollow-upperiodis18,7±12,2months.Inthefirststage(FET)-theleftsubclavianwasconservedinallcases.Insixofthesepts,afteranaverageperiodof37days,aTEVARwasperformed,tocompletetheexclusionoftheaneurysmalsacorthefalselumeninthe descending aorta. In 2 pts, the interval was longer and in the same intervention, afenestratedendoprosthesiswasimplantedintheabdominalaortabythevascularteam.AfterTEVAR,meanICUtimewas16hoursandhospitalizationwas5,2days.Oneptdiedinthe1stmonth post-intervention TEVAR + EVAR fenestrated. The remaining pts are stable andasymptomatic, in Class I NYHA, without endoleaks and with the expected involution of theaneurysmalsacandpositiveremodelingoftheaorta.Therewerenocasesofparaplegiaorotherneurologicalcomplicationsdocumented.Conclusion: This strategy is safe and effective. Clinical follow-up associated with closepostoperative imaging surveillance is required not only to determine the optimal intervalbetweenthetwostages,whichisdependentontheanatomyandunderlyingpathologyofeachpatient,butalsotoidentifypossiblecomplications.Thequalityoflifeoftheseptsinthemedium-termisexcellent.

CO62TAKAYASU'SAORTITISINDUCEDASCENDINGAORTADISSECTIONBrunoFernandes1;JoanaSaraiva2;LinaCarvalho31 - Department of Pathological Anatomy, CHUC; 2 - Department of Cardiothoracic Surgery,CHUC;3-InstituteofPathologicalAnatomyandMolecularPathologyofFMUCIntroduction: Takayasu aortitis is awell known yet rare form of large vessel vasculitis. Alsoknownaspulselessdisease,occlusivethromboaortopathy,andMartorellsyndrome,isachronicinflammatory aortitis. Vessel inflammation leads to wall thickening, fibrosis, stenosis, andthrombusformation.Methods:A64-year-oldwomanwasreferredtoemergencyforlackofpulseintheupperandlower limbsandchanges inheartrate.AngioRMNrevealeddissectionoftheascendingaortawhileinPET, intenseuptakeofFDG-F18involvingascending,crossa,descendingthoracicandabdominalsegmentsoftheaorta,wasevidenturgentsurgicalcorrectionoccurred.Anaortaringsegment with 2.5cm length, showed whitish and smooth intimate, with linear transversallaceration,withregularborders.Dissection1cmlongofthemedialtunicawasoccupiedbyaclotincontinuitywithathrombusoccupyingtheneoformedlumen.Results:Microscopyexaminationconfirmedhyalinizationofthetunicamediawithimpregnationoffibrin/thrombuswithbloodcellelements.Endothelialinflammatorycharacteristicstogetherwith vasa vasorum and vascular trajectory of the periphery of the tunica media withinflammatorycellsinvolvementallowedthediagnosisofTakayasuaortitis.Conclusion: Takayasu aortitis is rare in the presented age group, with early non-specificsymptoms. Thediagnosis of aortic dissectionwas crucial, constituting amedical emergency.Heather L-Gomik (2008) supports the hyaline structural alteration of the tunicamedia. Thediseasehasbeenrecognizedformorethan100years,andpatientswithTakayasuaortitisremainrelativelypoorandtreatmentissuboptimal.Keyareasforimprovementincludetheneedforincreasediseaseawarenessandearlierdiagnosis,andimprovedmeansformonitoringdiseaseactivity. The demonstration of diferential expression of Toll-like receptors in arteries, isparticularlyintriguingandworthyoffurtherinvestigation.CO63PO-(16102)-SYPHILITICAORTITISDIAGNOSISINCLINICALSETTINGBrunoFernandes1;ArsénioSantos2;LinaCarvalho31 - Department of Pathological Anatomy, CHUC; 2 - Department of Cardiothoracic Surgery,CHUC;3-InstituteofPathologicalAnatomyandMolecularPathologyofFMUCIntroduction:Cardiovascularsyphiliscanmanifestasaorticaneurysms,aorticregurgitationandcoronary ostial stenosis. Tertiary syphiliswas themost commom reported causeof thoracicaortic aneurysm in the pre-antibiotic era, contributing to 5- 10% of cardiovascular deaths.However,inthe21stcentury,ithasvirtuallydisapperedfromthedevolopingnations.Tertiaysyphilismaydevelopinaboutonethirdofcasesofuntreatedsyphilis.Inthepre-penicilinera,itwascalculatedthatcardiovascularsyphiliswasresponsiblefor10-15%ofclinicalsyphilis.Methods:Wepresentararecaseofsyphiliticaortitisinaeraofhighlyeffectiveantibiotics.Results:A48-year-oldmanwithnoknownclinicalcardiacpathologywenttoemergencywithan episode of chest pain of short duration and great intensity, being hospitalized with adifferential diagnosis of coronary disease, ascending aortic aneurysm and aortic valveregurgitation. Two segments of the aorta, 5cm and 9.5cm length were observed, both had

thickenedwall(1cm),andfirmplaqueswithdiferentshapesandsizes.Theintimaoftheaortaappearedroughandpitted,withtheappearanceoftreebark.Therewereheterogeneouslesionsof the tunica media: hyalinization and calcification, macrophages aggregates, areas ofhemorrhage and lymphoplasmacytic infiltrate forming vascular sheaths. Adventitia exhibitedhyperplasiaofnervepathwayswithsurroundinglymphoplasmocyticinfiltrate.Thediagnosisofsyphilitic aortitis was purposed and serological analysis revealed positivity for Treponemapallidum.Patientunderwentsurgicalcorrectionofanaorticaneurysm.Conclusion:TheserologicalpositivityforTreponemapallidumandthehistopathologicalstudyallowedthecurrentlyrarediagnosisofAscendingAorticAneurysmbyTertiarySyphilis.Inthepresent scenario with early and widespread use of antibiotics, it is considered a very raredisease.CO64TRAUMA:ANUNUSUALCAUSEOFENDOCARDITISAnaBraga1;MartaMarques1;MiguelAbecasis1;JoséPedroNeves11-HospitaldeSantaCruzIntroduction: Infective endocarditis (IE) remains a dangerous condition with considerableassociatedmortality.UsualriskfactorsforIEincludethepresenceofaprostheticheartvalve,structuralorcongenitalheartdisease, intravenousdruguse,anda recenthistoryof invasiveprocedures.Methods:TheauthorsdescribethecasereportofapatientwithIEhavingtraumaasanunusualriskfactor.Results: A 33-year old male patient was referred to our department due to infectiveendocarditis. The patient had a fever of unknown origin for 15 days before going to theemergencydepartment.Afteradmissionitwasidentifiedbytransthoracicechocardiographya14mmposteriorabscessoftheaorticvalveprovokingmajoraorticregurgitationwithmoderateLVdysfunction.Aftercarefulevaluationoftheclinicalhistoryitwasfoundthatthepatienthadaknownbicuspidaorticvalvewithfollow-upsincetheageof14.AllotherusualriskfactorsforIEwereexcluded,includingintravenousdruguseandrecenthistoryofinvasiveprocedures.Theonlyrelevantpreviouseventwasatraumatichaemathomainhisleftjawcausedbyaworkingaccidentwithanironbeaminaconstructionsiteasthepatientisacivilengineer.Vancomycinplusgentamicinwereempiricallystartedafterbloodculturestaken.TheisolatedinfectiveagentwasStaphylococcuslugdunensismethicillinsensitiveandtheantibiotherapywasde-escalatedtoflucloxacilinplusgentamicin.Duetocardiacdysfunctionthepatientwassubmittedtocardiacsurgeryonthefourthdayofdirectedantibiotictherapyandareplacementoftheaorticvalvebyamechanicalprostheticvalveandclosureoftheabscesswithbovinepericardialpatchwasperformed.Thevalvesenttomicrobiologyevaluationshowedthesameinfectiveprovocativeagent.Thepatienthadagoodclinicalandlaboratorialrecoverycompletingthe42-dayantibioticscheme. After antibiotherapy period completion, echocardiography was repeated and theabscess found was larger then the previous one, presenting itself like an aortic pseudoaneurysm.Thepatientwasresubmittedtosurgerywithre-closureof the initialabscesswithautologous pericardial patch and replacement of the prosthetic mechanical valve for anundersizedone.Thepatientwasdischargerclinicallywell,havingacompletenormallifeatthemoment.Conclusion: This clinical case illustrates trauma as an unusual cause of endocarditis andemphasizestheimportanceofadetailedclinicalhistory.

CirurgiaVasculareEndovascularCO65PREDICTORSOFPROGNOSISINPATIENTSWITHTYPEBAORTICDISSECTIONMarinaDias-Neto2;FilipaPoleri1;SérgioSampaio21-FaculdadedeMedicinadoPorto;2-DepartamentodeAngiologiaeCirurgiaVascular,CentroHospitalardeSãoJoãoIntroduction: Type B aortic dissection (TBAD) affectsmostlymenwith an estimated annualincidence between 2.9 and 4.0 per 100,000, and it appears to be increasing. DISSECTclassificationwaspublishedin2013aimingtoreuniteclinicalandanatomicalcharacteristicsofinteresttocliniciansinvolvedinTBADmanagement.InPortugal,theincidenceofthecondition,aswellasitscharacteristicsandoutcomes,arenotwelldocumented.Theaimofthispaperistodescribetherealityofatertiaryinstitutionwithareferralareaofabout0,6millionhabitants.Methods:ItisaretrospectivestudythatincludedallpatientswithTBADadmittedfromMarchof 2006 to 2016. The patientswere categorized according to their demographic and clinicalcharacteristics. For each patient, the computerized tomography scan that enable the TBADdiagnosiswasclassifiedusingDISSECTclassification.Overallmortalityratesandaorta-relatedmortalityrateswereestimatedusingKaplan-Meiermethod.Coxregressionwasusedtostudydeterminantsofmortality.Results:Weincluded35patients,estimatingaTBADincidenceofapproximately0.6per100,000person-year. Themajorityweremen (83%)with amean age of 60±12 years-old; 71%werehypertensive,56%wereex-smokersoractivesmokersand13%haddiabetes.AstoDISSECTclassification,76%wereacute(Duration),66%hadaprimaryIntimaltearlocationinaorticarch, themaximumtrans-aorticdiameterwas44±13mm(Size),60%extended fromaorticarchtoabdomenoriliacarteries(Segmentalextent),26%presentedwithComplications,being rupture and branch vessel malperfusion the most frequent, and 28% had partialThrombosis of false lumen (versus 66% with permeability of false lumen). Eight patientsunderwentsurgery(24%),6oftheminacutephaseand2oftheminsubacutephase.At12months,overallsurvivalofwholeserieswas73,1%±8,3%andsurvival freefromaortic-relatedmortalitywas83±6,7%(Figure1AandB).Thepresenceofcomplicationswasidentifiedasanindependentriskfactorofoverallmortalitybutnottoaortic-relatedmortality.Conclusion: The incidence of TBAD verified was lower than what has been described inliterature. DISSECT classification can be easily applied to TBAD cases. The presence ofcomplications predicts highermortality. Further studies are needed to characterize TBAD inPortugal.

