INTRODUCTION: The Abdominal aortic aneurysm (AAA) module of the Portuguese National Vascular Registry (RNPV) is a prospective, voluntary, population-based registry, that encompasses more than 90% of portuguese vascular departments. The aim of this study was to evaluate the results of the first 1000 infra-renal AAA included in the Portuguese RNPV. METHODS: Data were collected from November 2019 to December 2022 and analyzed for demographic aspects, treatment indication, aneurysm anatomic characteristics, type of intervention (EVAR and open surgical repair - OSR), outcome at 30-days and 1-year. EVAR and OSR were compared within elective and urgent settings. RESULTS: A total of 1122 patients were included in the period of study. After applying the exclusion criteria, we analyzed the first consecutive 1000 patients with infra-renal aneurysm submitted to EVAR or OSR, in elective or urgent settings. Elective procedures were perfomed in 79.2% of cases. Patients were predominantly male (91.8%), with a mean age of 74.1 ± 10.6 years. The overall 30-day mortality was 2.7% (EVAR 1.8% and OSR 5.9%; p=0.003). Pos- operative complications were more frequent in the OSR group, with significant repercussion in hospital length, reinterventions and early mortality. Baseline AAA diameter was identified as a predictor of 30-day mortality. Intra- hospital mortality was inversely related with the caseload of the center (p=0.032), mainly due to higher mortality in OSR (p=0.04). The center caseload did not impact the intra-hospital mortality in elective standard EVAR procedures. Urgent repair was performed in 205 patients with significantly larger AAA-diameter (70.5 ± 21.5 mm versus 57.5 ± 14.3 mm, p<0.001). The preponderance of EVAR was less pronounced comparing to OSR (53.7% versus 46.3%). The 30-day mortality rate was 34% (EVAR 28.8% and OSR 44.4%, p=0.024). A multivariate analysis identified age (p < 0.001) and 30-day pulmonary failure (p<0.001) to be independent risk factors for mortality. CONCLUSION: Vascular registries reflect real-world practice and offer the advantage of rapid feedback of current practice. Portuguese results with AAA treatment are generally favourable and comparable to existing literature from other countries in Europe and North America.

INTRODUCTION: Spontaneous isolated visceral artery dissection is a quite rare condition and designates a dissection that originates in the visceral artery itself with no involvement of the aorta. The objective of this revision article is to summarize the current evidence on this rare pathology. METHODS: A non-systematic literature search was performed using the PubMed database. Only English literature was considered. A narrative review was constructed, with the following headings: epidemiology; etiology; diagnosis; treatment; and follow-up. RESULTS: The celiac trunk is very rarely affected by isolated dissection. Simultaneous isolated celiac and splenic artery dissection are even rarer with less than 50 cases described so far. Even if there are associated with several possible risk factors, their definitive etiology remains unknown. The clinical presentation is quite variable ad most of the patients can be handled medically. Nonetheless, careful follow-up appears to be recommended and endovascular or open surgery should be performed in case of complications. CONCLUSIONS: Spontaneous isolated celiac and splenic artery dissection are very rare and definitive etiology remains unknown. Individualized treatment and careful follow-up are recommended.

INTRODUCTION:A right aortic arch and agenesis of internal carotid artery (ICA) are both extremely rare vascular devel- opment anomalies. Etiology of the both anomalies might be associated with the abnormal regression of the dorsal aorta. Most cases of ICA are asymptomatic due to sufficient collateral circulation and it is usually an incident finding on head and neck imaging by color Doppler ultrasonography, computed tomography (CT) or magnetic resonance imaging (MRI). ICA agenesis has a significant association - 24-67% - with intracranial aneurysms and their early detection can spare the patient serious complications.CLINICAL CASE:A 28-year-old male had a single episode of hypertension that motivated the realization of several tests. During the investigation he was submitted to a duplex ultrasonography that revealed a diffuse narrowing of the left common carotid artery (CCA), with a markedly decrease in the peak systolic velocity and the absence of the left internal carotid artery (ICA) was suspected. Contrast-enhanced computed tomography (CT) demonstrated no abnormalities, such as cerebral infarc- tion or intracranial vascular malformations, but confirmed a right-sided aortic-arch, with anomalous origin of the left subcla- vian artery with a common origin of both CCAs and the absence of the left ICA. Examination of the head CT in bone window demonstrated an absence of the left internal carotid canal.CONCLUSION:This clinical case emphasizes the importance of recognizing this condition due to the associated hemody- namic changes and in order to discover and evaluate other additional vascular malformations (aneurysms, collateral channels) and their life threatening potential risks (subarachnoid hemorrhage or ischemia). Also, it has a special importance in case of planning carotid or trans-sphenoidal hypophyseal surgery. To our knowledge, only 8 cases have been reported right aortic arch associated with agenesis of the left internal carotid artery.

