Statistics

 array:21 [
  "pii" => "X2013251412001125"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Jan.11347"
  "estado" => "S300"
  "fechaPublicacion" => "2012-05-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2012;32:404-6"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 11927
    "formatos" => array:3 [
      "EPUB" => 314
      "HTML" => 11010
      "PDF" => 603
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512001128"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Jan.11347"
      "estado" => "S300"
      "fechaPublicacion" => "2012-05-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:404-6"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 16828
        "formatos" => array:3 [
          "EPUB" => 360
          "HTML" => 15405
          "PDF" => 1063
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Aneurisma verdadero gigante de la arteria radial tras ligadura de fístula arteriovenosa para hemodiálisis"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "404"
            "paginaFinal" => "406"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Giant true aneurysm of the radial artery following ligation of an arteriovenous fistula for haemodialysis"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Fig. 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier España"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "11347_108_25720_es_11347_f1.jpg"
                "Alto" => 210
                "Ancho" => 600
                "Tamanyo" => 95394
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Exploración física"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => " Servicio de Angiología y Cirugía Vascular del Hospital Universitario Miguel Servet,  en nombre del Grupo Servicio de Angiología y Cirugía Vascular, Cristina Feijoo-Cano en nombre del grupo del Servicio de Angiología y Cirugía Vascular del Hospital Universitario Miguel Servet"
            "autores" => array:4 [
              0 => array:1 [
                "apellidos" => "Servicio de Angiología y Cirugía Vascular del Hospital Universitario Miguel Servet"
              ]
              1 => array:1 [
                "apellidos" => "en nombre del Grupo Servicio de Angiología y Cirugía Vascular"
              ]
              2 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Feijoo-Cano en nombre del grupo del Servicio de Angiología y Cirugía Vascular del Hospital Universitario Miguel Servet"
              ]
              3 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Feijoo-Cano"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412001125"
          "doi" => "10.3265/Nefrologia.pre2012.Jan.11347"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001125?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001128?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000003/v0_201502091350/X0211699512001128/v0_201502091351/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412001117"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jan.11325"
    "estado" => "S300"
    "fechaPublicacion" => "2012-05-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:406-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 11756
      "formatos" => array:3 [
        "EPUB" => 332
        "HTML" => 10515
        "PDF" => 909
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Nephrogenic ascites: a thing of the past?"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "406"
          "paginaFinal" => "408"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ascitis nefrogénica: ¿una entidad del pasado?"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11325_16025_30590_en_t1_911325_copy1.jpg"
              "Alto" => 908
              "Ancho" => 675
              "Tamanyo" => 239784
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Characteristics of the ascites fluid"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Raquel Díaz-Mancebo, Rafael Sánchez-Villanueva, Elena González-García, Marta Ossorio-González, Rafael Selgas-Gutiérrez"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Díaz-Mancebo"
            ]
            1 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Sánchez-Villanueva"
            ]
            2 => array:2 [
              "nombre" => "Elena"
              "apellidos" => "González-García"
            ]
            3 => array:2 [
              "nombre" => "Marta"
              "apellidos" => "Ossorio-González"
            ]
            4 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Selgas-Gutiérrez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169951200111X"
        "doi" => "10.3265/Nefrologia.pre2012.Jan.11325"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X021169951200111X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001117?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001117/v0_201502091614/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251412001133"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.Dec.11308"
    "estado" => "S300"
    "fechaPublicacion" => "2012-05-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:403-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6390
      "formatos" => array:3 [
        "EPUB" => 333
        "HTML" => 5369
        "PDF" => 688
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Topiramate-induced metabolic acidosis: a case study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "403"
          "paginaFinal" => "404"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Acidosis metabólica inducida por topiramato: a propósito de un caso."
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lucía Fernández-de Orueta, Javier Esteban-Fernández, Harald F.J. Aichner, Ángel Casillas-Villamor, Sergio Rodríguez-Álvarez"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Lucía"
              "apellidos" => "Fernández-de Orueta"
            ]
            1 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Esteban-Fernández"
            ]
            2 => array:2 [
              "nombre" => "Harald F.J."