CO66ENDOVASCULARTREATMENTOFCAROTIDBLOWOUTSYNDROMERogerRodrigues1;JoãoCosta1;GabrielAnacleto1;DiogoRoriz1;ÓscarGonçalves11-CentroHospitalarUniversitáriodeCoimbraIntroduction:Carotidblowoutsyndrome(CBS)isalifethreateningcomplicationassociatedwithheadandneckcancers(HNC)anditstreatment.Themortalityratewasreportedtorangefrom3%toover50%intheliterature.Directsurgicalrepairoftherupturedinternalcarotidarteryisoften not technically possible due to the difficult anatomy and underlying poor co-morbid

status.Endovasculartechniquessuchascoilembolizationandstentgraftingofferanalternativetosurgicalligationwithbetterpatientoutcomes.Methods:Wedescribethesuccessfuluseofanendovascularapproachinacaseofemergentruptureof thecommoncarotidartery (CCA)withmassivebleeding inapatientsubmittedtoradiotheraphyforthetreatmentofaneckmalignancy.Results:A75-year-oldmanwithasquamouscellcarcinomaoftheesophagushavingundergonechemotherapy and radiotherapy,was admitted to the emergency roomwith haematemesiswithapproximately1hourofevolution.Anangiogramrevealed, intherightcommoncarotidartery,contrastextravasationwithapossiblefistulacommunicatingtotheesophagus.Aself-expandablecoveredstentwasdeployedintherightcommoncarotidartery.Successfulrepairofthevesselwasconfirmedinthecontrolangiogram.Thepatientwasdischarged10dayslaterwithoutneurologicaldeficitorrecurrentbleeding.CarotidblowoutsyndromeisoneofthemostcomplexbleedingcomplicationsthatmayoccurinHNCpatients.Itisusuallyalife-threateningeventand is accompaniedwithunexpectedlymassivebleedingandhighmortality/morbidityrates.Shortandlongtermeffectsofradiationoverarterieshavebeenreported.Radiationcaninducedamagetothevasavasorumoflargearteriesanditmightleadtotheruptureofarteries.IntheHNCpopulationwithprevioussurgeryorradiotherapy,ahighindexofsuspicionmustbemaintained for CBS in patients presenting with any recent history of oral bleeding orhaemorrhagingfromanexposedneckwound.Conclusion:Currentevidenceshowsthattherewasnosignificantdifference intechnicalandhemostaticoutcomesbetweenthereconstructiveanddeconstructiveendovascularmethods.Permanentvesselocclusionresultedinhigherimmediatelycerebralischemiaandstentgraftinginduced themorepotentiallydelayedcomplications, suchas infection, rebleeding,andstentthrombosis.Inthepresentcase,theendovascularmanagementofCBSofthecommoncarotidarteryhadhightechnicalsuccessandallowedimmediatehaemostasis. Ithasbeensuggestedthat self-expanding stent-grafts are useful for the initial control of carotid bleeding but areassociatedwithmoredelayedcomplications.CO67ENDOVASCULARTREATMENTOFPROPERHEPATICARTERYANEURYSM–CASEREPORTTiagoSoares1;RicardoCastro-Ferreira1;MarinaNeto1; JoãoRochaNeves1; JoséPedroPinto1;JoelSousa1;LuisGamas1;PauloDias1;SérgioSampaio1,2;JoséFernandoTeixeira11-CentroHospitalarSãoJoão;2-FaculdadedeMedicinadaUiniversidadedoPorto,MEDCIDESIntroduction:Hepaticarteryaneurysms(HAAs)arerare,representingabout0.1-2%ofallarterialaneurysms. They are the second most common splanchnic aneurysms, after splenic arteryaneurysms.Theyhavethehighestrateofruptureamongallsplanchnicarteryaneurysmsandfrequentlybecomesymptomatic.Methods:Topresentacaseofahepaticarteryaneurysmtreatedbyendovasculartechnique.Results: A 65-year old man who had a medical history of hypertension, dyslipidemia andsmoking,withan incidental findingonaCT imagingofahepaticarteryaneurysm(maximumdiameter 75mm) was admitted for selective arteriography and treatment. He wasasymptomatic. We proceeded to aneurysm exclusion with a self-expandable covered stent(Viabahn®)6x100mm.Finalangiographyrevealedpermeabilityofrighthepaticartery,splenicartery and gastroduodenal artery, and no visible endoleaks. He was discharged on the 4thpostoperativeday,asymptomaticandwithoutanalyticchanges.Ona6monthsfollow-up,CT-angioconfirmedafullypatentstentwithnovisibleendoleaksandcompleteaneurysmexclusion.

Conclusion: HAAs should be diagnosed before rupture. Abdominal pain, bleeding orcompressionmaybethefirstsymptoms.Exclusionbyendovasculartechniques,namelythroughcovered-stentuse,maybeagoodoption.CO68ENDOVASCULARTREATMENTOFACOMPLICATEDTYPEBACUTEAORTICDISSECTIONWITH3-DULTRASOUNDCONTROLRogerRodrigues1;JavierVillaverde2;JorgeNoya2;GabrielAnacleto1;ÓscarGonçalves11-CentroHospitalarUniversitáriodeCoimbra;2-HospitalClínicioeUniversitáriodeSantiagodeCompostelaIntroduction: Acute typeB aortic dissection (ATBAD), identifiedwithin 2weeksof symptomonset,accountsfor25%-40%ofallaorticdissections.Approximately25%ofpatientspresentingwith ATBAD are complicated at admission by malperfusion syndrome or hemodynamicinstability,resultinginahighriskofearlydeathwhenuntreated.Methods:WepresentacaseofapatientwithacomplicatedtypeBdissectiontreatedbyanendovasculartechniquewithcontrolofthesealingzonewithtransesophagealEchocardiogram(TEE)and3-Dimages.Results:A56-year-oldpatientwasadmittedtotheintensivecareunitforhavingatypeBaorticdissectioncomplicatedbypersistentchestpainanduncontrolledhypertension.WeperformaTEVAR(thoracicendovascularaorticrepair)withaGORE®TAG®conformablethoracicstentgraftwith active control system to seal theprimary entry tear,which covered the left subclavianartery.Theoriginoftheleftsubclavianarterywascoveredbythestentgraftandavascularplugwas put in place, to avoid endoleak. The procedure was performed with transesophagealechocardiogramwith3-Dimagestodetermineifthestentgraftwasinthetruelumen.Conclusion:Thetreatmentofacute,complicated typeBaorticdissectionhasevolved in thepast severalyears.Thoracicendovascularaorticrepairwhenanatomyissuitable,hasbeenregardedasthepreferable treatment to seal theprimaryentry tear, redirect and re-establishadequate truelumenflow,andtherebypromoteaorticremodeling.TheavailabilityofTEVAR,albeitapplieduntilrecentlyasanoff-labeltreatment,hasclearlyproducedbetterresultsthanproceduressuchas open surgical or endovascular fenestration. However, the results of this treatment mayimprovewhen associatedwith other imaging tests. The TEE has a high performance in thediagnosisofthispathology,especiallyinregardtothedetectionoftheflapandthetwolumens,aswellasforthecalculationofthesizeoftheentrancetear.Itpresentsanaddedvalueintheendovasculartreatment,sinceithelpsintheimplantationofthedevicesbothforthelocationofthetruelumen,itsdefinitivepositionandtheresultoftheprocedure.TEVARisthepreferredtreatment for acute, complicated type B aortic dissection with improved late survival andpositiveaorticremodelling.Theefficacyofthistreatmentissignificantlyincreasedinassociationwithotherimagingtechniquessuchastransesophagealechography.

CO69HOSTILETHORACICAORTICANEURYSMTREATEDBYFENESTRATEDTHORACICSTENTGRAFTWITHPROXIMALSEALINGINISHIMARUZONE0JoelSousa1;JoãoNeves1;VicenteRiambau2;JoséTeixeira11-HospitaldeS.João,Porto,Portugal;2-HospitalClinic,Barcelona,SpainIntroduction:Thoracicendovascularaorticaneurysmrepair(TEVAR)isanestablishedtreatmentforthoracicaorticdiseaseinboththeacuteandelectivesetting,withsuchawidespreadusethatalmost50%ofallthoracicaorticsurgeryinEuropeisperformedbythesemeans.Nonetheless, the feasibility of TEVAR is determined by several anatomic factors, and thesuitabilityoftheproximalanddistallandingzonesremainoneofthemainlimitationstoitsuse.Theadventofcustom-madethoracicstentgraftswidenedtheendovascularoptions insomechallenginganatomies.Methods:Theauthorspresentacasereportofadescendingthoracicaorticpseudo-aneurysm,with no suitable proximal landing zone, successfully treated by means of a custom-madefenestratedthoracicstentgraft.Results:Malepatient,57yearsold,withmultiplecardiovascularriskfactorsandpastmedicalhistoryof coronaryhearthdisease, pulmonary emphysemaandhigh speed trauma20 yearsbefore.Thepatientwasreferredafterbeingdiagnosedwithanasymptomaticsaccularpseudo-aneurysmofthedescendingthoracicaorta,with50mmoflargestdiameterandlocatedatthelevel of the aortic isthmus. Inadequate proximal sealingwas evident, even if deliberate leftsubclavianandcarotidcoveragewereperformed.Duetotheprohibitiveopensurgicalrisk,andtaking into account the post-traumatic etiology of the lesion, an endovascular solutionwasplanned.Thepatientwasthereforesequentiallytreatedbymeansofaleftcarotid-subclavianbypassfollowedbycustom-madefenestratedTEVAR,withasinglefenestrationforboththeleftcommon carotid artery and brachiocephalic trunk, granting proper sealing in the distalascendingaorta(Ishimaruzone0).Rapidpacingwasusedduringtheimplantation,withheartfrequency of 180 bpm and systolic pressures of 40mmHg, allowing for a more precisedeploymentwithnowindsockeffect.Theprocedurewas successfulanduneventful,withnointra-operative endoleaks, birdbeaks or retrograde dissections. There are no reportedcomplicationsat6monthsfollow-up.Conclusion:Custom-madefenestratedthoracicstentgraftsareanaccessible,reproducibleandsafe therapeutic option when dealing with hostile thoracic arch anatomies, and should beconsideredasaminimally-invasiveeffectivesolutioninselectedcases.CO70DIGITALSUBTRACTIONANGIOGRAPHYORCOMPUTEDTOMOGRAPHYANGIOGRAPHYINTHEPREOPERATIVE EVALUATION OF LOWER LIMB PERIPHERAL ARTERY DISEASE – ACOMPARATIVEANALYSISMarinaDias-Neto1;CatarinaMarques2;SérgioSampaio11-DepartamentodeAngiologiaeCirurgiaVascular,CentroHospitalardeSãoJoão;2-FaculdadedeMedicinadoPortoIntroduction:Forseveralyears,digitalsubtractionangiography(DSA)wasconsideredthegoldstandardmethodfortheevaluationofPADpatients.Thisisaninvasivetechniqueandallowsagoodevaluationofcollateralsandthevessellumen,evenincaseswithassociatedcalcification.Nevertheless,recenttechnicaldevelopmentofcomputedtomographyangiography(CTA)has