Introdução: Os registos clínicos são ferramentas fundamentais para a conhecer a realidade e poder auditar o tratamento de aneurismas da aorta abdominal (AAA). A Sociedade Portuguesa de Angiologia e Cirurgia Vascular, promotora do Registo Nacional de Procedimentos Vasculares (RNPV), desenvolveu um módulo para esta patologia que iniciou o seu funcionamento em Dezembro de 2019. O objetivo deste artigo é apresentar dados referentes ao primeiro ano de funcionamento do módulo de AAA. Métodos: O módulo de AAA do RNPV abriu a possibilidade (voluntária) de registo em Dezembro de 2019. Após formação específica aos investigadores, os centros participantes deram início aos registos, de forma progressiva, ao longo do ano de 2020. O registo é realizado numa ferramenta informática especialmente desenvolvida para o efeito. São registados todos os casos de AAA (incluindo justa- ou supra-renais), com ou sem envolvimento das artérias ilíacas, de etiologia degenerativa. São excluídos aneurismas toraco-abdominais e ilíacos isolados. São registados dados demográficos, anatómicos, co-morbilidades, modo de admissão, detalhes sobre o tratamento e seguimento até aos 30-dias/intra- -hospitalar. O seguimento aos 1 ano e 5 anos é opcional. Para a finalidade deste relatório, foram apenas analisados dados referentes ao modo de admissão e tipo de tratamento, assim como a mortalidade aos 30-dias/intra-hospitalar. Resultados: Entre Dezembro de 2019 e Dezembro de 2020, foram registados 350 doentes na plataforma do módulo de AAA do RNPV. A idade média dos doentes registados é de 74.3 ± 13.7 anos, e 92.0% são do sexo masculino. O modo de admissão foi eletivo em 76,9% dos casos. O diâmetro máximo do aneurisma aórtico foi em média 63.9mm ± 19.9mm. A maioria dos doentes apresentava AAA infra-renal, numa percentagem semelhante em casos eletivos e em urgência (79% vs 76%), p=0.16. A indicação para tratamento foi o diâmetro aórtico em 59.4% dos casos. O tratamento endovascular (EVAR) foi utilizado em 68.9% dos casos. Em cirurgia eletiva, a percentagem de EVAR foi 75.7% e em urgência 45.7%, p < 0.01. Em cirurgia eletiva, a mortalidade aos 30 dias ou intra-hospitalar foi de 3.3% (8 doentes). Para doentes tratados por EVAR foi de 2.8% e para cirurgia aberta 5.2%, p<0.01. A mortalidade aos 30 dias ou intra-hospitalar em urgência foi 41.9%, por EVAR foi 20.0% e por cirurgia aberta 61.6%, p<0.01. Conclusão: No primeiro ano de funcionamento, o módulo AAA do RNPV produziu importantes dados que ajudam a compreender os padrões de tratamento desta patologia em Portugal. Estes dados podem ajudar os diferentes Serviços a melhorar a sua prática, através da comparação com os valores de referência gerados.

