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Introduction: Inadequate systemic perfusion as a consequence of heart disease may compromise inflow to lower limb revascularization procedures, decreasing short and mid-term patency. It may be theorized that patients suffering from heart valve disease or reduction of left ventricular ejection fraction (LVEF) have worse limb outcomes after lower limb revascularization. Method: This retrospective study included all first lower limb revascularization procedures performed in a tertiary hospital, between January 2017 and December 2018, in patients with diagnosed PAD and an available preoperative transthoracic echocardiogram (TTE). The group with moderate to severe heart disease in TTE (Group 1, defined as LVEF, Angiologia e Cirurgia Vascular, Vol 17 No 2 (2021): June

Introduction: Traumatic Thoracic Aortic Injury (TTAI) is a major cause of mortality in high-velocity trauma. While most cases result in instant death, TTAI may be present in patients with multiple traumatic injuries and therefore a high index of suspicion is necessary. Endovascular treatment offers significant advantages in this context and is now standard of care. The purpose of this study is to review our contemporary institutional experience with endovascular repair of TTAI. Methods: A retrospective analysis of discharge data for patients admitted with TTAI between 2010 and 2019 was performed from our institutional administrative database (level 1 trauma center). We extracted ICD-9 procedure code 39.73 ��� endovascular implantation of graft in the thoracic aorta and cross-checked with hospital registries to identify all TTAI cases. Follow-up was extracted from patient charts. The primary endpoints were primary technical and clinical success. Secondary endpoints were time to diagnosis and to surgical procedure relative to traumatic event, overall mortality, ongoing primary clinical success, and procedural details (upper limb revascularization, spinal drainage, systemic heparinization and endograft oversizing). Results: We identified six patients with TTAI who underwent TEVAR between 2010 and 2019. All were victims of high impact deceleration trauma, aged between 24 and 57 years old, and otherwise healthy. Additional major injuries were present in all patients (Injury Severity Score 14���57). All patients were submitted to CTA at admission which allowed for early diagnosis of TTAI and treatment in less than 24 hours in all cases expect one (which was treated in the first 48 hours). Grade III lesions were present in all six patients. All patients underwent TEVAR with 100% technical and clinical success. Three patients had a lesion that extended above the subclavian artery and consequently required subclavian coverage, but no patient was submitted to upper limb revascularization. Spinal drainage was not used in any case and there were no neurologic events. Half the patients were submitted to the procedure under systemic heparinization. The median oversizing of the endograft was 16% (10���35%). There was no in-hospital mortality nor mortality during follow-up (median duration of 35,5 months with an IIQ of 84,5 months) and the ongoing primary clinical success is 100%. Conclusion: Endovascular repair is a safe and effective therapy for TTAI even in patients with multiple trauma, and good mid-term results are expected. The procedure specifications such as the need for upper limb revascularization, use of spinal drainage, endograft oversizing, and systemic heparinization are still unclear. The long-term consequences need to be clarified., Angiologia e Cirurgia Vascular, Vol 17 No 2 (2021): June

Nowadays, axillofemoral bypass is viewed as an end-of-line solution for lower limb revascularization, owing to its classically described poor long-term patency, and recent advances in endovascular options for patients with complex aortoiliac anatomy not suitable for open reconstruction. There is a marked difference in patient profiles in published series of axillofemoral bypass, reflecting changing procedures indications due to technical innovations. The objective of this study is to determine the contemporary profile of patients treated with axillofemoral bypass and their outcome.Patients who underwent axillofemoral bypass surgery in a tertiary hospital from April 2011 to September 2017 were identified. Surgical indication, patency, amputation and death rates were recorded. Patients were grouped in axillouni vs axillobifemoral, 1st revascularization procedure vs reintervention, and primary aortoiliac occlusive disease vs primary aneurysmal disease, and were compared using Kaplan-Meier survival analysis.54 patients were included. 80% underwent an axillobifemoral bypass. Median age was 67 years; 96% were male. The most prevalent cardiovascular risk factors were HTA (81%) and history of smoking (76%). Primary vascular disease was aneurysmal in 24% of patients. The remaining group had peripheral occlusive arterial disease. In 53%, axillofemoral bypass was the first revascularization performed (naif group). On these, indications for this procedure were aorto-iliac occlusive disease (89%) and AA thrombosis (19%). In patients previously submitted to revascularization (47%), the most common first procedures were aortobifemoral bypass (56%), femoro-femoral bypass (44%) and EVAR (36%). Indications for axillofemoral bypass on this group were: prosthesis thrombosis (64%), secondary aorto-enteric fistulae (28%) and prosthesis infection (8%). Primary patency of axillofemoral bypass was 93% at 1 month and 80% at 5 years (Graphic 1). Differences were not significant regardless the vascular surgery status (naif vs reintervention), but axillobifemoral bypass and aneurysmal disease groups had a higher patency than axillounifemoral bypass and occlusive disease groups, respectively. No patient with aneurysmal disease required amputation over a 5-year follow-up. In primary occlusive disease group, 88% of patients were free-of-amputation at 1 month and 83% at 5 years. Patients who underwent this procedure had a survival rate of 78% at 1 month and 59% at 5 years (Graphic 2). No major difference was recorded between study groups.Axillofemoral bypass, although being an increasingly uncommon procedure, still allows acceptable rates of patency and limb salvage. As patients with aortoiliac disease usually have multiple comorbidities and a short life- -expectancy, axillofemoral bypass is attractive owing to its less invasive character.