improved its specificity and sensibility, besides the fact that CTA is a fast and non-invasiveprocedure.Objective:TocharacterizeacohortoflowerlimbPADpatientsandclarifyiftherearedifferencesamongthepatientspreoperativelyevaluatedbyDSAorCTA.Methods:ThisretrospectivestudyfocusedonPADpatientswithaRutherfordclassification≥3andsubmittedtointervention(endovascularrevascularizationoropensurgery).TheCTAgroupincludedallpatientssubmittedtothismethodastheirpreoperativeexam,betweenMarch2009andApril2017. In thesameperiodof time,patients submitted toDSAas theirpreoperativeexam, were randomly selected. The exclusion criteria were: realization of the exam for adifferent diagnosis than PAD, amputation not preceded by revascularization, absence ofintervention during a period of 1 year after the realization of the exam. The groups werecompareduponthetypeofsurgery(openvsendovascular),numberofrevascularizationsectors,reintervention,amputation,mortalityandlengthofhospitalstay.Results:34CTApatientsand71DSApatientswereincluded.Thegroupsweredemographicallyandclinicallyhomogeneous. Inwhatregardstoarterial lesions, theDSAgroupshowedmoreoftenlesionsofthedistalsectorwithTASCCorDclassification(25%inDSAgroupand0%inCTAgroup;p=0,001),aswellasscarcityofrunoffvessels(0or1in72%ofDSApatientsgroupand26% in CTA group; p=0.001). There were no differences about the endovascular and opensurgeryratio(1.8toCTAand1.4toDSA;p=0.305),reinterventionrates(21%CTAand16%DSA;p=0.517),majoramputation(9%CTAand11%DSA;p=1),minoramputation(9%CTAand16%DSA;p=0.541),mortality(18%CTAand23%DSA;p=0,602),orlengthofhospitalstay(medianand(interquartilerange)of14(27)forCTAand14(17)forDSA;p=0.933).Conclusion:CTAseemstobeamethodformorphologicalandtherapeuticplanningofPADthatisnon-inferiortoDSA.CO71DEEPVEINTHROMBOSISASFIRSTMANIFESTATIONOFHIBERNOMA-ACASEREPORTAnaMesquita1;JoséVidoedo2;MiguelMaia2;JoaoVasconcelos2;JoaoAlmeidaPinto2;AbreuDeSousa11-IPO-Porto;2-CentroHospitalardoTamegaeSousaIntroduction:Hibernomaisaveryrarebenigntumorthatarisesfromvestigialremnantsoffetalbrown adipose cells and usuallymanifests as a slowly growing, painless soft-tissuemass. Itmainlyoccurs inadults, inthethirdandfourthdecadeof life,slightlymore inwomenand iscommonlyseeninthesubcutaneousregionsoftheback,neck,thighsandretroperitoneum.Itwasoriginallydescribedin1906byMerkel,whonamedit“pseudolipoma”.In1914,Geryderivedthenamehibernomafromthetumor’shistologicalsimilaritytobrownfatinhibernatinganimals.Ahibernomamaybeconfusedwithalipomaclinicallyandcannotbecompletelydistinguishedfromhypervascularlesionssuchaslipossarcoma.Methods:A36-year-oldwomanpresentedwithpainandedemaoftheleftleg.Itwasdiagnosedwith non-recent femoro-popliteal venous thrombosis, was medicated with rivaroxaban andprescribedcompressionstocking.Results:Theedemasubsidedafter2weeksbutshestillcomplainedofpaininthethighseveralweeksafter first visitalongwith subtle localized softenlargement in theupper thigh. Itwasrequested a CT scan that showed a nodular image with 60X 47 mm medially to vastusintermediusandbeneaththesartoriusandrectusfemorismuscles,whichwassuspectedtobea lipossarcoma. In this context, amagnetic ressonance imagingwas requested and showedcontactwithfemoralvesselswithnocleavageplan,suspectedtobeamixoidlipossarcoma.Thebiopsy didn’t show malignancy. She was operated with local excision of the mass andpreservationofadjacentstructures.Pathologicevaluationrevealedahibernomawith11.5cm,

PS100positiveandMDM2negative.Thepatientwasevaluatedatoutpatientclinic6monthsaftersurgeryandhadnoevidenceofrelapse.Conclusion:Thefirstclinicalmanifestationofthispatientwasadeepveinthrombosisandthediagnosisofthelipomatoustumorwasdelayed.ClinicalawarenessoflessfrequentcausesofDVTisakeypointtotimelydetectionofthislesionsthatarerareandcurable.Theincreasedvascularityof this lesion raised suspicionofmalignancy.Malignancypotential isperhaps themostdifficultaspecttoascertaininthispatient,beingonlycompletelydisclosedaftersurgicalexcision.Optimaltreatmentiscompletesurgicalresection.Localrecurrencedoesnotoccurwithcompleteexcision.Noreportsofmetastasesofmalignanttransformationhavebeenidentifiedinthereviewedliterature.CO72INFRARENALABDOMINALPENETRATINGAORTICULCER,ANATYPICALLOCATIONOFARAREDISEASENelsonCamacho1;GonçaloRodrigues1;RodollfoAbreu1;RitaFerreira1;JoanaCatarino1;RicardoCorreia1;RitaBento1;MariaEmíliaFerreira11-CentroHospitalardeLisboaCentral,HospitaldeSantaMartaIntroduction:Penetratingaorticulcer (PAU) isclassically included inacuteaortic syndromes,togetherwithaorticdissectionandintramuralhematoma.Thesethreedisordersareconsidereddifferentstagesofthesamedisease.PAUistheresultofmedialdegenerationwithdisruptionoftheintima,mainlyduetoatheroscleroticriskfactors.Mostofthemarelocatedondescendingthoracicaortaandonlyafewsmallseriesandcasereportsdemonstratelocationoninfrarenalabdominal aorta.Clinical presentation varies in spectrum, fromasymptomatic to fatal aorticrupture.Treatmentoptionsincludemedicaltherapy,particularlystrictbloodpressurecontrol,and surgical approach. Nowadays endovascular exclusion is commonly performed, althoughopensurgicalreconstructionremainsthegoldstandard.Methods:ReportacaseofendovascularrepairofaninfrarenalabdominalPAU.Results:A72-year-oldman,withhypertension,type2diabetes,hypercholesterolemia,lumbarosteoarthrosis,wasreferredtoVascularSurgeryoutpatientclinicwiththediagnosisofinfrarenalabdominalPAUonaComputedTomographyAngiography(CTA).Thisexamwasperformeddueto chronic lumbar complaints from lumbar osteoarthrosis. The patient denied any othercomplaint.Physicalexaminationwasnormal.Athoraco-abdomino-pelvicCTArevealedtwositesofPAUintheinfrarenalaortawith10mmand21mmofdepthandassociatedaorticenlargementof39mmmaximumdiameter.ThisexamrevealedanenlargementofthedepthofthePAUandtheaortadiameterin2and3mm,respectively,inthecourseof2months.An EVARwas performed, in a standard aorto-biiliac fashion. The post-operative periodwasuneventfulandthepatientdischarged3dayslater.1monthafterthesurgery,patientremainedasymptomaticandthefollow-upCTAdemonstratedexclusionofbothPAU,noendoleaksandstabilityofaorticdiameter.Alongtermfollow-upshouldbemaintained,asforregularEVAR.Conclusion:PAUisarareclinicalentity,withinfrarenalabdominalaortalocationevenscarcer.Asymptomaticpatientmustberegularlyfollowedandthresholdtotreatmentlow,bearinginmind the possible catastrophic evolution of the disease. Endovascular approach should beconsidered as a first approach, considering the technical feasibility and the comorbiditiesassociatedwiththiselderlypopulation.

CO73CREATIVEVASCULARACCESSCONSTRUCTIONINSAMEPATIENTPedroPintoSousa1;PauloAlmeida2;PedroSáPinto2;RuiAlmeida21-CentroHospitalardeVilaNovadeGaia/Espinho;2-CentroHospitalardoPortoIntroduction:Creatingandmaintainingafunctionalvascularaccess(VA)isacriticalfactorinthesurvivalofadialysispatient.However,itwillnotfunctionforever,implyingacreativeattitudefrom the vascular surgeon either tomaintain its functionality or built a new one whereverpossible,beingitautologousorsynthetic.Methods:Describe theVAhistoryof a59years-oldmalewithmorbidobesity andend-stagechronickidneydisease.Results: His VA construction started in2012 with failed attempts in both forearms until afunctionalbrachiocephalicartery-venousfistula(AVF)intherightupperlimbwasachieved,butwasdeemed to ligation as severe venoushypertension secondary to central venousdiseaserelatedtoCVCuse.Ashehadnogoodsuperficialconduitintheleftarmwedecidedtoharvestthe deemed right cephalic vein and implant it in the left arm, creating an autologousarteriovenousshuntbetweenthebrachialarteryandaxillaryvein(AV).Despiteinitialpatency,itfailedirreversiblyweeksaftercreation.Asnomoresuperficialveinswereavailableintheupperlimbs,aprostheticaccesswasthenextstep.Wedecidedforahybridgraft(HG)betweentheleftbrachial artery and theAVbecause thepatient biotope and a scarred axilla impeded a safereinterventionontheAV.Thisgraftwasbeingusedsince2015withmultipleinterventionsformaintaining patency (PTA, segmental graft replacement and thrombectomies). Recently wenoticed a significant diffuseprosthesis deterioration and reducedAVF flowwithnopossiblesegmental reconstruction. We were then forced to proceed with total graft substitutionpreservingtheoutflowstentedsegmentoftheHG,usinganearlycannulationgraft(ECG)andpreventCVCuse.Afterthissuccessfulreconstruction,thepatientstartedhemodialysisonthefollowingdaywithnointercurrencesregistered.Discussion:Generally,CVC’sarerelatedwithpoorerdialysisqualityandpatientsurvival.Hence,fightingforanyotherfunctionalaccessisveryimportant.Therangeofsolutionswilldependonthe vascular surgeon capacities, imagination and device access. Once faced with no morefeasibledirectautologousaccess,thereisarangeofcomplexautologousfistulas,includingveinstranslocations.When nomore native vessel can be used for puncture,we still have awidearmamentarium (normal grafts, ECG or HG) that should be considered according to patientspecifications.HGbesidessomehemodynamicadvantages,canbeveryusefulwhenthelandingvessels are difficult to access. ECG offer the advantage of almost immediate cannulation,preventingCVCplacementanditsassociatedcomorbidities.CO74PERCUTANEOUSTREATMENTPSEUDO-ANEURISMOFTHEHANDINHEMOPHILICPATIENTVítor Ferreira1; Arlindo Matos1; Duarte Rego1; Joao Gonçalves1; Gabriela Teixeira1; InêsAntunes1;CarlosVeiga1;DanielMendes1;JoanaMartins1;RuiAlmeida11-CentroHospitalardoPorto-HospitaldeSantoAntónioIntroduction: Pseudo aneurysms of the hand are infrequent lesions, usually associatedwithperforating trauma.Thediagnosis isbasedonclinical suspicionand imageconfirmationofapulsatileswelling.Varioustreatmentmodalitiesarecurrentlydescribedintheliterature.Methods:Presentationofaclinicalcaseanddiscussionofthetreatmentstrategyinstituted.