Introduction: Post-implantation syndrome ( PIS ) is the clinical and biochemical expression of an in (cid:23) ammatory response following endovascular repair of an aortic aneurysm ( EVAR ). The reported incidence in literature varies from 14-60%. Recentently, a study has demonstrated that red blood cell distribution width ( RDW ) is an independent biomarker predictor of the PIS in patients submitted to EVAR in the early postoperative period. multi-system organ failure with need of aggressive medical treatment and prolonged hospital stay. (6) Some studies have reported that a serious systemic in (cid:23) ammatory response might result in a cardiovascular or any other adverse event during the (cid:21) rst year after EVAR or a lower quality of life during a mean follow-up of 4 years. (7,8) ( ). Based on current evidence, this acute systemic in (cid:23) ammatory response is de (cid:21) ned as the presence of fever (>38ºC) and leukocytosis (>12,000/ μ L) according to the severe systemic in (cid:23) ammatory response syndrome ( SIRS ) criteria without any evidence of an infection. (2) This unexpected systemic in (cid:23) ammatory response may occur several hours or days after an EVAR . The incidence of this disease has been varying from 14 to 60%, being not systematically reported. (2,3,4) Although this condition has been known for quite a long time, its pathogenetic mechanisms and clinical relevance are still debated. A hypothesized cause of PIS is related to the amount of new-onset thrombus within the aneurysm thrombus and its release of tumor necrosis factor- α ( TNF - α ), interleukin-6 ( IL -6) and other cytokines within the aortic aneurysm. (4,5) It is generally a transient benign condition with no major adverse consequences for the patients. Though, according to literature, in some patients it may negatively a (cid:22) ect the outcome. Some severe cases have also been described, in whom serious clinical signs develop, including SIRS and Methods: Retrospective institutional review of consecutive excluding artery diabetes Age, gender and cardiovascular risk factors were found to be similar in both groups (P>0.05). Regarding the procedure approach, the majority of patients were treated with percutaneous access (72%) (P=0,49). In both groups ( PIS vs. no PIS ), the hemoglobin values signi (cid:21) cantly decreased (P=0,04) after surgery by approximately 14%. The same trend was observed for mean corpuscular volume ( MCV ) (P=0.032), which re (cid:23) ected the increasing of the RDW although not reaching statistical signi (cid:21) cance. Although delta variation of hemoglobin and delta RDW did not reach statistical signi (cid:21) cance comparing both groups (P=0,53 and P= 0,07 respectively), delta MCV was found to be signi (cid:21) cantly lower in the group with PIS (P=0.012). The importance of having a biomarker which measurement allows the prediction of patients who have more risk to develop PIS , may help with the early management of this condition.

Introduction: Post-implantation syndrome (PIS) is the clinical and biochemical expression of an inflammatory response following endovascular repair of an aortic aneurysm (EVAR). The reported incidence in literature varies from 14-60%. Recentently, a study has demonstrated that red blood cell distribution width (RDW) is an independent biomarker predictor of the PIS in patients submitted to EVAR in the early postoperative period. Methods: Retrospective institutional review of consecutive patients submitted to elective EVAR (January 2015- April 2020). The primary outcome was to evaluate the incidence of PIS, defined as fever (>38ºC) and leukocytosis (>12000/μL), excluding infection complication. The secondary outcomes were to identify the potential role of clinical and biomarker parameters to predict the risk of developing PIS after EVAR. Results and conclusion: According to the inclusion criteria, 107 patients were identified. The median age was 75 years old (93.5% men). Comorbidities presented: hypertension (75%), smoking (66%), hypercholesterolemia (59%), coronary artery disease (32%), chronic kidney disease (30%), and diabetes mellitus (DM) (18%). The incidence of PIS was 10,2%. Age, gender and cardiovascular risk factors were found to be similar in both groups (P>0.05). Regarding the procedure approach, the majority of patients were treated with percutaneous access (72%) (P=0,49). In both groups (PIS vs. no PIS), the hemoglobin values significantly decreased (P=0,04) after surgery by approximately 14%. The same trend was observed for mean corpuscular volume (MCV) (P=0.032), which reflected the increasing of the RDW although not reaching statistical significance. Although delta variation of hemoglobin and delta RDW did not reach statistical significance comparing both groups (P=0,53 and P= 0,07 respectively), delta MCV was found to be significantly lower in the group with PIS (P=0.012). The importance of having a biomarker which measurement allows the prediction of patients who have more risk to develop PIS, may help with the early management of this condition.

Turner syndrome (TS) is a disorder of female development with cardinal features of short stature and congenital cardiovascular defects. Congenital or acquired cardiological problems occur commonly in TS, being potentially progressive and responsible for severe complications, such as aortic dissection in young women. Accordingly, we describe a case of type A aortic dissection occurring in a woman with TS, highlighting the need to prioritize investigation in those patients to avoid a catastrophic aortic scenario.

