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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Percutaneous left atrial appendage &#40;LAA&#41; closure devices have been developed as a non-pharmacologic alternative to oral anticoagulant &#40;OAC&#41; therapy for stroke prevention in patients with non-valvular atrial fibrillation &#40;NVAF&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Vascular access site complications following percutaneous LAA closure are infrequent&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a> but may be associated with serious consequences&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a patient with a high-output fistula between the right superficial femoral artery and femoral vein after LAA closure successfully treated with a PK-Papyrus covered coronary stent using a 6F guiding catheter&#46; To the best of our knowledge this is the first time a PK-Papyrus coronary stent has been used in this setting&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">An 86-year-old female patient with NVAF&#44; high risk of stroke &#40;CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score of 5&#41; and contraindication to OAC therapy &#40;previous hemorrhagic stroke&#41;&#44; underwent percutaneous closure of the LAA with an Amulet device &#40;AGA&#47;St&#46; Jude Medical&#44; Minneapolis&#44; MN&#41;&#46; The procedure was performed under general anesthesia&#44; with fluoroscopic and two- and three-dimensional transesophageal echocardiographic guidance&#46; The right femoral vein was cannulated using the Seldinger technique and a transseptal puncture was performed with a Mullins sheath and Brockenbrough needle&#46; A 20 mm Amulet occluder device was successfully deployed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">At the end of the procedure after manual compression&#44; prolonged pulsatile bleeding by the femoral venous access was observed&#46; A control angiography obtained from the contralateral &#40;left&#41; femoral artery revealed a high-output fistula between the right superficial femoral artery and femoral vein &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#46; After discussion with the vascular team the decision was made to implant a covered stent&#46; A 26 mm&#215;4&#46;5 mm PK-Papyrus covered coronary stent &#40;Biotronik&#44; B&#252;lach&#44; Switzerland&#41; was inserted via the left femoral artery and deployed at the arteriovenous &#40;AV&#41; fistula using a 6F multipurpose catheter &#40;Cordis Corporation&#41; and a coronary guidewire &#40;Balanced Heavyweight&#44; Abbott Vascular Inc&#46;&#41;&#46; At final angiography&#44; complete sealing of the AV fistula was documented &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was discharged after 48 hours without complications&#46; Six months after the procedure&#44; she was asymptomatic and Doppler ultrasonography of the right femoral segment was normal&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Percutaneous LAA closure is a demonstrated alternative strategy to OAC therapy for stroke prophylaxis in patients with NVAF&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Vascular access site complications &#40;perforations&#44; pseudoaneurysms or AV fistulas&#41; following percutaneous LAA closure are infrequent&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a> but require immediate assessment and management and may be associated with adverse outcomes&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">These vascular complications can be treated percutaneously using covered stents with high technical success&#44; thus avoiding high-risk urgent vascular surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#8211;6</span></a> To the best of our knowledge this is the first time a PK-Papyrus coronary stent has been used in this setting&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The PK-Papyrus covered coronary stent is a sixth-generation bare-metal stent made of a cobalt-chromium alloy&#44; which allows for thinner struts while still maintaining optimal radial strength and radiopacity&#46; The polyurethane membrane covering the stent is only 90 &#956;m thick&#46; The wide size range &#40;diameter 2&#46;5-5&#46;0 mm&#44; length 15-26 mm&#41; enables a broad range of vessels to be treated confidently and efficiently&#46; Many current covered stents designed for peripheral interventions require large guiding catheters to be deployed&#46; The PK-Papyrus stent is compatible with 5F- and 6F-guiding catheters &#40;recommended sizes are 5F for 2&#46;5-4&#46;0 mm stents and 6F for 4&#46;5-5&#46;0 mm stents&#41;&#44; and thus may reduce vascular complications related to the large &#40;&#62;6F&#41; catheters and sheaths frequently used in these interventions&#46; In addition&#44; the techniques and materials used for the implantation of a PK-Papyrus covered stent in a peripheral segment are the same as used in coronary interventions&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0045" class="elsevierStylePara elsevierViewall">AV fistulas following percutaneous LAA closure are infrequent&#44; but may associated with adverse outcomes&#46; The PK-Papyrus covered coronary stent can be a good choice for percutaneous treatment of these complications&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Case report
Percutaneous closure of iatrogenic femoral arteriovenous fistula using a covered coronary stent
Oclusão percutânea de fístula arteriovenosa femoral iatrogénica usando stent coronário recoberto
Juan Carlos Rama-Merchan, Ignacio Cruz-González
Corresponding author
cruzgonzalez.ignacio@gmail.com

Corresponding author.