Results:Clinicalcase:Man,35yearsold,withhemophiliaA.Historyofperforatingtraumaofthepalmarfaceoftherighthand3weeksago,havingbeensuturedinthelocalhospital.Sincethenhe notices a pulsatile swelling in the palm of the hand associated with paresthesias anddecreasedsensitivityintheindexfinger.Apseudo-aneurysmwith2x3cmwasobserved,partiallythrombosed,andwithprobableorigininthepalmararchorinthecommondigitalartery.Heunderwentangiographydemonstratingthepatencyofthepalmararchbutwithoutperfusionofthepseudo-aneurysm,andthecontroldupplexscanshowedcompletethrombosisofthefalseaneurysm.After2monthsoffollow-up,thedupplexscanwasrepeatedandrepermeabilizationofthepseudo-aneurysmwasverified.ThepatientwasthentreatedwithpercutaneousDoppler-guidedthrombininjection.Immediatethrombosisofthelesionwasfound,withnoevidenceofischemiccomplications.Heremainedasymptomaticunderclinicalsurveillance.Conclusion: For small pseudo-aneurysm conservative non-interventional treatment withexternalcompressionmaybeeffective.Conventionalsurgicaltreatmentwithsimpleligationorarterial reconstructionmay be indicated in larger pseudo-aneurysm. Recently, endovasculartechniquessuchascoilembolizationhavealsobeendescribed.HemophiliaAisageneticdiseaseofrecessivehereditarytransmissionlinkedtotheXchromosome,withdeficiencyoffactorVIIIofthecoagulationcascade,whichmanifestswithincreasedriskofhemorrhage.Inthisparticularcase,giventheriskofhemorrhage,wechoseminimallyinvasivepercutaneoustreatment,withclinicalandimagologicalsuccessandnocomplications.Percutaneoustreatmentbyecodoppler-guidedinjectionofthrombinisaneffectiveandsafetreatment,particularlyinpseudo-aneurysmassociatedwithsurgicalriskfactors.CO75ACUTEIATROGENICLIMBISCHAEMIA,AREPORTOF2LATEPRESENTATIONCASESRicardo Correia1; Ana Garcia1; Gonçalves Frederico1; Rodolfo Abreu1; Rita Ferreira1; NelsonCamacho1;JoanaCatarino1;MariaEmíliaFerreira11-HospitaldeSantaMartaIntroduction:With increasinguseofpercutaneousvascularprocedures,accesscomplicationsthatpresenttoavascularsurgeonincrease.Themostlimb-threateningconditionisacutelimbischaemia.Acutelimbischaemiaisthemostcommonvascularsurgicalemergency.Inspiteofrecentadvancesinvascularsurgery,itcontinuestocarryapoorprognosis,ifnotearlydiagnosedandmanaged.Methods: This is a case-report of 2 patients referenced to a vascular surgery emergencydepartmentofatertiaryhospitalwithlateacutelimbischaemia.Results:Patient1:Male,42years,alcoholic,autonomous,presentedwithpainwithelbowactivemovementsinasecondaryhospital.Excludedacuteorthopaedicinjury,doctorrecordedsignsofacutelimbischaemiaandreferencedpatienttoatertiaryhospital,wherevascularsurgeondiagnosedanacuteadvancedupperlimbischaemia.Bed-sideEco-Dopplershowedanechogeniclinearmaterialonathrombosedumeralartery,surgicallyconfirmedtobeaguidewire(Fig.1.Surgicalextractionofintra-umeralguidewire).Reviewingpatienthistory,thisguidewireshouldhavebeenmissedover6months,bythetimethepatientwashospitalizedonanICUforalcoholiccoma.Patientunderwentumeral,radialandulnarthromboembolectomyandhadano-reflowstatus. Patient 2: Male, 56 years, autonomous, presented with cardiorespiratory arrest,responsive to advanced life care support. Patient underwent coronary catheterization withfemoralaccess.24hours later,hepresentedtoavascularsurgeonwithanacute lower limbischaemia;bed-sideEco-Dopplershowedathrombosedcalcifiedplaqueonfemoralbifurcation.Patient underwent femoral thromboembolectomy and recovered a good foot perfusion.However,poorpersistentglobalstatus,withlimitedmobilization,pressureforcesandprolonged

vasotropicsupport,promotedprogressionofacyanotic legplaquetoanecroticevolving legulcerwithsepticresponse,despitepersistentgoodperfusionofthefoot(Fig.2.Necroticevolvinglegulcer).Unfortunately,thetworeportedpatientsunderwenturgentmajorlimbamputation,patient1abovetheelbow,andpatient2abovetheknee.Conclusion:Acutelimbischaemiacontinuestocarryapoorlimbandlifeprognosisifnotearlydiagnosed. We should be alert for the increasingly prevalence of iatrogenic acute limbischaemia,andregularlyevaluateperfusionstatusoflimbsafteranypercutaneousprocedure.

CO76DIGITALARTERYANEURYSM-CASEREPORTJoséTeixeira1;JoseVidoedo11-HospitalParticulardeVianadoCasteloIntroductionandMethods:A71-year-oldpatient,housewife,withahistoryofhypertension,elevatedcholesterolandhypotyroidismwasreferredtotheoutpatientclinicfortumefactionoftherighthand5thfingernoticed3-4monthsearlier.Shedeniedpastorrecenthistoryoftrauma,cardiac or infectious disease and had no familial history of aneurysmatic disease. She wasasymptomaticexceptforlocalslightdiscomfortwhenshehadtopressorpushsomethingwithherhand.Shehadnosensitivityormobilityimpairment.Onexaminationaround,soft,pulsatilemassinthelateralaspectofthe5thfingerwasevident.Allperipheralpulseswerepalpablewithnoevidenceofabnormaloraugmentedpulsatilityorthrill.Herperipheralpulseswerepalpableandsymmetricalanddidn’thaveaugmentedabdominalpulsatility.Anultrasoundscanrevealedaroundmassmeasuring14x7mm,havinghighintensityandpulsatileflowinsidewithturbulencesuggestinganeurysmoforrelatedwiththeproperdigitalartery.Results:Shewassubmitedtoressectionoftheaneurysmunderdigitalnerveblockanduseofaringtourniquetatthefingerbase.Anobliqueincisionwasmadeandundercarefulldissectiontheaneurysmwasdisclosedandextirpedaftercontrolandligationoftheinflowandoutflowvessels.Eightmonthsaftersurgerythepatientremainedasymptomaticwithnosignsoflocalrecurrence.Hystologicexaminationrevealedasacularaneurysmaticformationsurroundedbypapillaryendothelialhyperplasticlesions.Conclusion:Digitalarteryaneurysmsareveryrareandmostrelatedwithoccupationalorsportstrauma.Theyarerecognizedsometimesbycausinglocaldiscomfortorneurologicalsymptoms

due tonervecompression.Mostcasescanbe treatedby straight ressectionafter ligationofproximalanddistalcontiguousvesselstakingcarenottocompromiseflowtothedistalfinger.CO77TRUEBRACHIALARTERYANEURYSMAFTERARTERIOVENOUSFISTULAFORHEMODIALYSIS–CASEREPORTTiago Soares1; Ricardo Castro-Ferreira1; João Rocha Neves1;Marina Neto1; Joel Sousa1; JoséPedroPinto1;LuisGamas1;AlfredoCerqueira1;SérgioSampaio1;JoséFernandoTeixeira11-CentroHospitalarSãoJoãoIntroduction: Brachial artery aneurysms are relatively uncommon and generally due toinfectious, post-traumatic or iatrogenic etiology. They seem to affect 4.5% of arteriovenousfistula. The usual manifestation is an accidental finding of a pulsatile, painless, andasymptomaticmass.Complicationsincludesacthrombosis,thromboembolicischaemicevents,anddisruptionwithprofusebleeding.Methods:Theaimofthisstudyistopresentacaseoftruebrachialarteryaneurysminend-stagerenaldiseasepatientafterarteriovenousfistulacreation.Results: Sixty-six-year-old men with a past medical history of hypertension, dyslipidemia,smokingandpoliquisticrenaldisease.HestartedahemodialysisprograminMarch2006,usingabrachiocephalic fistulaon the leftupper limb,built in February2005. Submitted to kidneytransplant in June 2010 and subsequent fistula ligation in December 2012. He goes to theemergencyserviceinJune2016withapulsatilemassonthemedialaspectoftheleftarm.Pain,rednessandheatwerepresent.Radialpulsewaspalpable.Inflammatoryparameterswerehighandultrasoundrevealedafusiformaneurysmofthebrachialarterywithpartialthrombosisandtriphasic flow.AnMRIwasperformed,documentingabrachialarteryaneurysm,with44mmgreatestdiameterandanextensionof17.5cm.Patientwashospitalizedunderantibiotictherapyandsubmittedtoareversedgreatsaphenousveininterpositiongraft.Dischargefromhospitaloccurredonthe7thpostoperativeday,withnosensitiveormotordeficitsandapresentradialpulse.Conclusion:Arterialaneurysmisarare,butsignificantcomplicationlongafterthecreationofahemodialysisaccess.Highflow,immunosuppressionandincreasedresistancefollowingligationoftheAVfistulamayacceleratethisprocess.CO78FUNCTIONALPOPLITEALARTERYENTRAPMENTSYNDROMELuís Gamas1; João Rocha Neves1; Luís Machado1; Ricardo Ferreira1; Pedro Paz Dias1; JoséTeixeira11-CentroHospitalarSãoJoão,EPEIntroduction: Popliteal artery entrapment is an uncommon syndrome, caused by extrinsiccompressionof thepopliteal arterybymuscular or tendinous structures. It occursmainly inyoungindividuals,withnoatherosclerosticriskfactors,andameanageofpresentationof20to40years,andhashigherprevalenceinmales(83%ofpatients).Clinicalpresentationdependsonthedegreeofarteriallesion,themostcommonbeingintermittentclaudication,withcriticalischemiabeingfrequent.Occasionally,itmaypresentasacuteischaemia.