Introduction: Severe ilio-femoral occlusive disease can limit the endovascular treatment of aorto-iliac aneurysms. In high surgical risk patients, inventive and staged hybrid interventions can be the answer to achieve definitive treatment. Clinical Case: A 68-year-old male, with multiple comorbidities, presented with simultaneous occurrence of bilateral common iliac aneurysms and severe ilio-femoral occlusive disease associated with right critical limb-threatening ischemia. In order to exclude the iliac aneurysms, preserve pelvic flow and revascularize the threatened limb we decided for a three-staged hybrid intervention. First, we began with a right external iliac angioplasty with femoral endarterectomy to create adequate arterial access. In a second intervention, we implanted a bifurcated aortoiliac endograft through this access. In order to prevent pelvic ischemia, contralateral leg outflow was directed to the left internal iliac artery with a combination of self-expandable and balloon-expandable covered stents. Finally, a right femoro-posterior tibial artery bypass completed the revascularization. At 1,5-year follow-up, no complications are reported and the patient is asymptomatic. Conclusion: In patients with poor medical condition and complex aorto-iliac aneurysmal and occlusive disease, a staged hybrid approach like the one described in this case-report can be feasible and associated with durable midterm patency and excellent clinical outcome.

Introduction: Over the past decade, endovascular treatment (EVT) is taking over visceral arterial aneurysms treatment considering its effectiveness, safety and minimal invasiveness. Methods: We retrospectively evaluated our department experience in visceral arterial aneurysms endovascular approach from 2009 to 2019. Results: From 2009 to 2019, nineteen visceral artery aneurysms were submitted to EVT (mean age 62,5 years, 53% women). The addressed arterial segments were: the splenic artery (52%, n=10) followed by the renal artery (21%, n = 4), the hepatic artery (11%, n = 2), the superior mesenteric artery (11%, n = 2) and the celiac arrtery (5%, n = 1). Average diameter was 26,9 ± 5,4 mm [range 21–39 mm]. The majority were asymptomatic incidental findings (74%). Concomitant aneurysms were found in 3 patients (15,8%). EVT included: stent-graft exclusion (n = 9), aneurysm-sac coil embolization (n = 6), stent-assisted coil embolization (n=2) and segmental artery exclusion (n=2). Median radiological follow-up was 46,8 months [range 1,1–128 months]. Early SMA occlusion was reported in one case after stent-assisted coil embolization, however without ischemic symptoms. End-organ loss was reported in one case (renal artery coil embolization, without overall renal function worsening). Conclusion: Nowadays, endovascular approach is the first-line intervention for most visceral arterial aneurysms. Although still limited, the reported results are favourable and are in line with the current literature.

Introduction: Over the past decade, endovascular treatment (EVT) is taking over visceral arterial aneurysms treatment considering its effectiveness, safety and minimal invasiveness. Methods: We retrospectively evaluated our department experience in visceral arterial aneurysms endovascular approach from 2009 to 2019. Results: From 2009 to 2019, nineteen visceral artery aneurysms were submitted to EVT (mean age 62,5 years, 53% women). The addressed arterial segments were: the splenic artery (52%, n=10) followed by the renal artery (21%, n = 4), the hepatic artery (11%, n = 2), the superior mesenteric artery (11%, n = 2) and the celiac arrtery (5%, n = 1). Average diameter was 26,9 ± 5,4 mm [range 21–39 mm]. The majority were asymptomatic incidental findings (74%). Concomitant aneurysms were found in 3 patients (15,8%). EVT included: stent-graft exclusion (n = 9), aneurysm-sac coil embolization (n = 6), stent-assisted coil embolization (n=2) and segmental artery exclusion (n=2). Median radiological follow-up was 46,8 months [range 1,1–128 months]. Early SMA occlusion was reported in one case after stent-assisted coil embolization, however without ischemic symptoms. End-organ loss was reported in one case (renal artery coil embolization, without overall renal function worsening). Conclusion: Nowadays, endovascular approach is the first-line intervention for most visceral arterial aneurysms. Although still limited, the reported results are favourable and are in line with the current literature.

Treatment of aortic pathologies involving the aortic arch represents a great challenge for vascular surgeons. Endografting techniques, comparing to open surgery, are less invasive approaches. However, an adequate proximal landing zone remains a challenge and, regarding this issue, parallel graft techniques represent a viable endovascular treatment option in patients with challenging aortic arch pathology by extending the proximal landing zone while maintaining aortic side branches perfusion. Parallel graft techniques required a thorough planning and the clinical and imagiological follow-up are mandatory. They appear to be a safe and minimally invasive alternative techniques in selected fragile patients. The authors report three clinical cases that required the use for parallel grafts to treat complex pathology of aortic arch.