              "apellidos" => "Aichner"
            ]
            3 => array:2 [
              "nombre" => "Ángel"
              "apellidos" => "Casillas-Villamor"
            ]
            4 => array:2 [
              "nombre" => "Sergio"
              "apellidos" => "Rodríguez-Álvarez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512001136"
        "doi" => "10.3265/Nefrologia.pre2011.Dec.11308"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001136?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001133?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001133/v0_201502091614/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "Giant true aneurysm of the radial artery following ligation of an arteriovenous fistula for haemodialysis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "404"
        "paginaFinal" => "406"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => " Servicio de Angiología y Cirugía Vascular del Hospital Universitario Miguel Servet,  en nombre del Grupo Servicio de Angiología y Cirugía Vascular, Cristina Feijoo-Cano en nombre del grupo del Servicio de Angiología y Cirugía Vascular del Hospital Universitario Miguel Servet"
        "autores" => array:4 [
          0 => array:1 [
            "apellidos" => "Servicio de Angiología y Cirugía Vascular del Hospital Universitario Miguel Servet"
          ]
          1 => array:1 [
            "apellidos" => "en nombre del Grupo Servicio de Angiología y Cirugía Vascular"
          ]
          2 => array:4 [
            "nombre" => "Cristina"
            "apellidos" => "Feijoo-Cano en nombre del grupo del Servicio de Angiología y Cirugía Vascular del Hospital Universitario Miguel Servet"
            "email" => array:1 [
              0 => "cristifeijoo@hotmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "Cristina"
            "apellidos" => "Feijoo-Cano"
            "email" => array:1 [
              0 => "cristifeijoo&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "  Zaragoza,  Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          1 => array:3 [
            "entidad" => " Hospital Universitario Miguel Servet, Zaragoza,   "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Aneurisma verdadero gigante de la arteria radial tras ligadura de f&#237;stula arteriovenosa para hemodi&#225;lisis"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11347_16025_30607_en_f1_811347.jpg"
            "Alto" => 472
            "Ancho" => 1386
            "Tamanyo" => 291973
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Physical examination"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Aneurysms and pseudoaneurysms develop in approximately 8&#37; of arteriovenous fistulas &#40;AVF&#41; created for haemodialysis&#46;<span class="elsevierStyleSup">1</span> They are potential sources of embolisation and thrombosis&#44; and can occasionally erode the skin&#44; giving rise to infection and local bleeding&#44; and can even deform the affected limb&#46; True aneurysms in AVF are dilations in which the structure of the vein or artery wall remains intact&#46; They frequently consist of venous aneurysms in long-term autologous fistulas associated with venous stenosis&#46; True arterial aneurysms are less common and frequently occur in the axillary or humeral arteries following ligation of an AVF in the elbow&#46;<span class="elsevierStyleSup">1</span> The increase in arterial flow and wall vibration are believed to be involved in the pathogenesis of this condition&#46; On the other hand&#44; pseudoaneurysms or fake aneurysms are expandable dilations caused by persistent subcutaneous bleeding through a continuous deterioration of the fistula or prosthesis wall&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CLINICAL CASE</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A 65 year-old male was referred from the nephrology department to the vascular surgery unit due to a large pulsatile mass in the left forearm that has been present for several years&#44; undergoing an accelerated and progressive growth in recent months&#46; The patient had a background of arterial hypertension&#44; dyslipidaemia&#44; and a left radiocephalic fistula created 20 years earlier for haemodialysis due to terminal chronic renal failure&#46; Six years after having received a transplant&#44; this fistula was ligated&#46;</p><p class="elsevierStylePara">The physical examination revealed an enormous pulsatile mass in the anterior side of the left forearm&#44; with no signs of thrill or murmur &#40;Figure 1&#41;&#46; The hands were well perfused&#44; with both radial and ulnar pulses present&#46;</p><p class="elsevierStylePara">We first performed a Doppler ultrasound analysis&#44; which revealed intense blood flow within the mass&#44; although we were unable to determine whether this was an aneurysm or pseudoaneurysm&#46; We proceeded with an axial computed angiotomography angiography<span class="elsevierStyleBold"> </span>&#40;CTA&#41;&#44; and