Methods:A40-year-oldfemalepatient,physicaleducationteacher,presentedwithahistoryofleftfootparesthesiaandleftcalfmusclepainduringjoggingforoneyear.Thepatientusedtopreviouslyrun10kilometers,currentlymentioningclaudicationat500meters.Noothermedicalconditionswerementioned.Lowerextremityarterialduplexultrasoundrevealedleftpoplitealarterycompressionandocclusionduringactiveplantarflexionandpassivedorsalflexion.Thepatient was referred to a vascular surgery center. Physical examination revealed palpablebilateral lowerextremitypulses,with leftasymmetry. Lower limbangiographyandmagneticresonanceimaging(MRI)wereperformedwhichdemonstratedleftpoplitealarterycompressionandocclusionduringaresistedplantarflexion.MRIrevealednoanatomicanomalies,pointingtoaprobablefunctionalentrapmentcausedbycalfmusclehypertrophy(typoVI).Results: Entrapment correction surgery was performed through a posterior approach andexposure. During the procedure, the artery showed no signs of significant fibrosis. Sincecompressionbythemedialheadofthegastrocnemiusmusclewasobserved,myotomyof itslateralfiberswasperformed.Thepatientwasdischargedontheseconddaypost-surgery.Afterthreemonths,thepatientremainedfreeofsymptoms,havingtakenupsportspracticewithnolimitations.Conclusion:Continuouspoplitealarterycompressionleadstoitsprogressivefibrosis,whichmaycausethrombosisorpost-stenoticaneurysmaldilation.Treatmentshouldbeperformedassoonaspossibleastoavoidthiscourseandtheeventualnecessityofinterpositionorbypassgrafting.Futhermore, late intervention worsens the interposition/bypass grafting prognosis5. In thissense,thepossibilityofthisdiagnosisshouldbeconsideredinayoungpatientpresentingwithintermittent claudication.Diagnostic testsareoftendecisive fordifferentialdiagnosisand toestablishthediseasesubtypeandinterventionstrategy.Inmostpatients,aculpritmuscularortendinous anomaly is detected before surgery, however, in some individuals, especiallyphysicallyactiveones,compressionresultsfrommuscularhypertrophy.CO79TRUE BRACHIAL ARTERY ANEURYSM IN A PATIENT WITH VASCULAR ACCESS FORHAEMODIALYSISANDKIDNEYGRAFTMafaldaCorreia1;AndréMarinho1;CarolinaMendes1;LuísAntunes1;ÓscarGonçalves11-ServiçodeAngiologiaeCirurgiaVasculardoCentroHospitalareUniversitáriodeCoimbraIntroduction:Truebrachialarteryaneurysmsarerareandsomeofthemhavebeendescribedasalatecomplicationinpatientswithvascularaccessforhaemodialysisandkidneygraft.Thepurpose of this paper is to present a clinical case of a patient with a true brachial arteryaneurysmanditsfollowingtreatment.Methods:Thiscaseconcernsacaucasianmalepatientwith43yearsoldwhohadvesicoureteralrefluxat7yearsold,andsubsequentend-stagerenaldisease,andstartedonhaemodialysisattheageoftwelve.Thepatienthadhomolateralradialandbrachiocephalicarteriovenousfistulas(AVF), two sequential kidney grafts and was under immunosuppressant therapy for severalyears.Aspartofthemedicalhistoryhealsohadbilateralamaurosis,HepatitisBandCandwassubmittedtototalparathyroidectomyandafollowingauto-transplant.Inthelatestyearsthepatientpresentedwithseveralaneurysmsrelatedtothevascularaccess.Afterthefindingofananastomotic false aneurysm and venous aneurysms complicating the AVF, the patient hadremovaloftheaneurysmsandligationoftheAVF.Later,hewasdiagnosed,indifferenttimes,withtwotruebrachialarteryaneurysms.Atthetimeofthediagnosisofthefirsttrueaneurysm,the patient presented with local pain and occasional paraesthesias relative to compressionsymptoms.Atphysical examination thepatienthadabrachialpulsatilemassandapalpableradialpulse.TheDopplerultrasoundexamrevealedatruebrachialarteryaneurysmwith4,5cm

diameter.After twoyears, thepatientwasonceagaindiagnosedwitha truebrachial arteryaneurysmwith3,1cmdiameter.Atthistimethepatientwasasymptomaticandhadpalpablebrachialmassandradialpulse.Results: At the time of the diagnosis of the first true brachial aneurysm the patient wassubmittedtopartialaneurysmectomyandbrachiobrachialgraftwithPTFE8.Thepatencyofthegraftpersisteduntil thediagnosisof the secondaneurysm.After twoyears, thepatientwassubmittedtopartialaneurysmectomyandaxilobrachialgraftwithPTFE8.Duringthefollow-upperiod,thepatientremainedasymptomatic,hadpalpableradialpulseandtheDopplerultrasoundexamconfirmedthepatencyofthegraft.Conclusion: The surveillance of patientswith long duration AVF and kidney graftsmight beadvantageousintheearlydetectionofarterialaneurysms.Thesurgicaltreatmentinthisgroupofpatientsisafirsttreatmentoptionthatisassociatedtoalowmorbidity.CO80HILAR RENAL ARTERY ANEURYSM - EX-VIVO RECONSTRUCTION ANDAUTOTRANSPLANTATIONPedroPintoSousa1;CarlosVeiga2;ArlindoMatos2;PedroSáPinto2;RuiAlmeida21-CentroHospitalarVilaNovadeGaia/Espinho;2-CentroHospitalardoPortoIntroduction:Renalarteryaneurysm(RAA)isarareclinicalentitywithanestimatedprevalenceof0.15%to0.1%inthegeneralpopulation.Themajorityofpatientspresentasymptomaticallyand the diagnosis is made incidentally during a hypertension study test, and more rarely,fortuitously after backache. Indications to treat have been subject of intense debate,nevertheless there seems to be some consensus that RAAs greater than 2 cm in diameter,expandingRAA,with thrombusor inpregnantwomenshouldbe treated.Treatmentoptionsvarybetweensurgicalorendovascularapproach.Thecomplex(hilar)RAAconstituteasubsetofRAAthatpresentatherapeuticdilemmabecauseoftheiranatomic locationandmayrequireextracorporealarterialreconstructionandauto-transplantation.Methods:Wedescribea71-year-oldwomanwithapersonalhistoryofhypertensionformorethantwentyyearsbutnormalrenalfunction.Followingthestudyforanabdominaldiscomforta complex RAAwas incidentally diagnosed. Computed tomographic angiographywith three-dimensional reconstruction revealed a 13mm, saccular aneurysm located at the right renalhilum.Results:Weperformedhand-assistedlaparoscopicnephrectomywithexvivorepairoftheRAA.Theaneurysmwasresectedandapolarrenalarterywasimplantedovertheresectedareawitha latero-terminalanastomosis.Complementarily, therenalveinwasaugmentedwithaspiralgreatsaphenousveingraftandfinallythekidneywasimplantedintotherightiliacfossa.Theinterventionandpostoperativecoursewereuneventfulandthepatientsubmittedtoultrasoundevaluation on the day after procedure. It revealed normal renal perfusionwith normal flowindices.Inthelastfollow-uprealized,twomonthsaftersurgerythepatientwasalivewithawell-functioningauto-transplant.Conclusion: RAAmaybe nowadaysmore frequently diagnoseddue to the increasing use ofimaging techniques. While renal artery trunk aneurysms are most often treated using anendovascular procedure it is not suitable for renal artery branch aneurysms. Hand-assistedlaparoscopic nephrectomywith ex vivo repair and auto-transplantation is a challenging butfeasibleoptionfortreatinghilumRAA.

CO81ANTIPHOSPHOLIPIDSYNDROMEANDACUTEPOSTPARTUMLIMBISCHEMIAInêsAntunes1;CarlosPereira1;RuiMachado1;DuarteRego1;VitorFerreira1; JoãoGonçalves1;GabrielaTeixeira1;VeigaCarlos1;DanielMendes1;RuiAlmeida11-ServiçoAngiologiaeCirurgiaVascularCentroHopsitalardoPortoIntroduction: ThediagnosisofAntiphospholipid syndrome (APS) implies the identificationofantiphospoholipid antibodies and arterial/venous thrombosis or pregnancy loss. Duringpregnancy,thereisanincreasedriskofthromboticcomplications.Methods:PresentacaseofacutelowerlimbischemiainapatientwithAPSduringpostpartumperiodMaterials/Methods:reviewofaclinicalcaseandavailableliteratureResults: Patient diagnosed with APS (triple antibody positive and antecedent of 3 previousabortions) underwent cesarean at 29 weeks of gestation. She was medicated with aspirin00mg/dayandenoxaparin60mg/dayandhaddischargeonthesecondpostoperativeday.After3 days she came to the emergencydepartmentwith acute limb ischemia.AngioCT revealedthrombosis of the right iliac axis and pulmonary thromboembolism. Endovenoushypocoagulation with unfractionated heparin was immediately started. Due to the highthromboticriskassociatedwithanytypeofsurgicalinterventionandimprovementofischemiawithhypocoagulation,itwasdecidedtopostponesurgicalrevascularization.Atthe10thdayofhospitalizationangioCTwasrepeatedwithmaintenanceoftheiliacthrombosisandclinicallythepatienthadsevereclaudicationandankle-armindexof0.26.Onthe16thdayofhospitalization(after5plasmapheresissessions),shewassubmittedtotrans-femoralthrombectomy,withagood femoralpulseat theendof theprocedure.On the3rdpostoperativedaywedetectedpulselossandangioCTconfirmedre-thrombosisoftheiliacaxisandanoclusionofthepoplitealartery.Anewattemptatrevascularizationwasmadeandanewtransfemoralthrombectomywasperformed,withimmediatepulserecovery.Weperformedintraoperativeangiographythatconfirmedocclusionofthepoplitealarteryandweproceededtrans-poplitealthrombectomy.Intraoperative control angiography revealed permeability of ilio-femoro-popliteal axes withsomedefects of fillingof the crural arteries (anterior tibial andperoneal arteries).After theprocedurethepatientbecomeassymptomatic,withanankle-armindexof0.55(withnormalflowinfemoralandpoplitealarterybutmonophasycflowindistalarteries)andhaddischargedmedicatedwithaspirin,antivitaminikKandcorticoid.Conclusion:Thebeneficial/riskofrevascularizationsurgeryshouldbewellconsideredaswellasthe timing in which it should be performed. Plasmapheresis is important to minimize thethromboticriskassociatedwiththesurgicalprocedure.Intra-operativeangiographyisessencialsincearterial thrombosis canoccur in several sectors,whichcanconditionate thesuccessofrevascularizationprocedure.CO82CO-EXISTENCE OF ABDOMINAL AORTIC ANEURYSM WITH UROLOGIC NEOPLASM: WHICHSHOULDBETREATEDFIRSTINTHEENDOVASCULARERA?José Oliveira-Pinto1,2; Nilo Mosquera3; José Vidoedo5,6; Sérgio Moreira-Sampaio4,5; JoséTeixeira4,51 - Departamento de Angiologia e Cirurgia Vascular do Centro Hospitalar de São João; 2 -DepartamentodeCirurgiae Fisiologia, FaculdadedeMedicinadaUniversidadedoPorto;3 -Complexo Hospitalário Universitário de Ourense; 4 - Departamento de Angiologia e Cirurgia