Endovascular aneurysm sealing (EVAS) using the Nellix system is an alternative method for abdominal aortic aneurysm (AAA) repair. Type 1 endoleaks are not an uncommon complication following conventional endovascular aortic aneurysm repair (EVAR), occurring in up to 10 % of cases. The incidence of these endoleaks following Nellix EVAS was determined to be up to 3,1% in short-term follow-up. Early detection and classification of this issue is crucial to avoid the potential of sac rupture, previously described. As so, we report a successful endovascular treatment of type 1a endoleak, twenty-four months after a Nellix EVAS implantation. An 82 year-old male underwent a Nellix endovascular repair for a 55 mm infra-renal aortic aneurysm in 2014. Final angiography showed successful aneurysm exclusion with no endoleaks. Regular follow-up using computed tomography angiography (CTA) showed a relatively satisfying good stentgraft positioning, no signs of endoleaks and shrinkage of the aneurysm sac. CTA of 2016 showed a new type 1a endoleak associated wit a significant growth of the aneurysm sac. The authors performed prompt embolization of the endoleak with 0,018” detachable coils and Onyx 34. Final angiography showed patency of the endografts with satisfactory exclusion of the endoleak. The incidence and significance of type 1 endoleaks following Nellix EVAS was previously studied in literature, with some cases reported and the natural history of untreated type 1 endoleak after EVAS might lead to sac rupture and death. The embolization of the endoleak with coils and Onyx appears to be a safe and effective management choice to achieve technical and clinical success in the treatment of these cases.

Introduction: Endovascular techniques have been revolutionizing the revascularization of patients with chronic limb threatening ischemia (CLTI), showing consistently high limb salvage rates. However, endovascular recanalization of infrapopliteal occlusive disease can be technically demanding and the failure rate for these types of lesions is about 20%. In that case, an alternative vascular access may be required. We report our experience concerning CLTI patients who underwent retrograde access and recanalization of chronic occlusions after failure of anterograde attempts. Methods: Retrospective institutional review of consecutive patients requiring retrograde punctures to obtain endovascular revascularization (2013–2018) – 51 limbs in 50 patients. The primary outcome was to evaluate the technical success and the limb salvage - major-amputation free survival. The secondary outcomes were the rate of major and minor amputation, the global survival of this population and the characterization of the population and the endovascular procedures performed. Results and conclusion: The technical success was achieved in 76,5% of the procedures. The major amputation free-survival rate was 81,4% at 6 months. The femoro-popliteal and distal territories were concomitantly treated in 63,3% of the procedures and isolated distal territory was treated in 32,7%. Femoral approach was always initially performed (90,2% anterograde). Direct revascularization according to the angiosome concept was obtained in 64,6% of the cases. Anterior tibial artery was punctured in 33,3% of cases followed by pedal artery (27,5%), peroneal artery (19,6%), common plantar artery (7,8%), posterial tibial artery above the ankle (3,9%), supra-articular popliteal artery (3,9%), lateral plantar artery (2%) and metatarsal artery (2%). Percutaneous transluminal angioplasty (PTA) was performed in 69,4% of the procedures (2% with Drug Elluting Balloons) and PTA and stenting in 28,6%. During follow-up 19,4% of patients were submitted to major amputation and 29,4% to minor amputation. The rate of healing at 6 months was 43,3%. The results of the retrograde access and recanalization of chronic occlusions are comparable to data reported in the literature, confirming it as a valuable alternative. As so, the retrograde access approach for revascularization of CLTI patients appears to be a safe and effective alternative that expands revascularization options after the failure of a conventional endovascular anterograde approach, allowing the salvaging a greater number of limbs, particularly in patients with significant co-morbidities.

Introduction: The prevalence of Diabetes Mellitus (DM) is increasing. Diabetic patients have a 15-25% lifetime risk of developing a foot ulcer and its annual incidence can reach 25-30% if arterial disease is present. Diabetic angiopathy is a unique vascular disease that has predilection for below-the-knee arteries. Endovascular techniques have been revolutionizing the revascularization of neuroischemic diabetic foot (NIDF) patients, showing consistently high limb salvage rates.In addition, the survival of NIDF patients reaches 50% at 5 years after revascularization and limb salvage, but decreases to 50% at 2 years after a major amputation.

