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Innovations can help ports become smarter and more effective and differentiate themselves from competitors. This study aims to explore the current state of innovations and smart technologies at Brazilian ports. The study sampled sixteen ports, representing 70% of port movements in Brazilian public ports in 2021. This is an exploratory and descriptive field study involving qualitative analysis. The results show that the surveyed ports are seeking strategies to innovate. Only one of the surveyed ports had a registered patent. Half of all ports had agreements with educational/research institutions, companies, or other ports for developing innovations. By contrast, no port engaged in technology transfer contracts with educational/research institutions, companies, or other ports. Few surveyed ports collaborated with HUBs, laboratories, or innovation centres. The three most widely used smart technologies at the surveyed ports were cloud computing, automated systems, and drone technologies. This study shows that Brazilian ports are undergoing a transformation process, but they find themselves in different stages of maturity regarding the appropriation and development of new technologies. New technologies are still incipient for some ports, while others have yet to adopt them. For example, only a few surveyed ports used smart technologies such as the Internet of Things, blockchain technology, or automated systems. Innovations and the inclusion of new technologies can generate benefits, but they require time and financial resources.

Por meio de uma revisão da literatura e através de uma pesquisa documental, qualitativa, o artigo tem o objetivo de relacionar os principais estudos pertinentes aos sistemas cooperativos no setor portuário. Para atingir esse objetivo, é apresentada a importância do uso da tecnologia para a transformação digital nos portos, com destaque para a tecnologia, Internet das coisas (IoT), como sistemas cooperativos. O estudo evidenciou que a IoT vem se tornando responsável pelas novas transformações digitais que estão ingressando no mercado portuário, viabilizando diferencial estratégico e competitivo.

The main objective of the research was to prospect the state of the art in the management of innovation and port governance in order to identify models and practices in the different ports around the world, through the international scientific bases Web of Science and Scopus, which allowed the exploratory study. More specifically, we sought to raise the level of development in the field of scientific production in the areas of innovation management and port governance. Scientometric methods were applied to prepare graphs that reflect the treatment of data and information generated from selected publications, as well as the search in the patent database of the National Institute of Industrial Property – INPI. In general, a gap in scientific production related to the researched field of knowledge was evidenced, which may be associated with the low level of port innovations which, therefore, may also reverberate in the search for patent protection. Thus, it is recommended that scientific productions be encouraged to support innovations in the port sector, in addition to incremental innovations, playing a prominent role in the collaborative action of agents in the port cluster and scientific, technological and innovation institutions (ICTs).

Background In countries without organized population screening, incidental detection remains the major form of abdominal aortic aneurysm (AAA) diagnosis. Despite the presumed homogeneity in AAA prevalence, its rate of repair is highly variable, with Portugal treating 2 to 6 times fewer AAA per habitant than other western countries. Objectives To evaluate the detection rate and monitoring of incidental AAA in a multicentre cohort from Portuguese hospitals. Methods All abdominal CT scans performed in men ≥ 65 years old in three major Portuguese hospitals between January and June 2018 were selected for review. CT scans prescribed by the Vascular Surgery or Emergency Departments were excluded. Patients with previously known AAA were also excluded. Subjects with newly detected aneurysms were assessed for the two primary outcomes: the description of the finding by the radiologist in the written report; the effective follow-up recommendations by the prescriber of the CT or by the general practitioner (GP). Patients with newly found AAA that met criteria for monitoring or treatment and failed to be given guidance were contacted and included in surveillance programs. Results Overall, 3292 abdominal CT scans were selected for review. A total of 133 newly found aneurysms were detected (4.2% prevalence in the cohort). Of those, 48 cases (36%) were not described by the radiologist in the written report. Further 42 patients (32%) were not successfully oriented by the ordering physician or GP, despite having had their AAA mentioned. Overall, only 32% (n = 42) of the newly diagnosed AAA were correctly identified and referred to monitoring. Conclusions Incidental AAA is a common occurrence in in-hospital abdominal CTs. A significant number is not documented by the radiologist and the vast majority is not referred to monitoring. This could be a major reason for the low elective treatment rate of AAA in Portugal.

