Original article
Results of endovascular treatment of venous anastomotic stenosis in prosthetic arteriovenous for hemodialysis PTFE grafts. Comparative analysis between patent and occluded grafts
Resultados del tratamiento endovascular de la estenosis de la anastomosis venosa en las fístulas arteriovenosas protésicas para hemodiálisis de PTFE. Análisis comparativo entre fístulas permeables y trombosadas
Ferrán Plá Sáncheza,
, Guillermo Moñux Ducajúb, Oscar Uclés Cabezac, Rodrigo Rialb, Adriana Baturone Blancoc, Julio Reina Barrerac, Antonio Martín Conejeroc, Francisco Javier Serrano Hernandoc
Corresponding author
a Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
b Servicio de Angiología y Cirugía Vascular, Hospital Universitario HM Torrelodones, Madrid, Spain
c Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Madrid, Spain
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Comparative analysis between patent and occluded grafts" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "432" "paginaFinal" => "437" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ferrán Plá Sánchez, Guillermo Moñux Ducajú, Oscar Uclés Cabeza, Rodrigo Rial, Adriana Baturone Blanco, Julio Reina Barrera, Antonio Martín Conejero, Francisco Javier Serrano Hernando" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Ferrán" "apellidos" => "Plá Sánchez" "email" => array:1 [ 0 => "ferplasan@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Guillermo" "apellidos" => "Moñux Ducajú" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Oscar" "apellidos" => "Uclés Cabeza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Rodrigo" "apellidos" => "Rial" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Adriana" "apellidos" => "Baturone Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Julio" "apellidos" => "Reina Barrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Antonio" "apellidos" => "Martín Conejero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 7 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Serrano Hernando" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Angiología y Cirugía Vascular, Hospital Universitario HM Torrelodones, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados del tratamiento endovascular de la estenosis de la anastomosis venosa en las fístulas arteriovenosas protésicas para hemodiálisis de PTFE. Análisis comparativo entre fístulas permeables y trombosadas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1057 "Ancho" => 1508 "Tamanyo" => 63494 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0080" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Primary permeability.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vascular access (VA) plays an essential role in the management of kidney patients, both because of the morbidity and mortality that it entails and because of its impact on the patient's quality of life<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a>. That is why maintaining a functioning VA is a real challenge, both for patients and for the doctors.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the fact that, due to their lower morbidity and greater permeability, autologous accesses are the best VA and most recommended for all patients<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>, a high percentage of patients perform dialysis through prosthetic fistulas made of polytetrafluoroethylene<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> (PTFE). This access has a high rate of failure during the first 18 months after the placement<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>, mainly due to the development of intimal hyperplasia in the venous anastomosis<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">However, and despite the fact that the different scientific societies recommend follow-up for early detection of dysfunction<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–12</span></a>, it is controversial whether it should be performed a preventive repair because there are doubts about the benefits it provides in terms of patency or long-term durability of the fistula<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Thus, the purpose of this study is to analyze the results of endovascular treatment (EVT) of venous anastomosis stenosis (VAS) in prosthetic arteriovenous fistula (pAVF), comparing its usefulness when performing permeable pAVF versus thrombosed pAVF.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We retrospectively analyzed all the patients who underwent EVT in the Hospital Clínico San Carlos (HCSC) between January and December of 2019, to treat the stenosis in the venous anastomosis of the pAVF. Patients without follow up were excluded. The study was approved by the local ethics committee and informed consent was obtained from all patients included in the study.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients were separated into two groups according to the situation of the fistula at the time of treatment:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">none-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Group A: Thrombosed pAVF resulting from VAS (intraoperative detection).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">none-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Group B: Patients with VAS of pAVF.</p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">The detection of VAS was based on the occurrence of difficulties with dialysis performance and/or ultrasound findings. The following combinations of findings will be used as criteria of severity or high risk of thrombosis:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">none-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Vascular lumen reduction >50% + peak systolic velocity (PSV) ratio >2.