Introduction: Currently, the prevalence of Diabetes Mellitus (DM) in Portugal is 13,3% in adult population. Patients with DM have a 15-25% lifetime risk of developing a foot ulcer. Additionally, diabetic angiopathy is a unique vascular disease that has predilection for below-the-knee arteries. Meanwhile, endovascular techniques have been revolutionizing the revascularization of neuroischemic diabetic foot (NIDF) patients, showing consistently higher limb salvage rates. The survival of NIDF patients reaches 50% at 5 years after revascularization and limb salvage, but decreases to 50% at 2 years after a major amputation. With this study, the authors intend to describe their experience on endovascular revascularization for the treatment of NIDF patients. Methods: Retrospective institutional review of consecutive patients requiring endodistal revascularization (January 2010 - December 2017) - 464 limbs in 326 patients. We evaluated demographics and co-morbidities data and performed statistic analysis to determine factors and outcomes as limb salvage, major and minor amputation rates. The primary outcome was to evaluate the technical success, the limb salvage, the rate of major and minor amputation and the global survival of this population. The secondary outcomes were to characterize the population, the endovascular procedures performed and the evolution over the last years. Operative reports were reviewed to analyze the endovascular procedures and techniques. Results and conclusions: The technical success was achieved in 85% of the procedures. The iliac sector was only treated in 0,7% of the procedures and femoro-popliteal sector in 63,2%. Antegrade femoral approach, was obtained in 91, 3% of the procedures. A complementary retrograde distal approach was performed in 7,6% of procedures. Direct angiossomic revascularization was obtained in 60,9% of the cases. In the femoral and popliteal arteries, PTA was performed in 56,3% of the procedures and recanalization, PTA and stenting in 42,4%. During FU, 14,1% of patients was submitted to major amputation and 36,4% to minor amputation. The major amputation free-survival rate was 80,1% at 12 mo and the rate of healing at 12 mo was 63,2%. The 12 mo global survival was 79,8%. Direct angiossomic revascularization (p=0,014) and the number of tibial arteries recanalized (p=0,01) were both associated with a higher limb salvage rate and a faster healing of the ulcer. In the opposite side, there was an association between the increasing of renal dysfunction and poor healing (p=0,04). The endovascular reintervention rate was 20,4%. The results of the author’s study on endodistal revascularization, highlights the need to prioritize investigation and revascularization in NIDF patients to improve the outcome of foot ulcer, giving the possibility of salvaging a greater number of limbs.

INTRODUCTION:Extracorporeal membrane oxygenation (ECMO) has evolved as a life-saving measure for patients requiring emergent support of respiratory and cardiac function. The femoral artery is the standard site for vascular access when initiating adult venoarterial (VA) ECMO. Cannulation-related complications are a known source of morbidity and it has been speculated that patients undergoing ECMO via femoral arterial cannulation are more likely to develop peripheral vascular complications (up to 70%).METHODS:Retrospective institutional review of patients requiring ECMO (January 2011-August 2017). The primary outcome of this study was to investigate the prevalence of cannulation-related complications on VA ECMO and to determine its effect on patient morbimortality.RESULTS:Eighty-two patients underwent ECMO during the period of study, 56,1% were male with a mean age of 55,8 years. The VA mode was used in 61 patients, 56 with peripheral cannulation. Femoral arterial access was established in 52 patients (73% percutaneously). Vascular complications were observed in 28,6% of the VA femoral ECMOs: 12 acute limb ischemias and 3 major hemorrhages. At the time of femoral cannulation, distal peripheral catheter (DPC) was placed in 5 patients and none developed limb ischemia. For those who developed limb ischemia, several interventions were performed: DPC placement in 9 cases, fasciotomy in 4 and 2 major amputations. Thirty patients underwent arterial cannulas open surgical removal: 8 underwent balloon catheter trombectomy and 5 needed femoral reconstruction. There was an association between PAD (p=0,03) and ischemic cardiopathy (p=0,02;OR 4,5) with the present of vascular complications after ECMO implantation.CONCLUSIONS:Cannulation of femoral vessels remains associated with considerable rates of vascular events (28.6%). PAD and ischemic cardiopathy are associated with vascular complications in this form of cannulation.