Throught a literature revision and a qualittive documental reaserch, the article aims to relate the main concerning studies to the cooperative portuary systems. To achive this objective, the importance of the use of tecnology to the digital transformation on the ports is presented, with enphasis on tecnology of the Internet of Things (IoT), as cooperative systems. The study showed that the iot has become responsible for the new digital transformations that are entering the port market, enabling a strategic and competitive differential. Por intermedio de una revisión bibliográfica y a través de una investigación documental cualitativa, el presente artículo pretende relacionar los principales estudios pertinentes a los sistemas cooperativos en el sector portuario. Para lograr este objetivo, se presenta la importancia de utilizar la tecnología para la transformación digital en los puertos, con énfasis en la tecnología, Internet de las Cosas (IoT), como sistemas cooperativos. El estudio mostró que IoT se ha convertido en responsable de las nuevas transformaciones digitales que están entrando en el mercado portuario, posibilitando un diferenciador estratégico y competitivo. Por meio de uma revisão da literatura e através de uma pesquisa documental, qualitativa, o artigo tem o objetivo de relacionar os principais estudos pertinentes aos sistemas cooperativos no setor portuário. Para atingir esse objetivo, é apresentada a importância do uso da tecnologia para a transformação digital nos portos, com destaque para a tecnologia, Internet das coisas (IoT), como sistemas cooperativos. O estudo evidenciou que a IoT vem se tornando responsável pelas novas transformações digitais que estão ingressando no mercado portuário, viabilizando diferencial estratégico e competitivo.

Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA.rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000-2004, 2005-2009, and 2010-2015) were compared in patients ≥ 50 years old to assess the variations over time.A total of 2 275 patients ≥50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 ± 0.24/100 000/year in 2000-2004, 3.17 ± 0.39/100 000/year in 2005-2009 and 3.21 ± 0.28/100 000/year in 2010-2015 (p .001). When comparing the time periods 2000-2004 to 2005-2009, the age standardised rate of admission (n = 1460) increased from 1.57 ± 0.25/100 000/year to 2.24 ± 0.32/100 000/year (p .001). The operative mortality rates decreased during this time period (from 55.3 ± 4.7% to 48.8 ± 4.7%, p .001). In 2010-2015, the age standardised rate of admissions due to rAAA decreased (1.98 ± 0.22/100 000/year). Operative mortality remained stable (48.9 ± 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 ± 0.10/100 000/year and 0.93 ± 0.29/100 000/year, respectively) but later increased (1.14 ± 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 ± 0.18/100 000/year, 2.21 ± 0.27/100 000/year and 2.26 ± 0.26/100 000/year in 2000-2004, 2005-2009, and 2010-2015, respectively, p .001).Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.

Orientador: Claudia Maria Bauzer Medeiros Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Computação Resumo: O geomarketing trata do gerenciamento de informação combinando dados espaciais e de negócios para apoio à decisão dentro de um domínio de mercado. Atualmente, este conceito vem evoluindo para aplicações em outros domínios. No entanto, os inúmeros modelos propostos não são devidamente implementados e os sistemas existentes não são extensíveis, problema. Suas principais contribuições são: (1) proposta de uma arquitetura conceitual para um sistema de geomarketing levando-se em conta novos métodos e tecnologias envolvidas; (2) estudo dos diferentes tipos de modelos espaciais de mercado e técnicas baseadas em geomarketing; (3) identificação de alguns tipos de problemas no setor de telefonia em que estas metodologias podem ser aplicadas; (4) validação da arquitetura através do projeto e implementação de um protótipo Web, o VoroMarketing. Este protótipo é modular e extensível, permitindo a utilização de diferentes modelos espaciais; (5) configuração do protótipo para atender a problemas específicos no setor de telecomunicações Abstract: The goal of geomarketing is to manage and to combine spatial and business data for decision support within the domain of marketing applications. This concept is evolving to include other application domains. However, the models proposed are seldom properly implemented; moreover, existing systems are not extensible, and support only one specific simulation model. This thesis contributes to solving these issues. The main contributions are the following: (1) proposal of a conceptual architecture for a geomarketing information system, that takes into consideration new methods and technologies; (2) a comparative study of distinct types of spatial marketing models and techniques; (3) identification of some kinds of problems in the telephone/telecommunications domain that can profit from the use of such techniques; (4) validation of the architecture by means of a Web geomarketing prototype, VoroMarketing. This is a modular and extensible prototype that supports the use of distinct spatial models; (5) configuration of the prototype to solve specific problems in the telecommunications domain Mestrado Mestre em Ciência da Computação

