Letter to the Editor
Reply to the Letter to the Editor: “A peripheral comment”
Resposta à Carta ao Editor «Um comentário periférico»
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=> array:1 [ 0 => array:2 [ "autoresLista" => "Henrique Mesquita Gabriel" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Henrique" "apellidos" => "Mesquita Gabriel" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511730255X?idApp=UINPBA00004E" "url" => "/08702551/0000003600000010/v2_201711040052/S087025511730255X/v2_201711040052/en/main.assets" ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply to the Letter to the Editor: “A peripheral comment”" "tieneTextoCompleto" => true "saludo" => "To the editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "785" "paginaFinal" => "786" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Carlos Rama-Merchán, Ignacio Cruz-González" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Juan Carlos" "apellidos" => "Rama-Merchán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Ignacio" "apellidos" => "Cruz-González" "email" => array:1 [ 0 => "cruzgonzalez.ignacio@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Cardiology Department, Complejo Hospitalario de Mérida, Badajoz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cardiology Department, Hospital Universitario de Salamanca and IBSAL, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta à Carta ao Editor «Um comentário periférico»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with great interest the comments by Dr. Henrique Mesquita Gabriel<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> on our paper “Percutaneous closure of iatrogenic femoral arteriovenous fistula using a covered coronary stent” recently published in the Portuguese Journal of Cardiology.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> We would like to make some comments:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0010" class="elsevierStylePara elsevierViewall">It is well known that vascular access (VA) complications are common and remain an important cause of adverse events following interventional procedures.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,4</span></a> It is therefore key to identify them as soon as possible. Also, operators should be trained to resolve them in the fastest and most effective way.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0015" class="elsevierStylePara elsevierViewall">In the case we presented the maximum diameter of the superficial femoral artery was 4.8 mm, therefore the 26 mm×4.5 mm PK Papyrus covered coronary stent totally sealed the fistula after postdilatation with a 5.0 mm balloon.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0020" class="elsevierStylePara elsevierViewall">We agree with Dr. Mesquita Gabriel<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> that stents in peripheral vessels are subject to much more demanding mechanical conditions, however we did not expect there to be problems in the superficial femoral artery at the level we implanted the stent in a 86-year-old woman.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0025" class="elsevierStylePara elsevierViewall">Although the use of ultrasound-guided femoral punctures has demonstrated reductions in VA complications,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> especially in patients in whom femoral access can be challenging, the availability of this technique in many laboratories is still limited. For this reason, we usually perform a preoperative assessment of the VA site (vessel size, tortuosity, calcification, etc.) by computed tomography to minimize the risk of complications.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Open surgery is a very good therapeutic option in the event of vascular complications, but it is associated, among other things, with greater patient discomfort and prolonged hospitalization.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a> A percutaneous technique with rapid and effective repair of the VA injury is desirable, especially in elderly high-risk patients.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> The case was discussed with our vascular surgical team.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Coronary stents are known to have several limitations when they are used in the peripheral vascular territory (related to size, mechanical deformation, integrity, etc.), however occasionally (especially with small femoral arteries) they can be useful to quickly resolve a serious VA complication. Note that we are indeed more familiar with coronary stent deployment technique, and that they can be delivered through a smaller size sheath (via the contralateral femoral artery). In addition, the availability of peripheral vascular stents in many cardiac laboratories is limited and a learning curve is needed. In the case presented the stent was delivered using a 6 F sheath.</p></li></ul></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A peripheral comment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. 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Mack" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1008232" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2010" "volumen" => "363" "paginaInicial" => "1597" "paginaFinal" => "1607" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20961243" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and prognosis of vascular complications after transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.P. Mwipatayi" 1 => "A. Picardo" 2 => "T.V. Masilonyane-Jones" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jvs.2013.03.046" "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2013" "volumen" => "58" "paginaInicial" => "1028" "paginaFinal" => "1036" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23993436" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.H. Seto" 1 => "M.S. Abu-Fadel" 2 => "J.M. 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Klenk" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2003" "volumen" => "38" "paginaInicial" => "78" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12844093" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous management of vascular complications in patients undergoing transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Stortecky" 1 => "P. Wenaweser" 2 => "N. Diehm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcin.2012.01.021" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Interv" "fecha" => "2012" "volumen" => "5" "paginaInicial" => "515" "paginaFinal" => "524" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22625190" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003600000010/v2_201711040052/S0870255117306844/v2_201711040052/en/main.assets" "Apartado" => array:4 [ "identificador" => "29267" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cartas ao Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003600000010/v2_201711040052/S0870255117306844/v2_201711040052/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117306844?idApp=UINPBA00004E" ]
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