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">none-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Added to a flow rate Q <span class="elsevierStyleInf">A</span> [mL/min] <600 or a flow reduction >25% as compared to the previous measurement.</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">All procedures were performed in an operating room with “C-arc” type X-ray equipment. In group B, an intraoperative fistulography confirmed the findings prior to treatment, while patients in group A were rescued by surgical thrombectomy and subsequent fistulography to assess patency.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Primary stenting was performed in all cases, using three types of devices: self-expanding stents, covered stents, or drug-eluting stents.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Technical success was defined as residual stenosis <30%, and clinical success was defined as immediate effective dialysis capable of reestablishing normal hydration, normal Blood Pressure, fluid and electrolyte balance and correction, at least partially, the metabolic and systemic abnormalities of uremic syndrome.</p><p id="par0075" class="elsevierStylePara elsevierViewall">After surgery, all patients were scheduled every six months for clinical follow-up and Doppler ultrasound. In the event of problems occurring during the hemodialysis session patients were referred to our center.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Primary permeability was defined as the period elapsed from the performance of the procedure until thrombosis of the VA or the need for therapeutic or preventive procedures for the rescue of the VA. Secondary patency was considered as the time elapsed since the therapeutic intervention to the definitive thrombosis of the pAVF.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The demographic characteristics and comorbidity of the patients were collected. The preoperative anatomical characteristics of the artery and vein and intraoperative data were also recorded.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">The primary objective of the study was to evaluate and compare primary and secondary patency in both groups. The secondary objective was to identify factors, both pre- and intraoperatively that could be associated with better patency. Variables are expressed in absolute numbers and percentages. The Kolmogorof-Smirnof test was used to evaluate the distribution of the quantitative variables. Continuous variables with normal distribution are expressed as mean and standard deviation, and variables without a normal distribution are presented as median and interquartile range. The Student <span class="elsevierStyleItalic">t</span>-test was used to evaluate the differences between the variables with normal distribution, and the Mann-Witney <span class="elsevierStyleItalic">U</span> test if they did show a normal distribution. Qualitative variables were compared using the Chi-Square test or Fisher's Exact test. Survival to an event was estimated using the Kaplan-Meier method and multivariate analysis was performed using Cox regression to detect other possible factors associated with increased survival.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">p</span> value <0.05 was considered statistically significant. The analysis was performed using the statistical package SPSS (version 20.0; IBM Corporation, Somers, NY, USA).</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">A total of 204 pAVFs were created between January 2009 and December 2019 in our center, of which 91 were repaired due to VAS. Of these, 8 were treated using open surgery, and 6 did not have a subsequent follow-up, so they were excluded from the study, with a total of 77 patients finally included.</p><p id="par0105" class="elsevierStylePara elsevierViewall">There were 55 cases that underwent treatment of thrombosis of the pAVF (71.4%, group A), as compared with 22 who had a patent pAVF at the time of surgery (28.6%, group B). The mean time elapsed from the placement of the VA until repair from completion was 9 (±8.63) months in group A, and 7.84 (±7.4) in group B, with no significant differences between groups (<span class="elsevierStyleItalic">p</span> = 0.602).</p><p id="par0110" class="elsevierStylePara elsevierViewall">The preoperative anatomical characteristics and the demographic data are collected in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. There were no significant differences in the cause of chronic renal failure or other comorbidities, as well as in the characteristics of the preoperative mapping or prosthesis used.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Technical success was 100% in group B and 94.5% in group A. In one case, repair was not considered after thrombectomy due to the characteristics of the lesion, and in the other two remaining cases a repair was not achieved because an adequate opening of the stent after its post-dilation was not accomplished due to long stenoses with marked deterioration of the prosthetic material.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Clinical success was 100% in group B, compared to 91% in group A, since five cases presented immediate occlusion after procedure or during the first hemodialysis session, without allowing clinically effective therapy.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Regarding the type of device used, there were no significant differences between both groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Twelve covered stents were implanted, 7 in group A (12.7% of the total) and 5 in group B (22.7%). The use of drug-eluting stent was 27.3% in group A and 22.7% in group B, and uncovered self-expanding stents were used in the rest of the cases. The median follow-up was 9 months (3–20).