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 = .275] and 35% vs 36% [P = .745], respectively). However, patients operated on by general surgeons reported worse surgical scars (2.8 vs 2.1; P = .007), higher number of residual VVs (2.4 vs 1.7; P = .006), and higher number of days absent from work (40 vs 27 days; P = .005) and took longer to resume physical activities (60 vs 41 days; P = .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. info:eu-repo/semantics/publishedVersion

Background The incidence of abdominal aortic aneurysm (AAA) repairs in Portugal is one of the lowest mentioned in the literature. This phenomenon can be justified either by a low prevalence of the disease or by its low detection rate. To date, the prevalence of the pathology is unknown. The objective of the study was to estimate the prevalence of AAA and its associated risk factors, in men aged ≥65 years and to evaluate the population's disease awareness. Methods All males aged ≥65 years registered in a Portuguese primary health care unit were invited to participate. The abdominal aorta was measured by ultrasound (inner to inner method). Concomitant risk factors and patient's AAA awareness were also assessed. An aortic diameter >30 mm was considered aneurysmatic. Results Nine hundred thirty-three patients were invited for the screening. Of these, 715 participated in the study (participation rate of 76.6%). The AAA prevalence in this sample was 2.1%. Eighty-five percent of the evaluated patients had never heard of the disease before. The mean age of the assessed population was 72.3 years; Multiple logistic regression analysis showed a positive association between AAA and history of smoking (odds ratio [OR] 8.8, P = 0.037) and history of dyslipidemia (OR 9.6, P = 0.035). A negative association was found between diabetes and AAA (OR 0.33, P = 0.045). Conclusions The found prevalence shows that a significant number of potentially fatal AAAs remains to be diagnosed in Portugal. These results highlight the need for an effective program of AAA detection in Portugal. The lack of awareness in the Portuguese population for this pathology should also prompt reflexion.

Objective/background Several abdominal aortic aneurysm (AAA) screening programs have demonstrated a similar prevalence of this disease in Westerns countries, ranging from 1.2% to 2.8%. However, the annual rate of AAA repair is significantly less even, and its relationship to AAA prevalence is not clear. The objective was to perform a systematic review, describing an international overview in the yearly rate of AAA repairs. Methods The number of elective and emergency AAA repairs was obtained via thorough review of publications indexed in PubMed and Scopus from 2010 to October 2018. Portuguese data were obtained from the national administrative database of health care. Data from the UK were extracted from the National Vascular Registry's 2015 annual report. Each country's population was assessed from published national censuses, thus allowing estimation of the number of AAAs treated per 100,000 habitants. Results Data from 14 countries were obtained. The yearly number of elective operations per 100,000 habitants was 2.2 in Hungary, 3.8 in Portugal, 5.3 in Spain, 5.9 in Iceland, 6.5 in Finland, 7.0 in New Zealand, 7.8 in the UK, 10.0 in Denmark, 10.2 in Sweden, 13.3 in the USA, 14.8 in Norway, 15.3 in the Netherlands, 15.6 in Italy, and 17.3 in Germany. The yearly rate of ruptured repairs was 0.5 in Hungary, 1.5 in Portugal, 1.8 in Spain, 1.7 in Iceland, 1.7 in Finland, 1.3 in New Zealand, 1.8 in the UK, 3.3 in Denmark (2013), 2.7 in Sweden (2013), 1.7 in the USA, 2.1 in Norway, 3.1 in the Netherlands, 2.3 in Italy, and 2.7 in Germany. Conclusion The rate of AAA treatment is highly variable, with a nearly eightfold variance between the countries with the highest and lowest rates of elective repair. Correlation between elective and ruptured repairs was not clear. A deeper understanding of the reasons for the disparities in AAA treatment among Western countries is of the utmost importance.