, Javier Martín-Moreiras, Alejandro Diego-Nieto, Javier Rodríguez-Collado, Pedro Luis Sánchez
Department of Cardiology, University Hospital of Cardiology & IBSAL, Salamanca, Spain
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To the best of our knowledge this is the first time a PK-Papyrus coronary stent has been used in this setting&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">An 86-year-old female patient with NVAF&#44; high risk of stroke &#40;CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score of 5&#41; and contraindication to OAC therapy &#40;previous hemorrhagic stroke&#41;&#44; underwent percutaneous closure of the LAA with an Amulet device &#40;AGA&#47;St&#46; Jude Medical&#44; Minneapolis&#44; MN&#41;&#46; The procedure was performed under general anesthesia&#44; with fluoroscopic and two- and three-dimensional transesophageal echocardiographic guidance&#46; The right femoral vein was cannulated using the Seldinger technique and a transseptal puncture was performed with a Mullins sheath and Brockenbrough needle&#46; A 20 mm Amulet occluder device was successfully deployed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">At the end of the procedure after manual compression&#44; prolonged pulsatile bleeding by the femoral venous access was observed&#46; A control angiography obtained from the contralateral &#40;left&#41; femoral artery revealed a high-output fistula between the right superficial femoral artery and femoral vein &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#46; After discussion with the vascular team the decision was made to implant a covered stent&#46; A 26 mm&#215;4&#46;5 mm PK-Papyrus covered coronary stent &#40;Biotronik&#44; B&#252;lach&#44; Switzerland&#41; was inserted via the left femoral artery and deployed at the arteriovenous &#40;AV&#41; fistula using a 6F multipurpose catheter &#40;Cordis Corporation&#41; and a coronary guidewire &#40;Balanced Heavyweight&#44; Abbott Vascular Inc&#46;&#41;&#46; At final angiography&#44; complete sealing of the AV fistula was documented &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was discharged after 48 hours without complications&#46; Six months after the procedure&#44; she was asymptomatic and Doppler ultrasonography of the right femoral segment was normal&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Percutaneous LAA closure is a demonstrated alternative strategy to OAC therapy for stroke prophylaxis in patients with NVAF&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Vascular access site complications &#40;perforations&#44; pseudoaneurysms or AV fistulas&#41; following percutaneous LAA closure are infrequent&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a> but require immediate assessment and management and may be associated with adverse outcomes&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">These vascular complications can be treated percutaneously using covered stents with high technical success&#44; thus avoiding high-risk urgent vascular surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#8211;6</span></a> To the best of our knowledge this is the first time a PK-Papyrus coronary stent has been used in this setting&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The PK-Papyrus covered coronary stent is a sixth-generation bare-metal stent made of a cobalt-chromium alloy&#44; which allows for thinner struts while still maintaining optimal radial strength and radiopacity&#46; The polyurethane membrane covering the stent is only 90 &#956;m thick&#46; The wide size range &#40;diameter 2&#46;5-5&#46;0 mm&#44; length 15-26 mm&#41; enables a broad range of vessels to be treated confidently and efficiently&#46; Many current covered stents designed for peripheral interventions require large guiding catheters to be deployed&#46; The PK-Papyrus stent is compatible with 5F- and 6F-guiding catheters &#40;recommended sizes are 5F for 2&#46;5-4&#46;0 mm stents and 6F for 4&#46;5-5&#46;0 mm stents&#41;&#44; and thus may reduce vascular complications related to the large &#40;&#62;6F&#41; catheters and sheaths frequently used in these interventions&#46; In addition&#44; the techniques and materials used for the implantation of a PK-Papyrus covered stent in a peripheral segment are the same as used in coronary interventions&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0045" class="elsevierStylePara elsevierViewall">AV fistulas following percutaneous LAA closure are infrequent&#44; but may associated with adverse outcomes&#46; The PK-Papyrus covered coronary stent can be a good choice for percutaneous treatment of these complications&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; 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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Apresentamos o caso de um paciente com uma f&#237;stula de alto d&#233;bito entre a art&#233;ria femoral superficial direita e a veia femoral&#44; depois de uma oclus&#227;o do ap&#234;ndice atrial esquerdo&#44; tratada com &#234;xito com um <span class="elsevierStyleItalic">stent</span> coron&#225;rio recoberto PK-PAPYRUS usando um cateter 6<span class="elsevierStyleHsp" style=""></span>F&#46; At&#233; onde sabemos&#44; esta &#233; a primeira vez que o PK-PAPYRUS &#233; o usado neste contexto&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Left atrial appendage &#40;LAA&#41; size by biplane two-dimensional transthoracic echocardiography &#40;TEE&#41;&#59; &#40;B&#41; LAA size by angiography &#40;windsock morphology&#41;&#59; &#40;C&#41; three-dimensional TEE showing complete occlusion of the LAA with the Amulet device &#40;red asterisk&#41;&#59; &#40;D&#41; angiography showing complete occlusion of the LAA with the Amulet device &#40;red asterisk&#41;&#46;</p>"
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Article information
ISSN: 21742049
Original language: English
DOI:10.1016/j.repce.2016.05.011
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