Vascular,CentroHospitalardeSãoJoão.;5-HospitalPrivadodaBoaNova,GrupoTrofaSaúde;6-CentroHospitalardeTâmegaeSousaIntroduction:PrevalenceofAbdominalAorticAneurysm (AAA)withconcomitantmalignancyrounds3-13%.Consideringonlyurologicalneoplasmstheprevalenceisaround3.6%.Survivalat5yearsofbladdercarcinomawithoutextravesicalinvasion(stageII)rounds63%.EndovascularAneurysmRepair(EVAR),duetoitsminimallyinvasiveprofile,isanoptionfortreatmentofAAAprior to urological surgery as it does not require laparotomy not conditioning the delay ofoncologicsurgery.Methods:Male,62yearsold.Historyof smokingandcoronaryarterydiseaseandurothelialcarcinomaofthebladder(T2N0M0).IntheabdominalCTscanusedforneoplasmstagingapara-renalAAAwith50mmofmaximumdiameterwasfirstlydetected.Thisaneurysmpresentedonly5mmofproximalnecklength,insufficientforasafeproximalsealingwithstandardendografts.Inconsequencethetreatmentofchoicewasatetra-fenestratedendograft(F-EVAR).Results:F-EVARoccurredwithoutcomplications:noendoleaks,accesscomplicationsorbranchthrombosis. Three months after F-EVAR, the patient underwent radical cystectomy withjejunocystoplasty,whichalsooccurredwithout intercurrences.TwodaysafterFEVARpatientwas discharged home. After one year of follow-up, abdominal CT scan did not reveal anycomplications related to the endovascular procedure. The patient died 18months after theinterventionasaconsequenceofmetastaticevolutionofbladderprimaryneoplasm.Conclussion: ThecoexistenceofAAAwithneoplasticurologicpathologyalthoughrareisnotnegligible.Intheabovecase,thepatientpresentedAAAwithabout5cm(1-11%riskofruptureperyear),associatedwithT2N0M0bladderurothelialcarcinoma(survivalataround63%at5years). Given the need for treatment of both pathologies, the doubt persisted aboutwhichprocedure shouldbeperformed first: aneurysm repairor cystectomy.Prior to theadventofEVAR,AAArepairwouldrequirelaparotomywithapotentiallygreaterriskofcomplicationsinthesubsequenturologicprocedure,prosthesisinfectionandsignificantdelayofthecystectomy.With the emergence of endovascular techniques, AAA repair occurs without conditioningpostponementorsignificantcomplicationsduringasubsequenturologicalprocedureandthen“EVARfirst”wasthedecision.TwodaysafterFEVARpatientwasdischargedhomeandthreemonthslattercystectomywasperformedalsowithoutcomplications.Inconclusion:incaseofconcomitantAAAandabdominalmalignancybalancebetweenriskofruptureandprogressionoftheneoplasticdiseaseneedtobeweighted.WiththeadventofendovasculardiseaseEVARpriortotheoncologicsurgeryrepresentsanefficient,promptandsafesolution.CO83SURGICAL THROMBECTOMY, FIBRINOLYSIS, ANGIOPLASTY AND STENTING: A COMBINEDAPPROACHFORTREATMENTOFAMAY-THURNERSYNDROMEPRESENTINGASPHLEGMASIACERULEADOLENSCarlosVeiga1;JoãoGonçalves1;PedroSousa2;CarolinaVaz1;IvoneSilva1;PedroSá-Pinto1;RuiAlmeida11-CentroHospitalardoPorto;2-CentroHospitalardeVilaNovadeGaia/EspinhoIntroduction:Phlegmasiaceruleadolens(PCD)isararecomplicationofdeepvenousthrombosis(DVT).Massiveileo-femoralDVTisusuallythecauseandprompttreatmentismandatoryasitrepresents a medical emergency. Reported amputation rates range from 12% to 25% andmortality ranges from25% to40%. Limb ischemia results fromobstruction toarterial inflowsecondarytoextremelevelsofvenoushypertension.Primarytreatmentgoalisrestorationofvenousoutflowandcanbeachievedbyendovascularorsurgical techniques.After thrombus

removalanunderlyingiliacveinstenosismaybepresent.May-Thurnersyndrome,aconditionwheretheleftcommoniliacveiniscompressedbytherightiliacartery,isthemostprevelantiliacstenoticlesion.Methods:Wereportacaseofa57years-oldmale,smoker,withnosignificantmedicalhistory,who presented to the emergency department with excruciating sudden left limb pain andswelling, with no trauma history, with a 2-hour onset. On physical examination he showedsignificantedema,purplishdiscolorationoftheentirelegandabsentdorsalispedisarterypulse.Results: Hipocoagulationwith intravenous heparin was immediately initiated and emergentsurgicalvenous thrombectomywasperformedassociatedwithdirect intravenous fibrinolyticagentinjection.Postprocedurephlebographyshowedaleftcommoniliacveinlesionwhichwastreatedwithangioplastyandvenous stentplacement.Pain,edemaandcoloration improvedmarkedlyafterprocedurewithoutanycomplications.Thepatientwasdischargedhomewithanticoagulationtreatmentandcompressionstocking.Conclusion: Endovascular approaches such as catheter-directed thrombolysis (CDT) orpharmacomecanical thrombolysis (PMT) are becoming the treatment of choice to achievevenous outflow in DVT. In cases of PCD, when rapid restauration of venous outflow ismandatory,CDThasthedisadvantageofhavingalongmeantreatmenttime.Thisway,surgicalthrombectomystillplaysanimportantroleincasesofPCD,especiallyifPMTisnotavailable.Inourcase, thecombinedusedofsurgical thrombectomywithdirect intravenous thrombolyticinfusionprovidedeffectivetreatmentofPCDanduncoveredanunderlying leftcommon iliacveinstenosis,whichwassuccessfullymanagedbyangioplastyandstenting.CO84TRAUMATICCAROTID-JUGULARAVFISTULAINACHILDPedroLima1;AnabelaGonçalves1;ManuelFonseca1;CarolinaMendes1;ÓscarGonçalves11-CentroHospitalarUniversitáriodeCoimbraIntroduction: Traumatic Arteriovenous fistulae of the neck vessels are a rare condition,comprisinglessthan4%oftraumaticfistulaefoundanywhereelseinthebody.Methods:Theauthorsproposetoreportaclinicalcaseofsuchaconditionina10-year-oldboywhosustainedagunshotwoundintheleftsideoftheneck.Results:Shortlyaftertheevent,thepatientwasadmittedtopaediatricICUandintubatedforairwayprotection.Apalpablethrill inthe leftsideoftheneckwasnoticed,givingrisetotheneed of imaging study. A communication between the left common carotid artery and theinternaljugularveinwasconfimedbyAngioCT.Nosignsofcerebralhypoperfusionorcardiacoverloadwerepresent.Thesurgicalcorrectionwasperformedbydirectsuturerepairofbothvessels involved. No complications on the postoperative period. During follow up,antiagregationwithacetilsalicilicacidfor1monthwasprescribedandnocomplicationsoccured.Conclusion:Thepatientlivesanormallifewithnolimitations.

CO85CAROTIDPARAGANGLIOMA-CLASSICALSURGICALTECHNIQUEBárbaraPereira1,2;ManuelFonseca2;AnabelaGonçalvestor2;JoãoAlegrio2;ÓscarGonçalves21-CentroHospilarUniversidadeCoimbra;2-CHUCIntroduction:Acarotidbodytumor isarareneoplasm,generallybenign,thatpredominantlyaffects people between their fourth and fith decades of life. Itmanifests as a pulsatile andgenerally painless cervical mass with firm consistency, located below the angle of the jaw.Clinicallyitcancauselocalizedpain,dysphagia,hiccups,hoarsenessandhypersensitivecarotidbodysyndrome.Surgeryisthetreatmentofchoice,bearinginmindthepossibilityofmalignanttransformation, peritumoral invasion and metastasis. The most widely-used technique issurgical resection, with or without concomitant preoperative endovascular embolisation.Overallcomplicationrates,strokeratesbetween0and8%andcranialnervepalsylessthan1%to49%.Mortalityratesvaryfrom0to3%.Methods:Clinicalcaseofa69yearsoldmalepatientdiagnosedwithacarotidbodytumorinaroutine ultrasound exam. The patient was asyntomatic. Complementary exams were thenconducted - CT scan andMRI supported the diagnosis.Neck CT scan:Well defined, nodularformation,enhancedafterintravenouscontrast,localizedonthejugular-carotidregion,withanaproximatediameterof36mm.NeckMRI:Expansiveheterogenoussolid lesion, localizedoncarotid bulb, well defined, enhanced after intravenous contrast, compatible with carotidparaganglioma–Shamblin’sII.Results:Patientwassubmitedtoacompletesurgicalclassicressectionofthetumor,withoutanypreviouslyprocedure.Proximaldissectionwasmadewithahelpofanoseandearsurgeon.Nopost-surgerycomplications,exceptwoundinfectionatweek3.Nonervedamage.Conclusion: Followup to 1 yearwithout any complain andno lesions. In an era ofmultipletechniquesthereshouldalwaysbeaplaceforclassic,wellplannedsurgeries.AnestesiologiaCO86LUMBARCEREBROSPINALFLUIDDRAINAGEINENDOVASCULARAORTICREPAIR–REFERENCECENTREEXPERIENCEAnaMargaridaMartins1;MarisaSilva1;MariaDeLurdesCastro1;AnaFerro11-CentroHospitalardeLisboaCentralIntroduction:Spinalcordischemia(SCI)andtheresultingparaplegiaareoneofthemostfearedpostoperativecomplicationsafterthoraco-abdominalaorticsurgery,withanincidence4,3-8,0%afterthoracicendovascularaorticrepair(TEVAR),increasingpatientsmorbi-mortality.Lumbarcerebrospinalfluid(CSF)drainagecatheterisrecommendedaspreventivemeasureinhighriskpatients.Objective:ToevaluatetheefficiencyandsafetyofCSFdrainagecatheteraspreventiveortherapeuticmeasureinendovascularaorticrepair(EAR).Methods: Retrospective study in 19 patients submitted to TEVAR or fEVAR (fenestratedendovascularaneurismrepair),inwhomCSFdrainagecatheterwasused,betweenJanuary2010andMarch2017.Collecteddataregardingdemographic,perioperativepatientscharacteristics,neurologic symptoms (NS) and other complications. All patients were submitted to general