Introduction and objectives Which is the best carotid stenosis treatment remains a controversial issue. To present day, no study has compared the results of carotid artery stenting versus carotid endarterectomy in Portugal. We aim to provide real life numbers regarding the outcomes of both procedures in Portuguese public hospitals. Methods Every patient registered between 2005 and 2015 with the main diagnosis of carotid stenosis and submitted to carotid endarterectomy or carotid artery stenting was included. The information was obtained through the Central National Healthcare Administrative database, a mandatory registry for hospital refunding. Primary outcomes were hospital mortality and stroke. Patient demographics, comorbidities and hospital length of stay were also evaluated. Results The study included 6094 patients: 1399 were symptomatic (mention of prior stroke) and 4695 asymptomatic. Carotid artery stenting was performed on 22% of the symptomatic and 18% of the asymptomatic patients. In the symptomatic patients, the in-hospital mortality was significantly higher in those submitted to stenting (3.6% vs. 1.6% in carotid endarterectomy, p = 0.025). No significant differences in outcomes were observed in the asymptomatic group (mortality 0.9% vs. 0.8%, p = 0.852; stroke rate of 2.6% vs. 2.3%, p = 0.652 – carotid artery stenting vs. carotid endarterectomy). In both groups, there was an important increase in the proportion of stenting between 2005 and 2012, followed by a gradual decline until 2015. Conclusion Despite its increasing frequency, a higher early mortality was documented for CAS in symptomatic patients. No worse outcome was observed in asymptomatic patients.

Introduction The parallel grafting technique (PGT) is a valuable alternative to prefabricated branched or fenestrated endovascular aortic repair. An often overlooked advantage of PGT is its unique adaptability to different anatomical challenges that might appear intra-operatively. Report A 72 year old male patient presented with a 60 mm thoracic aneurysm, 59 mm juxtarenal abdominal aortic aneurysm, and 32 mm common iliac aneurysm (CIAA). Thoracic endovascular aortic repair plus endovascular aortic repair with bilateral renal artery chimneys and CIAA exclusion applying the sandwich technique was proposed. Because of unfavourable angulation it was not possible to achieve selective left renal catheterisation via axillary access. Changing to a femoral approach allowed successful retrograde catheterisation. The procedure ended with a chimney for the right renal artery and a periscope for the left renal artery. The final angiogram showed no endoleaks and renal and hypogastric patency. The patient was discharged three days after the procedure and remains under ultrasound surveillance after 40 months because of a small type two endoleak. Conclusion When using a prefabricated branched device, the possibility of selectively catheterising a visceral branch often has no straightforward solution. However, parallel grafting is an extremely flexible technique, which was of paramount importance for the surgical outcome of the present case., Highlights • The parallel grafting technique (PGT) can be a valuable alternative to prefabricated branched or fenestrated endovascular aortic repair. • An often overlooked advantage of PGT is its unique adaptability to different anatomical challenges that might appear intra-operatively. • This is a complex case report with three year follow up, in which three consecutive aneurysms were treated with PGT. • In this case the unique adaptability of the technique was paramount for the outcome of the surgery.