</p><p id="par0135" class="elsevierStylePara elsevierViewall">In group A primary patency at 1, 6, and 12 months was 81.8%, 22.4%, and 15.7%, respectively; in group B primary patency was 100%, 85.9%, 76.4% (<span class="elsevierStyleItalic">p</span> < 0.001) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Secondary patency at 1, 6, and 12 months in group A was 85.2%, 45.8%, and 31.3%, respectively, versus 100%, 95.2%, 95.2% in group B (<span class="elsevierStyleItalic">p</span> < 0.001) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">There was no significant difference in the rate of reintervention between both groups (32.7% in group A vs. 36.4% in group B [<span class="elsevierStyleItalic">p</span> = 0.761]).</p><p id="par0145" class="elsevierStylePara elsevierViewall">In the multivariable analysis, the uncovered stent was independently associated with lower patency as compared to endoprostheses (HR 2.669; 95% CI; 1.146–6.216, <span class="elsevierStyleItalic">p</span> = 0.010). No other association factors were observed.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">Thrombosis is the most common complication of VA and the main cause of definitive loss of the fistula. This determines a series of negative consequences in the patient on renal replacement therapy; it increases morbidity and mortality, the frequency of hospitalization and healthcare costs<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Achievement of patency of VA is not always possible but different authors have described greater patency in those rescued preventively prior to thrombosis<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a>, in the latest guidelines there is no clear consensus regarding the usefulness of a follow-up<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–12</span></a>. For example, the latest GEMAV<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>, KDOQI<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and ERA-EDTA<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> guidelines recommend, according to the usual concept of significant stenosis, monitoring pAVFs using first-generation and not second-generation methods, while the ESVS<span class="elsevierStyleSup">12</span> does recommend it.</p><p id="par0160" class="elsevierStylePara elsevierViewall">The Spanish group of Gruss et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> published results that were similar to those shown in the present manuscript. They reported that the VA repaired after its occlusion presents a higher risk of definitive loss of the vascular access as compared to those treated for stenosis that were permeable (HR 4; 1.3–13.6).</p><p id="par0165" class="elsevierStylePara elsevierViewall">Similarly, Sands et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> found in a series of 97 pAVFs a longer patency of those undergoing a preventive repair than those repaired after being thrombosed (1023 vs. 689 days, <span class="elsevierStyleItalic">p</span> = 0.01); similar results have been published by others<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17–21</span></a>.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Regarding method of detection, Malik et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> published a controlled prospective study in which they demonstrated greater patency of pAVFs subjected to ultrasound monitoring. They compared clinical surveillance versus Doppler ultrasound, and they showed that the Doppler ultrasound allowed a greater detection of dysfunctional accesses and an increase in patency at one year.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Dember et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> conducted a clinical trial that included 64 patients randomized to an intervention group and the observation group. Although there were no significant differences in the time elapsed until definitive loss of the access, it is important to mention that in the observation group there was a higher rate of thrombosis (72% vs. 44%). Likewise, 8% of the thromboses in the intervention group occurred prior to treatment, and of the total number of accesses lost at the end of follow-up, only 16% were secondary to thrombosis, compared to 34% in the observation group.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Similar findings are reported by Ram et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>, with a lower rate of definitive occlusion in the group treated prior to thrombosis, but without a more prolonged useful life of the pAVF. They do not specify the reason for abandonment and in their conclusions do not rule out the possible, albeit modest, benefit of preventive treatment.</p><p id="par0185" class="elsevierStylePara elsevierViewall">In addition, it must be taken into account that, unlike the present study, both mentioned trials use simple angioplasty as rescue treatment, so the results must be interpreted with caution, since the superiority of stenting in this area seems to have been demonstrated<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,25</span></a>.</p><p id="par0190" class="elsevierStylePara elsevierViewall">We have not found studies in the literature similar to the one presented here, so this is the first study to compare the results of the stent as a treatment method in this context.</p><p id="par0195" class="elsevierStylePara elsevierViewall">An interesting finding to be highlighted is the higher rate of thrombosis observed in uncovered devices. Based on the concept that intimal hyperplasia is the pathophysiological process responsible for juxtanastomotic stenosis, it has been proposed the covered stent should be useful in the treatment of this pathology<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26–28</span></a>. It is reasonable to assume that, excluding the endothelial tissue, the results are better than simple angioplasty or the uncovered stent, as our results seem to indicate.