anesthesia(GA)asresultofcomplexityand lengthofsurgery.Knownriskfactors(RF) forSCIweretakenintoaccount.Results:19patients,89,5%(n=17)male,meanageof66±9years.63,2%wereclassifiedasASAIIIand36,8%asASAIV.9patientssubmittedtoTEVAR(47,4%);theremainingweresubmittedto fEVAR.73,7%wereprogramedprocedures.Therewere intraoperativecomplications in3patients:iliacartery(IA)rupturein2patients,lacerationoftheaxillaryarteryin1patient,allrequiredsurgicalrepair.Allcatheterswereplacedinawakepatients,beforeGAinduction,andwereleftinplace2,5days.7patientsneededdrainagebecauseofCSFpressure>10mmHgintra-or postoperatively. 3 patients developed early symptoms of SCI (decreased mobility andstrengthof legs).Complete recoveryoccurred inallpatients,exceptonewhorecovered justpartially.1patientdevelopedlateNS:paraparesiaon40thpostoperativeday(POD)asresultofspinal stroke. 30 days mortality was 10,5% (n=2), due to cardiorespiratory arrest– 1 byhypovolemicshock(on3rdPOD),1byunknowncause(14thPOD).Conclusion: This study was limited by the small sample size. CSF drainage catheter was anefficientmeasureinpreventionandtreatmentofSCIinthissample,sincetherewasnocaseofcomplicationsduetoSCI.CSFdrainageseemstobeaneffectivetechniqueinpreventingSCI.FurtherstudiesarerequiredtodeterminetheeffectivenessandcomparethedifferentmethodsavailableforthepreventionofSCIcomplications.

CO87RAPIDPACINGFORTHORACICENDOVASCULARAORTICREPAIR:ACASEREPORTHugoSilva1;AndreiaFernandes1;JoãoRodrigues1;DanielBrandão1;ManuelaVieira1;CatarinaCelestino11-CentroHospitalardeVilaNovadeGaia/EspinhoIntroduction:Endovascularaorticinterventionsaresuitablealternativestoopensurgery,beingless invasiveandhaving lowermortalityandcomplications.Accuratepositioningofthestentgraft is a critical point because of systolic thrush. Techniques used to prevent it includepharmacological (antihypertensive drugs, nitroglycerin, adenosine) andmechanicalmethods(temporarycavalocclusionbyballoon).RapidRightVentricularPacing(RRVP) isanemergingalternativewithgoodpatienttoleranceandlowlevelofcomplications.Methods: A 79 years-old male, American Society of Anaesthesiology (ASA) status 3(hypertension,chronicobstructivepulmonarydiseaseandhyperuricemia),withanaorticarchaneurysmpreviouslysubmittedtoanascendantaorticdebranching,wasproposedforThoracic

Endovascular Aortic Repair (TEVAR). ASA standard, invasive blood pressure, depth ofanaesthesiaandcerebraloximetrymonitoringwereused.Results: Patient was sedo-analgesiated with Midazolam 2mg and Fentanyl 100mcg. A flowdirected Pacing catheter was passed through an 8.5FR introducer inserted in right internaljugularvein.RRVPwas tested toa cardiac frequencyof180withoutpatient complaint.TwovascularValiantThoracicendoprosthesiswereplacedthroughafemoralaccess.Atthetimeoftesting position and prothesis deployment, RRVP was started and systolic blood pressuredroppedto50mmHg.AfterstoppingtheRRVPinbothplacements,normalrhythmandbloodpressure were observed. No relevant changes in cerebral monitoring were found. Finalangiographyshowednoendoleakofprosthesis.ThepatientwasadmittedatPost-AnaestheticCareUnitanddischargedafter24hours.Conclusion: RRVP results inacceleratedheart rate,with consequentdecreaseof intra-aorticbloodflow,allowingmoreprecisegraftdeploymentwithoutdisplacement,whichisassociatedwithlowerincidenceofendoleak.ThefasteronsetofRRVPandrapidreturntonormalvaluescan shorten the duration of the procedure. The procedure is done with minimal sedation,important in individualswithpoor clinical status. This alsoallows to continuallymonitor thepatient’sneurologicstatus,possiblydetectinganyprostheticdisplacementoracuteevent.Mostcomplications are puncture- related. Rhythm-associated complications can occur in patientswithheartdiseases.Inthiscase,nocardiaceventswerefound.RRVPhasbeenusedinTEVARwithreliableresultsandisagoodoptionfordifficultcases.It’sassociatedwithalowerincidenceof complications and less secondary effects than traditionalmeasures, allowing tomaintainpatients with mild sedation, shortening hospital’s length of stay. RRVP seems to beadvantageousovertraditionalmethodsofcontrollingbloodpressureinpatientssubmittedtoTEVAR.CO88RISKFACTORSFORPOSTOPERATIVETRANSFUSIONINCARDIACSURGERYWITHCPBMaria Helena Lima1; Ana Sofia Sampaio1; Júlio Teixeira1; Carreira Cláudia1;Manuel Cuervo1;ManuelCarreira1;ManuelAntunes11-CentroHospitalareUniversitáriodeCoimbraIntroduction:Theuseofbloodproductsisroutineincardiacsurgery.Useofbloodderivatesmayvary among institutions andentail high costs andpossible complications. This study aims toidentify predictors of the need for postoperative blood products transfusion after cardiacsurgerywithcardiopulmonarybypass(CPB),inordertofocusonpreventivemeasuresforhigh-riskpopulations.Methods: Observational retrospective study carried out in 104 consecutive adults whounderwent cardiac surgeryusingCPB inourhospital. Bloodproductsusedwere categorizedaccordingtotheUniversalDefinitionofPerioperativeBleeding(UDPB)inadultcardiacsurgery1(table1).Clinical,demographicandsurgicalvariableswereanalyzed.StatisticalanalysiswasperformedusingSPSSv23.Quantitativevariablesareexpressedasmean± standard deviation and qualitative variables as proportions (%). Values of p<0.05 wereconsideredstatisticallysignificant.Results:104patients,74males(71,2%),withanaverageageof67,2±13,4yearswereincluded.Meanbodymassindex(BMI)was26,1±4,2Kg/m2,and5,8%wereASAII,92,3%ASAIIIand1,9%ASA IV.Operativeprocedures included coronaryarterybypass in32 (30,8%)patients, valvaroperationsin59(56,7%),andcombinedproceduresin7(6,7%),with6omissions.Fortypatients(38,5%)receivedatleastonebloodproductinfinalpostoperative24h.ThedistributionofbloodproductsusedaccordingtoUDPBinadultcardiacsurgeryisexpressedintable2.Therewereno

significant statistical differences in blood products transfusion between gender, age, BMI,diabetes,LeftVentricularEjectionFraction(EFLV)andCBPduration.Althoughtherewasnosignificantcorrelationbetweenhypertensionandpostoperativeuseofbloodproducts,therewasastrongpositiveassociationbetweentheabsenceofhypertensionandUDPBclass0. Inourpopulation,therewasasignificantassociationbetweenthetypeofsurgery and UDPB score. There seems to be a strong positive association between valvularsurgeryandUDPBclass0andbetweencombinedproceduresandUDPBclass1.Reoperationforbleedingwithin24hwasrequiredin3,8%.Conclusions: Inourpopulation,theindependentpredictorofpostoperativebleedingwasthetype of surgery, with a strong positive association between valvular surgery and combinedprocedures and UDPB class 0 and 1, respectively. The percentage of reoperations due tobleedingaftercardiacsurgeryisinaccordancewiththeliterature.

CO89REVERSAL OF ACUTE SPINAL CORD INJURY IN THE IMMEDIATE POST-OPERATIVE PERIODAFTERTHORACOABDOMINALANEURYSMREPAIRWITHCSFDRAINAGEMarisaSilva1;AnaFerro11-CentroHospitalardeLisboaCentralIntroduction:Spinalcordinjuryafterthoracoabdominalaorticaneurysmsurgeryisadevastatingand unpredictable complication (1). With surgical manipulation, particularly with aorticclamping,cerebrospinalfluid(CSF)pressuremayrise,anditspressureexceedsthespinalarterialpressure,spinalperfusionmaybereduced,leadingtoneurologicaldysfunction.MethodsandResults:Thisclinicalcasereportstoa70-year-oldmalepatientwithanearlyonsetofpost-operativeparaesthesiaof the lower limbs in the immediatepost-operativeperiodofthoracoabdominal aortic aneurysm repair. Reversal of the neurological deficit was achievedafteremergencyCSFdrainage.Conclusion:CSFdrainagehasatherapeuticpotentialvalueofreducingitspressure,allowinganimprovementof spinalperfusionpressure, thereforediminishing the riskofan ischemicandpermanentlesion(2),thusitmayhavearoleinpreventingand/ortreatingacuteparaplegia.

CO90PERIOPERATIVE FAMILY CENTERED CARE: NURSING INTERVENTIONS THAT SUPORT CHILDANDFAMILYS'EMOTIONALMANAGEMENTDarioAntunes1;PaulaDiogo21-CHLC,EPE-HospitalSantaMarta;2-EscolasuperiordeEnfermagemdeLisboaIntroduction:Hospitalizationisanegativetonalityexperienceforbothchildandfamily,beingfearandanxietytheiremotionalmirror.Concerningthesurgicalexperience,theenvironment,invasiveness,fearofpain,ofnotwakingupfromanaesthesiaandparentalseparationarebothcausesandenhancersofchildand familyperioperativedistress.Astudyconcerningparent’semotional experience of child’s submitted to cardiac surgery, refer guilt for their son’scardiopathy,arollercoasterofemotions,impotenceandbeingseatedonpinsandneedleswhilewaiting during the surgery.Objective: Identify andmap the scientific production concerningnursinginterventionsthatpromotechildandfamily’sperioperativeemotionalmanagement.Methods:LiteraturewassearchedinCINAHLandMEDLINE,andalsoonJoannaBriggsInstitute(JBI)DatabaseofSystematicReviewsandImplementationReportsandCochraneLibrary.Searchwasdoneusingallidentifiedkeywordsandindexterms.Thestudywillconsiderquantitativeandqualitativestudies,aswellassystematicreviews.Thequantitativestudieswillinclude,althoughnotbeinglimitedtoexperimentalandepidemiologicalstudydesigns.Thequalitativestudieswillinclude,althoughnotbeinglimitedtophenomenology,groundedtheoryandethnography.Thesystematic reviewswill includemetaanalysisandmetasynthesis.Unpublished literaturewillalsobeconsidered.Results:Specificallyinpaediatricperioperativecare,theuseofpreoperativeprogramsbasedonpsycho-emotional resources adapted to the child’s age range, results in fear and anxiety’sreduction and consequently increasing well-being. Regarding parental presence duringanaesthetic induction, it has a very important effect in decreasing both child and parent’sanxiety. However, it should be supported and programed so that it is safe and effective.Communication with family during surgery, attending to multidisciplinary organization,periodicityandsupportedbyanursingliaisonprogram,isparticularlyimportantindecreasingfamily’sanxietyduringintraoperativeperiod.Conclusion: Family centred care are the paediatrics’ care philosophy. Concerning theperioperativeperiod,itexpressesthroughseveralinterventionslikepreoperativepreparation,parentalpresenceandnursingliaison.Thesenursinginterventionsareparticularlyimportantindecreasing stress andanxiety,promoting safety, respect andwell-being, andalsobecause itpromotesthechild’sdevelopmentandfacilitatesfutureexperiences.CO91ANALGESIAMANAGEMENTFORMITRALVALVEREPAIRVIAMINITHORACOTOMY–ACASEREPORTAndreia Fernandes1; Clara Gaio Lima1; Nelson Paulo1; Catarina Celestino1; Ana Fonte Boa1;FátimaLima1;ManuelaVieira11-CentroHospitalardeVilaNovadeGaia/EspinhoIntroduction:Minimallyinvasivecardiacsurgery(MICS),viaminithoracotomy,isthoughttobea fast track to extubation and recovery after surgery. Chronicpain, due to intercostal nerveinjury,develops inupto50%ofpostthoracotomypatients.Anumberofregionalanaesthesia