Organizations update and train their human resources to follow the evolution and practical use of new management knowledge and technologies. The project of the Technical Training Centre “Operational Excellence” a continuous education none is developed in the Ponta da Madeira Maritime Terminal - TMPM of Vale, located in São Luís (MA), Brazil. The paper approaches its methodology, resources and results based on the diagnosis, training and improvement actions measured by Operational Indicators as the Iron Ore Standard Pile, Effective Rate, MTTR (Mean time to repair) and Operational Losses, identifying positive effects on business results and employee training., Las organizaciones capacitan constantemente a sus recursos humanos para la evolución y práctica de nuevos conocimientos y tecnologías gerenciales. El Proyecto de Excelencia Operacional, educación continua, del Centro de Capacitación Técnica de la Terminal Marítima de Ponta da Madeira - TMPM de Vale, en São Luís (MA), Brasil tiene este propósito. El artículo analiza la metodología, recursos y resultados para las acciones de diagnóstico, capacitación y mejora reflejados en los Indicadores Operacionales de Pila Estándar de minerales, Tasa Efectiva, MTTR (tiempo promedio de reparación) y Pérdidas Operacionales de TMPM identificando resultados positivos para la empresa y formación de trabajadores., As organizações capacitam permanentemente seus recursos humanos para a evolução e uso prático dos novos conhecimentos e tecnologias gerenciais. O Projeto Excelência Operacional de educação continuada do Centro de Capacitação Técnica do Terminal Marítimo de Ponta da Madeira – TMPM da Vale, localizado em São Luís (MA) tem essa finalidade. O artigo analisa a metodologia, recursos e resultados pelo diagnóstico, treinamentos e ações de melhoria refletidas nos Indicadores Operacionais de Pilha Padrão de minérios, de Taxa Efetiva, MTTR (tempo médio para reparo) e de Perdas Operacionais do TMPM identificando resultados positivos para a organização e formação dos trabalhadores.

Background The main objective of this study was to assess the correlation between three semiquantitative and one computerized method based on Agatston Score (AS), when measuring abdominal aortic calcification (AAC) in abdominal aortic aneurysm (AAA) patients. Secondary aim was to access differences in AAC upon clinical variables, when different methods of calcium scoring are used. Methods This was an observational, retrospective, cross-sectional study. A database of AAA patients consecutively submitted to elective repair between 2008 and 2015 was used. Patients were excluded if they did not have preoperative imaging or presented scans incompatible with at least one of the whole set of calcification methods tested. Calcification measures were performed using AS, Aortic Calcification Index (ACI), AAC-8 and AAC-24 methods. The Pearson's correlation was used for primary analysis. Results Study population comprised 102 patients, 95% males, with a median age of 71 (interquartile range, IQR 66-76) years. AAAs presented median aortic diameter of 60 (54-70) mm. Pearson's correlation with AS was 0.816 for ACI, 0.703 for AAC-8 and 0.648 for AAC-24. ACI also presented the highest ICC for intraobserver agreement (0.972) and for interobserver agreement (0.966). ACI was associated more often to demographic and clinical variables in the dataset that associated with the computerized method. Conclusions ACI is suggested as a fast and easy-to-use method of assessing AAC in AAA patients. Its use should be encouraged to study AAC in AAA over other semiquantitative methods, in research settings.