</p><p id="par0200" class="elsevierStylePara elsevierViewall">The retrospective nature of the study has prevented us from having the functional data of group A prior to its inclusion in the study, which is an important limitation when it comes to knowing which pAVFs were previously dysfunctional and what is the appropriate method for their early detection.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0205" class="elsevierStylePara elsevierViewall">The EVT applied on a patent pAVF results in greater permeability than the EVT performed after its occlusion.</p><p id="par0210" class="elsevierStylePara elsevierViewall">Despite the heterogeneity of the published studies and the lack of evidence regarding the usefulness of follow-up for early detection of VAE, our results suggest that it would be advisable to establish follow-up programs capable of detecting VAE prior to the thrombosis of pAVF.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Likewise, as compared to the use of uncoated devices, the use of covered stents could improve the results of the rescue of dysfunctional VA.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Financing</span><p id="par0220" class="elsevierStylePara elsevierViewall">This research has not received specific aid from public sector agencies, the commercial sector or non-profit entities.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1809096" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1580805" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1809095" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1580806" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Financing" ] 10 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-24" "fechaAceptado" => "2021-03-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1580805" "palabras" => array:6 [ 0 => "Stenosis" 1 => "Anastomotic" 2 => "Stent" 3 => "Thrombectomy" 4 => "Graft" 5 => "Arteriovenous" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1580806" "palabras" => array:6 [ 0 => "Estenosis" 1 => "Anastomosis" 2 => "Stent" 3 => "Trombectomía" 4 => "Prótesis" 5 => "Arteriovenosa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyze the results of endovascular treatment of venous anastomotic stenosis (VAS) in humero-axillary arteriovenous grafts (HAG), comparing outcomes between patent and thrombosed HAG.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was made of endovascular treated patients because of a VAS in a HAG between January 2009 and December 2019. Group A: Thrombosed HAG secondary to a VAS. Group B: Patent HAG with a VAS detected during follow-up. Technical success was defined as residual stenosis after treatment <30%, and clinical success as satisfactory immediate dialysis after surgery. After ET a biannual clinical and ultrasound follow-up was performed. Statistical analysis: Survival analysis was performed for time-to-event data to assess patency.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Group A: 55 patients. Group B: 22. There were no significative differences in demographic and anatomical factors between groups.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Technical and clinical success were 100% in group B and 94.5% and 91% respectively in group A.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Primary patency at 1, 6 and 12 months was: Group A: 81.8%, 22.4% y 15.7% respectively. Group B: 100%, 85.9%, 76,4% (<span class="elsevierStyleItalic">p <</span> 0.001). Secondary patency at 1, 6 and 12 months was: Group A: 85.2%, 45.8% y 31.3% respectively. Group B 100%, 95.3%, 95.2% (<span class="elsevierStyleItalic">p <</span> 0.001). Use of non-covered stents was associated with an increased risk of occlusion (HR 2.669 IC 95% 1.146–6.216, <span class="elsevierStyleItalic">p</span> = 0.010).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A higher patency of EV performed on a patent HAG is expected. It is therefore advisable to develop surveillance programs that are capable to detect VAS before its occlusion.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Analizar los resultados del tratamiento endovascular (TEV) de las estenosis en las anastomosis venosas (EAV) de las fístulas arteriovenosas protésicas (FAVp), comparando su utilidad al realizarse sobre FAVp permeables frente a trombosadas.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y Métodos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de pacientes intervenidos mediante TEV por EAV de fístulas humeroaxilares realizadas entre enero de 2009 y diciembre de 2019 en nuestro centro. Grupo A: FAVp trombosada secundaria a EAV; Grupo B: FAVp permeable con EAV detectada en seguimiento. Se definió éxito técnico como estenosis residual ≤30% y éxito clínico como diálisis efectiva inmediata. Tras el TEV se realizó un seguimiento clínico y con Eco-Doppler semestral. Estudio estadístico: se realizó un análisis de supervivencia mediante el método Kaplan Meier para el estudio de permeabilidades.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Grupo A: 55 pacientes. Grupo B: 22. No existieron diferencias significativas en las características demográficas ni anatómicas entre grupos.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">El éxito técnico y clínico fueron del 100% en el grupo B frente a un 94,5% y 91% respectivamente en el grupo A.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La permeabilidad primaria a 1, 6 y 12 meses, en el Grupo A fue: 81,8%, 22,4% y 15,7% respectivamente, frente al Grupo B: 100%, 85,9%, 76,4% (<span class="elsevierStyleItalic">p <</span> 0,001<span class="elsevierStyleItalic">).