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SUMMARYWe report on the follow-up and epidemiological study triggered by the isolation of the first vancomycin-resistant Staphylococcus aureus (VRSA) detected in Europe. The patient and 53 close contacts were screened for S. aureus colonization and all isolates recovered were characterized by multiple molecular typing methods. The VRSA remained confined to the infected foot of the patient and was not detected in any of the close contacts. Nasal colonization with S. aureus was detected in 20 subjects, of whom 15 carried methicilin-susceptible isolates with the remaining five harbouring methicilin-resistant S. aureus (MRSA). The majority of the isolates belonged to clones that have been previously shown to be prevalent in Portugal, both in the hospital setting and in the community. Only one isolate, an MRSA, was closely related to the VRSA. Like most of the characterized VRSA isolates from other countries, the VRSA isolated in Portugal belonged to clonal complex (CC) 5. Despite the absence of VRSA dissemination, the recent increase in the incidence of lineages belonging to CC5 in some European countries, including Portugal, may result in more frequent opportunities for the emergence of VRSA.

Objectives Endarterectomy is the treatment of choice for arterial occlusive disease of the femoral bifurcation. Longitudinal arteriotomy and prosthetic patch angioplasty is the standard technique but, due to the increasing concerns with prosthetic-related infections and multidrug-resistant pathogens our group adopted an alternative approach. We present our experience with eversion femoral endarterectomy. Methods All patients submitted to eversion femoral endarterectomy in a single institution during 2016–2019 were retrospectively analyzed. Patient demographics, surgical data, and complications were captured from medical records. Results Nineteen patients, 84.2% male and a median age of 67 years (IQR 62–78) were submitted to eversion femoral endarterectomy with a median follow-up of 180 days (IQR 71–395). Seventeen (89.4%) patients were treated for chronic limb ischemia and the other two were submitted to femoral endarterectomy during endovascular aortic aneurysm repair. Most of the patients had smoking history (84.2%), followed by hypertension (68.4%), dyslipidemia (63.2%), coronary heart disease (29.4%), and diabetes (26.3%). Only 3 patients (15.8%) were submitted exclusively to endarterectomy, 13 (68.4%) were submitted to endarterectomy as an adjuvant for peripheral endovascular treatment, 2 (10.5%) as a concomitant procedure to endovascular repair of aortic aneurysm, and 1 (5.3%) was complemented with thrombectomy of the femoro-popliteal sector. Primary patency rates were 100% and 87.5% (CI (38.7–98.1)) at 6 and 12 months, respectively. Primary-assisted and secondary patency rates were 100%. The 30-day mortality rate was 5.3% ( n = 1) and complication rate 10.5% ( n = 2). One patient complicated with acute renal disease related to rhabdomyolysis. Another patient developed a wound-related hematoma treated with surgical drainage, but died three days after consequent to ischemia-reperfusion injury. Conclusions Eversion femoral endarterectomy is a safe and feasible technique, with good patency results and respecting the concept of leaving nothing behind. A careful control of the proximal and distal endpoints is essential for the success of the technique.

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IntroductionThere is much debate in the literature regarding the management of blunt cervical carotid injuries. This report describes a case of bilateral carotid artery dissection in the very uncommon case of a near hanging victim and the treatment controversies regarding its management.ReportA 50 year old male patient was admitted after attempted suicide through hanging, having been swiftly rescued by a bystander. On admission, six hours after the event there was no neurological deficit. There was evidence of soft tissue damage related to the rope position, subcutaneous emphysema, and neck swelling. The CT angiogram showed dissection of both common carotid arteries with significant luminal narrowing as well as fracture of the thyroid cartilage; brain injury was excluded. Heparin infusion was started and an endovascular repair with bilateral covered stent placement, requiring coverage of the external carotid artery on the left side, was performed. The vascular procedure was uneventful. The patient was discharged 36 days after the event, on dual antiplatelet drugs and under regular psychiatric and speech therapy care, and is currently alive and well 22 months after surgery with no neurological damage.DiscussionThe choice of treatment was not straightforward as there are no guidelines or consensus around its management. In this case, however, an endovascular repair seemed suitable and the result was optimal, with no neurological damage and a good result after 22 months.

Resumo A doença de Von Recklinghausen é uma facomatose de transmissão autossómica dominante. Apesar da heterogeneidade da expressão clínica, os estigmas cutâneos clássicos como manchas café au lait são frequentes. A arteriopatia é incomum, sendo a degenerescência aneurismática extremamente rara.Os autores apresentam o caso clínico de um homem de 63 anos com doença de Von Recklinghausen e degenerescência multianeurismática aorto-ilíaca, femoral e poplítea, submetido com sucesso a tratamento cirúrgico convencional.A degenerescência aneurismática na doença de Von Recklinghausen encontra-se associada a displasia muscular lisa e a invasão neurofibromatosa da parede vascular. Esta fragilidade arterial implica dissecção laboriosa e técnica cirúrgica meticulosa para limitar a hemorragia e a deiscência anastomótica.Abstract The Von Recklinghausen's disease is a facomatosis with autosomal dominant transmission. Despite the heterogeneity of clinical expression, the classic cutaneous stigmata such as café au lait spots are common. The arteriopathy is unusual, with rare aneurysmal degeneration.The authors disclose the clinical case of a 63 years old man with Von Recklinghausen's disease and multi-aneurysmal degeneration of the aorto-iliac, femoral and popliteal sectors, who successfully underwent open surgery. * Autor para correspondência. Correio eletrónico: pmalvesmartins@hotmail.com (P. Martins).

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