This research aimed to analyze the economic impact of Alcântara Port Terminal activity, a Greenfield enterprise, located in the state of Maranhão. Bibliographic research; documentary research; interview and economic impact analysis methodology proposed by the Bureau of Transport Economics of Australia were used. The economic impact was measured through the Value of Provided Services, Gross Value Added, Household Income and the Number of Generated Jobs, divided into direct, indirect and induced impact and evaluated for a period of 24 years (2024 to 2048). The results obtained indicate a contribution to regional development, proving the role of ports in improving product handling conditions (wealth) and benefiting people (income generation). Esta investigación tuvo como objetivo el análisis del impacto económico de la actividad Terminal Portuaria de Alcântara, un emprendimiento greenfield, ubicado en el Estado de Maranhão - Brasil. Se utilizó de la investigación bibliográfica; investigación documental; entrevista y metodología de análisis de impacto económico propuesta por Bureau of Transport Economics de Australia. El impacto económico fue medido por medio del Valor de los Servicios Proporcionados, Valor Adicionado Bruto, Ingresos de las Familias y el Número de Empleos Generados, dividido en impacto directo, indirecto e inducido y evaluado para un período de 24 años (2024 al 2048). Los resultados obtenidos indican una contribución para el desarrollo regional, comprobando el papel de los puertos para la mejoría de las condiciones de movimiento de productos (riquezas) y beneficiando personas (generación de ingresos). Esta pesquisa teve como objetivo a análise do impacto econômico da atividade Terminal Portuário de Alcântara, um empreendimento greenfield, localizado no estado do Maranhão. Utilizou-se da pesquisa bibliográfica; pesquisa documental; entrevista e metodologia de análise de impacto econômico proposta pelo Bureau of Transport Economics da Austrália. O impacto econômico foi medido por meio do Valor dos Serviços Prestados, Valor Adicionado Bruto, Rendimento das Famílias e o Número de Empregos Gerados, dividido em impacto direto, indireto e induzido e avaliado para um período de 24 anos (2024 a 2048). Os resultados obtidos indicam uma contribuição para o desenvolvimento regional, comprovando o papel dos portos para a melhoria das condições de movimentação de produtos (riquezas) e beneficiando pessoas (geração de renda).

This research aimed to analyze the economic impact of Alcântara Port Terminal activity, a Greenfield enterprise, located in the state of Maranhão. Bibliographic research; documentary research; interview and economic impact analysis methodology proposed by the Bureau of Transport Economics of Australia were used. The economic impact was measured through the Value of Provided Services, Gross Value Added, Household Income and the Number of Generated Jobs, divided into direct, indirect and induced impact and evaluated for a period of 24 years (2024 to 2048). The results obtained indicate a contribution to regional development, proving the role of ports in improving product handling conditions (wealth) and benefiting people (income generation)., Esta investigación tuvo como objetivo el análisis del impacto económico de la actividad Terminal Portuaria de Alcântara, un emprendimiento greenfield, ubicado en el Estado de Maranhão - Brasil. Se utilizó de la investigación bibliográfica; investigación documental; entrevista y metodología de análisis de impacto económico propuesta por Bureau of Transport Economics de Australia. El impacto económico fue medido por medio del Valor de los Servicios Proporcionados, Valor Adicionado Bruto, Ingresos de las Familias y el Número de Empleos Generados, dividido en impacto directo, indirecto e inducido y evaluado para un período de 24 años (2024 al 2048). Los resultados obtenidos indican una contribución para el desarrollo regional, comprobando el papel de los puertos para la mejoría de las condiciones de movimiento de productos (riquezas) y beneficiando personas (generación de ingresos)., Esta pesquisa teve como objetivo a análise do impacto econômico da atividade Terminal Portuário de Alcântara, um empreendimento greenfield, localizado no estado do Maranhão. Utilizou-se da pesquisa bibliográfica; pesquisa documental; entrevista e metodologia de análise de impacto econômico proposta pelo Bureau of Transport Economics da Austrália. O impacto econômico foi medido por meio do Valor dos Serviços Prestados, Valor Adicionado Bruto, Rendimento das Famílias e o Número de Empregos Gerados, dividido em impacto direto, indireto e induzido e avaliado para um período de 24 anos (2024 a 2048). Os resultados obtidos indicam uma contribuição para o desenvolvimento regional, comprovando o papel dos portos para a melhoria das condições de movimentação de produtos (riquezas) e beneficiando pessoas (geração de renda).

