Objective: Compare technical, clinical, and economic outcomes between endovascular and open approaches in patients with type D aortoiliac occlusive disease according to the TransAtlantic Inter-Society Consensus. Methods: Patients undergoing revascularization for type D aortoiliac lesions, either endovascular or open surgery approach, from 2 Portuguese institutions between January 2011 and October 2017 were included. The surgical technique was left to the surgeon discretion. Patients with common femoral artery affection, both obstructive and aneurysmatic, were excluded. Results: Twenty-seven patients underwent aortobifemoral bypass and 32 patients were submitted to endovascular repair. The patients undergoing endovascular procedure were more likely to present with chronic heart failure ( P = .001) and chronic kidney disease ( P = .022) and less likely to have a history of smoking ( P = .05). The mean follow-up period was 67.84 (95% confidence interval = 61.85-73.83) months. The open surgery approach resulted in a higher technical success ( P = .001); however, limb salvage and patency rates were not different between groups. Endovascular approach was associated with a shorter length-of-stay, both inpatient (6 vs 9 days; P = .041) and patients admitted in the intensive care unit (0 vs 3.81 days; P = .001) as well as lower hospital expenses (US$9281 vs US$23 038; P = .001) with a similar procedure cost (US$2316 vs US$1173; P = .6). No differences were found in the postsurgical quality of life. Conclusion: Endovascular approach is, at least, clinically equivalent to open surgery approach and is more cost-efficient. The “endovascular-first” approach should be considered for type D occlusive aortoiliac lesions.

Objective: Varicose vein (VV) surgery is frequently performed by surgeons without formal vascular training. We aimed to compare the outcomes of the procedure based on the background of the surgeon.Methods: All patients registered with VV surgery between 2004 and 2016 in Portuguese public hospitals were included in the study. Intrahospital outcomes were assessed from this administrative database. A random multicenter sample of 315 patients submitted to saphenous high ligation and stripping (175 patients from six vascular surgery departments and 140 patients from five general surgery divisions) were further queried over the phone, whereby additional nonregistered outcomes were evaluated: preoperative venous ultrasound, impact on quality of life by the 14-item Chronic Venous Insufficiency Quality of Life Questionnaire, visual analogue scale evaluation (score of 1 to 5) of the aesthetic results and general satisfaction, work absence days, and time to return to physical activities.Results: In 13 years, there were 153,382 patients submitted to VV surgery. Of these, 49% were operated on by general surgeons and 40% by vascular surgeons; in 11%, it was not possible to identify the specialty performing the operation. Twenty-three deaths were registered (no differences between groups). In the general surgery group, 14% of patients were hospitalized for more than one night compared with 3% in the vascular group (P < .001). Reintervention rate during the period analyzed was significantly higher in the general surgery group (13.5% vs 8.2%; P < .001). Rate of outpatient surgery was higher in the vascular surgery group (60% vs 36%; P < .001). Phone query revealed similar overall satisfaction and improvement in quality of life in both groups (4.2 vs 4.0 [P ¼ .275] and 35% vs 36% [P ¼ .745], respectively). However, patients operated on by general surgeons reported worse surgical scars (2.8 vs 2.1; P ¼ .007), higher number of residual VVs (2.4 vs 1.7; P ¼ .006), and higher number of days absent from work (40 vs 27 days; P ¼ .005) and took longer to resume physical activities (60 vs 41 days; P ¼ .001).Conclusions: Despite that the majority of VV surgery in Portugal is executed by general surgeons, this study highlights important advantages when it is performed by surgeons with vascular training.

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Recebido a 4 de julho de 2014; aceite a 10 de setembro de 2014 Disponível na Internet a 23 de outubro de 2014 PALAVRAS-CHAVETrombose venosa ilio-femoral; Trombólise dirigida por cateter; Qualidade de vida Resumo Objetivo: Caraterizar o síndrome pós-trombótico e a qualidade de vida em doentes com antecedentes de trombose venosa profunda (TVP) ilio-femoral, possíveis candidatos a trombólise dirigida por cateter na altura do diagnóstico. Material e métodos: Revisão retrospetiva dos processos clínicos dos doentes com o diagnóstico de TVP ilio-femoral de 1 de janeiro de 2009 a 31 de dezembro de 2013. Seleção dos doentes de acordo com os critérios consensualmente aceites para trombólise dirigida por cateter na altura do diagnóstico. Entrevista clínica, realização de eco-Doppler venoso dos membros inferiores com preenchimento da escala Villalta e dos questionários SF-36 e VEINES-QOL/Sym. Resultados: Durante este período foram observados, no Centro Hospitalar do Tâmega e Sousa, 369 doentes com TVP dos membros inferiores. Destas, 39 envolviam o sector ilio-femoral em doentes potencialmente candidatos a trombólise dirigida por cateter. Compareceram à convocatória 28 doentes, sendo 85,7% do sexo feminino. Sessenta e quatro por cento dos doentes usava regularmente meia elástica de contenção. Quarenta por cento dos doentes apresentavam um fator de trombofilia. Mais de 80% evidenciava alterações ao eco-Doppler, sendo que 46% mantinha oclusão venosa e 36% refluxo ilio-femoral. Do total dos doentes avaliados, 21% apresentava insuficiência femoro-poplítea. Cerca de 90% dos doentes evidenciava síndrome pós-trombótica, sendo grave em 18%. A qualidade de vida global, representada pelo estado geral de saúde, foi classificada como má em 43% dos doentes. A vitalidade e a saúde mental foram os domínios mais negativamente influenciados. Na análise estatística, os doentes com piores pontuações nos questionários de qualidade de vida foram os com síndrome pós-trombótica, as mulheres, os doentes com trombose no membro inferior direito, com refluxo ≥ 2 segundos, com insuficiência distal ao segmento envolvido pela TVP e quando a mesma foi diagnosticada no primeiro mês após um procedimento cirúrgico. Conclusão: Neste estudo verificamos uma elevada frequência de síndrome pós-trombótica e a uma diminuição significativa da qualidade de vida. Um subgrupo de doentes apresentou resultados particularmente preocupantes. Estes resultados sugerem que deverá ser considerado um ଝ Apresentado no XIV Congresso Nacional da Sociedade Portuguesa de Angiologia e Cirurgia Vascular, Braga 2014, como comunicação oral. * Autor para correspondência. Correio eletrónico: miguelopmm@hotmail.com (M. Maia).

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