</span> Permeabilidad secundaria a 1, 6 y 12 meses; en el Grupo A fue 85,2%, 45,8% y 31,3% respectivamente, frente al Grupo B 100%, 95,3%, 95,2% (<span class="elsevierStyleItalic">p <</span> 0,001). El uso de stents no cubierto se asoció a un mayor riesgo de oclusión (HR 2,669 IC 95% 1,146-6,216, <span class="elsevierStyleItalic">p</span> = 0,010).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Es esperable una mayor permeabilidad del TEV realizado sobre una FAVp permeable, por lo que es recomendable elaborar programas de seguimiento que sean capaces de detectar la EAV previo a la trombosis de esta.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1057 "Ancho" => 1508 "Tamanyo" => 63494 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0080" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Primary permeability.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1083 "Ancho" => 1508 "Tamanyo" => 63124 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0085" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Secondary permeability.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0090" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A (55) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group B (22) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 (50−77.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 (62−77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.234 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.5% (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.923 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetic nephropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42% (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.5% (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.955 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral arterial disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.6% (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.7% (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Systemic anticoagulation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.1% (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.8% (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.938 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vein diameter (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.1 (±1.47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.9(±1.38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.792 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Artery diameter (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.9 (±0.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1(±1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.760 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prosthesis (6 mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.5% (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.2% (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.571 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prosthesis (7 mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.5% (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.8% (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.571 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Demographic and preoperative variables.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0095" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A (55) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group B (22) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stent diameter (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.35 (±0.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.68 (±0.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.074 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stent length (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 (40–55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 (40–60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.580 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">One single stent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.1% (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.5% (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Drug-eluting stent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.3% (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.7% (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.459 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Covered stent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.7% (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.7% (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.224 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intraoperative characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vascular access morbidity and mortality: trends of the last decade" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 8 | 14 |
| 2024 October | 48 | 35 | 83 |
| 2024 September | 50 | 26 | 76 |
| 2024 August | 56 | 57 | 113 |
| 2024 July | 62 | 33 | 95 |
| 2024 June | 62 | 46 | 108 |
| 2024 May | 71 | 44 | 115 |
| 2024 April | 64 | 48 | 112 |
| 2024 March | 47 | 32 | 79 |
| 2024 February | 36 | 35 | 71 |
| 2024 January | 34 | 24 | 58 |
| 2023 December | 22 | 28 | 50 |
| 2023 November | 30 | 40 | 70 |
| 2023 October | 30 | 68 | 98 |
| 2023 September | 23 | 70 | 93 |
| 2023 August | 24 | 31 | 55 |
| 2023 July | 36 | 17 | 53 |
| 2023 June | 34 | 30 | 64 |
| 2023 May | 37 | 41 | 78 |
| 2023 April | 31 | 38 | 69 |
| 2023 March | 56 | 31 | 87 |
| 2023 February | 53 | 39 | 92 |
| 2023 January | 42 | 56 | 98 |
| 2022 December | 81 | 59 | 140 |
| 2022 November | 74 | 54 | 128 |
| 2022 October | 25 | 48 | 73 |
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