The recommendations about the preferred type of elective repair of abdominal aortic aneurysm (AAA) still divides guidelines committees, even nowadays. The aim is to assess outcomes after AAA repair focusing on differences between endovascular aneurysm repair (EVAR) and open surgical repair (OSR).The observational retrospective cohort study of consecutive patients submitted to elective AAA repair at a tertiary center, 2009-2015. Exclusion criteria were as follows: nonelective cases or complex aortic aneurysms. Primary outcomes were postoperative complications, length of hospital stay, survival, freedom from aortic-related mortality, and vascular reintervention. Time trends were assessed along the period under analysis.From a total of 211 included patients, those submitted to EVAR were older (74 ± 7 vs. 67 ± 9 years; P 0.001), presented a higher prevalence of hypertension (83.5% vs. 68.5%, P = 0.004), obesity (28.7% vs. 14.3%, P = 0.029), previous cardiac revascularization (30.5% vs. 14.7%, P = 0.005), heart failure (17.2% vs. 5.2%, P = 0.013), and chronic obstructive pulmonary disease (32.8% vs. 13.3%, P = 0.002). Patients were followed during a median of 49 months. EVAR resulted in a significantly shorter length of hospital stay (median 4 and interquartile range 3 vs. 8 (9); P 0.001), lower 30-day complications (10.6% vs. 22.8%, P = 0.017), lower aortic-related mortality, and similar reintervention after adjustment with a propensity score. Along the time under analysis, EVAR became the predominate type of repair (P = 0.024), the proportion of complications decreased (P = 0.014), and the 30-day mortality (P = 0.035).Although EVAR was offered to patients with more comorbidities, better and durable outcomes were achieved after EVAR, favoring its adoption for elective AAA repair.

Resumo As lesoes vasculares, embora muito raras, sao uma das complicacoes mais devastadoras no contexto de uma protese do quadril, pelo que o seu diagnostico correto e fundamental para evitar danos irreversiveis ao paciente. Apresentamos o caso de uma mulher branca de 70 anos com um membro inferior isquemico causado por uma perfuracao tardia da arteria iliaca externa devido a um parafuso acetabular. O problema foi resolvido simplesmente com o corte parte do parafuso, o que evitou outras opcoes cirurgicas que poderiam ser muito mais agressivas para o paciente. A avaliacao clinica cuidadosa permitiu um diagnostico correto e um tratamento criativo a tempo de prevenir outras consequencias para o paciente.

ResumoEm Portugal, a relação entre o número de aneurismas da aorta abdominal (AAA) tratados e a população total é das mais baixas descritas na literatura. Este fenómeno poderá ser justificado pelo défice de diagnóstico ou pela reduzida prevalência da doença na nossa população. Até à data, nenhum rastreio populacional sistemático foi realizado em Portugal. O rastreio oportunístico «A aorta não avisa» descreveu uma prevalência de 2,4% na população avaliada. Vários estudos demonstram o benefício do rastreio populacional de AAA, tendo‐se verificado diminuição da mortalidade específica e por todas as causas, pelo que este já é recomendado pelas principais sociedades internacionais de cirurgia vascular – European Society for Vascular Surgery (nível 1 recomendação) e Society for Vascular Surgery (nível 2 de recomendação) em homens com mais de 65 anos. Para além da sua justificação académica e científica, as vantagens de um programa de rastreio em termos de saúde pública são inegáveis e irrefutáveis com base na evidência atual.AbstractIn Portugal, the number of abdominal aortic aneurisms (AAA) treated in relation with its population is among the lowest in the literature. This phenomenon can be explained by a low diagnostic rate or a reduced prevalence of AAA in our population. To date, no systematic population screening was conducted in Portugal. The opportunistic screening “A aorta não avisa” described a prevalence of 2.4% in our population. Several studies have shown the benefit of population screening for AAA, by describing a significant decrease in specific and all‐cause mortality. In that way, the screening is already recommended in men over 65 years by the leading international Vascular Surgery societies ‐ European Society for Vascular Surgery (level 1 recommendation) and Society for Vascular Surgery (level 2 recommendation). In addition to its academic and scientific justification, based on the current evidence, the benefits of an AAA screening program in terms of public health are undeniable and irrefutable.