and analgesia techniques may be employed, and the anaesthesiologists play a key role infacilitatingoptimaloutcomesaftersurgery.Methods: We report a case of postoperative pain management with a local anestheticinfiltrationforMICS.Results:A63-year-oldwoman,80kg,AmericanSocietyAnaesthesiology(ASA)physicalstatus3[arterialhypertension,atrialfibrillation(AF),rheumaticmitralstenosisandclassIINYHAheartfailure] was presented for an elective minimally invasive mitral valve repair through aminithoracotomy and cryoablation of AF. No relevant facts were found on pre-operativeevaluation. Calculated EuroScore II was 1.55%. After premedication with intravenous (IV)midazolam 1.5mg, radial arterial and jugular central venous catether were placed. GeneralanaesthesiawasinducedwithIVremifentanil1mcg/kg/h,propofol50mg,rocuronium1mg/kg.A transesophageal echocardiography probe was inserted atraumatically, which revealedthickenedmitralvalveleaflets.ASAstandard,invasivebloodpressure,centralvenouspressure,depthofanaesthesiaandcerebraloximetrymonitoringwereused.Urineoutputandarterialbloodgasweremeasuredperiodically.Aright lateralminithoracotomywasperformed.Aftercardiopulmonarybypass(CPB)byfemoralcannulation,cryoablationwasperformedfollowedbyplacementofthemechanicalprosthesis.Totalbypasstimewas186minincluding139minaorticcross-clampingtime.AttheendingofCPB,therewasnoneedforinotropicsupport.Analgesiawith paracetamol 1g, tramadol 100mg andmorphine 10mgwas performed after protaminereversion.Immediatelybeforeclosureofskin,catheterwasplacednearlytointercostalspace(figures 1, 2) and ropivacaine 0,75%75mgwas administered.Anaesthesia and surgerywereuneventful. Patient was shifted to intensive care unit (ICU), being extubated 3 hours aftersurgery.Therewasnoneedforadditionalbolusofropivacaineduring2daysofICUstay.Shewas discharged home on the 4th postoperative day, without complications. In a telephoneinterview 3 weeks after surgery, the patient referred no pain and good satisfaction withanalgesiamanagement.Conclusion: Thoracotomy incisions are associatedwith severepain, leading to adecrease inpulmonary function, an increase in metabolic and hormonal activity and increased cardiacmorbidity. Regional analgesia techniques have an opioid-sparing effect, reducing stressresponseandpainchronification.Thelocalinfiltrationthroughcatheterwithlocalanaestheticsallowsexcellentanalgesiafor8-12hours,providingarouteofadditionalanalgesiaaccordingtopaincontrol.CO92IS INVASIVE PRESSURE MONITORING MORE RELIABLE THAN NON-INVASIVE IN PATIENTSWITHCARDIOVASCULARPATHOLOGY?–ACASEREPORTAndreiaFernandes1;LuísaCoimbra1;InêsDelgado1;JoséCarvalho1;CarlaBentes11-CentroHospitalardeVilaNovadeGaia/EspinhoIntroduction: Patients undergoing carotid endarterectomy (CEA) require strict arterial bloodpressure(BP)controltomaintainadequatecerebralperfusion.Invasivebloodpressure(IBP)isthegoldstandard,howeverartifactsmayleadtoerroneousreadings.Methods:WereportacaseofCEAusingIBPmonitoring.Results:A64-year-oldman,AmericanSocietyAnaesthesiology(ASA)physicalstatus3(diffuseatheromathosis,dyslipidemiaandnon-medicatedhypertension),waspresentedforanelectiveright CEA. ASA standard, neuromuscular block monitoring, anesthesia depth and cerebraloximetrywereusedasmonitorization.OnpreanaestheticassessmentnoninvasiveBP(NIBP)hadnosignificantdifferencebetweenrightandleftarms(180/90mmHg).IBPmonitoringwasplacedinleftradialarteryafterseveralattemptsinbotharms.Surgerywasperformedunderbalanced

generalanesthesia(GA).Intra-operativelythepatientremainedstable(140/86mmHg)howeverthesystoliccarotidarterystumppressure(SP)was210-220mmHg.ThisfindingwasconfirmedbymeasuringNIBPinbothlegs.AtthispointNIBPwasusedtomonitorandguidetheBPtargetuntiltheendoftheprocedureandduringpostoperativeperiod(PO)inpostanestheticcareunit(PACU). Surgery proceeded uneventfully. After discharge to theward (48h stay at PACU), ahypertensivecrisis leadtocervicalneckhaematomawhichrequiredemergentsurgeryunderGA. Intraoperatively theBPwasassessedwithNIBP.Afteranewperiodof48hatPACU thepatientwasdischargedtothewardandsubsequentlyfromthehospitalonthe8thpostoperativeday,withoutfurthercomplications.Conclusion: IBP allow beat-by-beat measures with optimization of BP in order to improvecerebral perfusionduringCEA. IBP canbe inaccurate inpatientswithdiffuse atheromatosis.NIBPmaybeanalternative,howeverisnotcontinuousandisexpectedtobelessaccuratethantheIBP.1ThehighIBP-NIBPdifference(>40mmHg)wasclinicallyrelevantandinthispatientmightbeexplainedbydiffuseatheromatosis.NIBPwascompatiblewithcarotidSP,indicatingthat,inthiscasewasareliableandaccuratemethodofmonitoring.CO93HEPARINRESISTANCEDURINGSURGICALRESECTIONOF INFERIORVENACAVAANDRIGHTATRIALTUMORTHROMBUS:ACASEREPORTMariaBeatrizBelloDias1;J.Mendes1;J.Gouveia2;C.Pestana2;J.Bismarck21-AnesthesiologyResidentatHospitaldaLuzLisboa;2 -AnesthesiologistatHospitaldaLuzLisboaHeparinresistanceisthefailureofunusuallyhighdosesofheparintoachieveatargetactivatedclotting time (ACT).We present the case of a 47-year-old female patient, ASA 2, who wasdiagnosedwithaneuroendocrineretroperitonealtumorwiththrombusintheleftrenalvein,inferiorvenacavaandrightatrium.Generalandcardiothoracicsurgeonscollaboratedtoremovethetumorundercardiopulmonarybypass.Heparinresistancewasconsideredandtreatedwith1000UIofantithrombinIIIconcentrate.Theauthorsreviewthemechanismsandmanagementofthisentity.CO94ANAESTHETIC MANAGEMENT IN A DUCHENNE MUSCLE DYSTROPHY PATIENT FORTREATMENTOFRECURRENTPNEUMOTHORAXSaraMota1;LiubaGermanova1;JoanaCortesão1;TeresaPaiva11-CentroHospitalareUniversitáriodeCoimbraIntroduction:Duchennemusculardystrophy(DMD)isanxlinkedrecessivedisorder.Longtermprognosis is ominous, with development of respiratory distress and cardiomyopathy inadvancedstageofthediseaseandexpecteddeathintheteens-to-mid20sduetorespiratoryorcardiacfailure.Peri-operativemanagementofthispatientsischallengingduetodifficultairwayanatomy(macroglossia,limitedneckandmandibularmobility).Additionally,theyareatriskofdeveloping malignant hyperthermia, rhabdomyolysis and hyperkalemic cardiac arrest whenexposedtohalogenatedinhalationalanaestheticsanddepolarizingmusclerelaxants.Methods:WedescribeacaseofDMDproposedtoathoracotomyfortreatmentofrecurrentpneumothoraxanditsanaestheticapproach.

Results: A 22-year-old male patient with DMD presented at emergency department duedyspnoeastartingat3daysassociatedwithrightscapularpain,enhancedbybreathing.Thepatientalreadypresentswithmildcardiomyopathy(ejectionfractionof55%,mildmitralandtricuspidregurgitation),severerestrictiverespiratorydefect,requiringcontinuousBiPAP.Thepatientwasmarkedlydenourished (BMIof12kg/m2)andpresentedwithnearlyabsentbreathingsoundsontherightside.Chestradiographyshowedlargepneumothoraxontherightsidewithnosignsof tension.Drainagewasperformed.Despite initial success, recurrenceofpneumothorax occurred on the several attempts of clamping. A bronchopleural fistula wassuspected and operative treatment was considered. Considering the comorbidities, he wasgradedASAIVwithadifficultairwayduetomacroglossia,limitedneckandmandibularmobility.Oro-trachealintubationwasperformedwithslightsedation(propofol,withoutneuromuscularblocks).Difficultairwayanatomy(directlaryngoscopy-Cormack4)successfullyapproachedwithabougie andMccoyblade. Fibreoptic intubationapproachwas immediately available in theoperating room, if required. Total intravenous anaesthesia was decided (remifentanil andpropofol, administered by continuous infusion, without neuromuscular blockers). Volumecontrolledprotectiveventilationasused(tidalvolume6-8ml/kg,respiratoryfrequencyof14-16/min;FiO2:0,5).Nobronchopleuralfistulawasdetectedandpleurodesiswasperformedwithbiologicglue.PatientremainedintubatedandwastransferredtotheICUformonitoring,havingbeendischargedonthe2nddaytotheward.Despitethis,pneumothoraxrecurrenceoccurred,and surgery was performed again, using the same anaesthetic approach, this time withsuccessfulclosureofthebronchopleuralfistula.Conclusion: Total intravenous anaesthesia, without neuromuscular blockers, is a safe andeffectiveoptionforDMDpatients.Anaesthesiologistsmustconsiderthepossibilityofcardio-pulmonary disabilities, difficult airway management, as well as the high risk of malignanthyperthermiainthesepatients.