we were able to observe an enlarged and elongated humeral artery&#44; an aneurysm or pseudoaneurysm of 62 millimetres in diameter in the radial area&#44; permeable ulnar and interosseous arteries&#44; and an obstructed distal radial artery&#46;</p><p class="elsevierStylePara">The suspected diagnosis of aneurysm or pseudoaneurysm of the radial artery secondary to a ligated radiocephalic AVF in the transplant recipient led to the indication of surgical treatment&#46;</p><p class="elsevierStylePara">We performed incisions in the elbow joint and distally along the radius&#44; and then isolated the humeral&#44; radial&#44; and ulnar arteries&#44; observing a giant true aneurysm along the entire radial artery&#46; We completely resected the aneurysm and performed a proximal and distal ligation of the radial artery&#44; since it was chronically thrombosed &#40;Figure 2&#41; and the vascularisation of the hand was ensured by the continuity of the ulnar and interosseous arteries&#46;</p><p class="elsevierStylePara">The postoperative period went without incident&#46; Upon discharge&#44; the patient&#8217;s humeral and ulnar pulses were constant&#44; with good perfusion in the hand&#46; A histological analysis confirmed that this was indeed a true aneurysm of the radial artery&#46; One year following treatment&#44; the patient is asymptomatic and without complications&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">True arterial aneurysms in the peripheral arteries are rare&#44; and only 5&#37; of them are located in the arms&#46; They are most commonly associated with local traumas and systemic diseases &#40;atherosclerosis&#44; giant cell arteritis&#44; and fibromuscular dysplasia&#41;&#46;<span class="elsevierStyleSup">2</span> The scarcity of this pathology makes it difficult to evaluate its epidemiological and clinical characteristics&#46; In AVF created for haemodialysis&#44; sporadic cases of true arterial aneurysms have been described&#44; primarily in the axillary or humeral arteries and following ligation of an AVF in the elbow after kidney transplantation&#46;<span class="elsevierStyleSup">3</span> In transplant recipients with well-functioning grafts after a reasonable period of time&#44; ligation of an AVF for haemodialysis is a controversial procedure&#46; However&#44; it is usually performed in order to avoid complications such as oedema&#44; vascular access steal syndrome&#44; high cardiac output&#44; thrombosis&#44; venous aneurysms&#44; pseudoaneurysms&#44; bleeding&#44; and aesthetic defects&#46;<span class="elsevierStyleSup">1&#44;4</span></p><p class="elsevierStylePara">The diagnosis of aneurysms and pseudoaneurysms tends to be clinical&#44; in the presence of a pulsating mass with progressive growth in the area of the vascular access&#46; Pulses distal to the lesion may or may not be present&#46;<span class="elsevierStyleSup">5</span> A Doppler ultrasound may reveal flow in the aneurysmal sac&#44; thrombosis&#44; or haematoma&#46; In unclear cases&#44; a CTA scan or magnetic resonance can be useful&#46; Fistulography may be indicated if the aforementioned techniques do not provide sufficient information&#44;<span class="elsevierStyleSup">1</span> and can be especially useful for planning surgical treatment&#46;</p><p class="elsevierStylePara">True arterial aneurysms must be quickly treated due to the risk of local and systemic complications&#44; including embolisation&#44; thrombosis&#44; skin erosion and infection&#44; bleeding&#44; and compression of adjacent nervous structures&#44; producing paraesthesia&#44; pain&#44; and reduced mobility&#46;<span class="elsevierStyleSup">6</span> The treatment of choice is a resection of the aneurysm and arterial reconstruction<span class="elsevierStyleSup">4</span> in order to guarantee adequate perfusion of the limb after the aneurysm has been excluded from circulation&#46; Another option is endovascular treatment&#46;<span class="elsevierStyleSup">7</span> In our case&#44; we opted for resection and ligation of the radial artery&#44; since it was chronically obstructed and the perfusion of the hand was guaranteed by the ulnar and interosseous arteries&#46;</p><p class="elsevierStylePara">Venous aneurysms do not require treatment unless they are associated with severe stenosis&#44; necrosis&#44; or skin disorders and there is a risk of rupture of the aneurysm&#46; Severe stenosis can be treated with angioplasty&#46; If necrosis or the risk of aneurysmal rupture appears&#44; a surgical review is necessary&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Pseudoaneurysms are ruptures contained by the soft tissue that occur primarily in puncture sites&#46; Pseudoaneurysms of PTFE &#40;polytetrafluoroethylene&#41; prostheses can also be treated using percutaneous or surgical approaches&#46;<span class="elsevierStyleSup">1</span> In the absence of infection&#44; a local repair can ensue by suturing the graft defect or by graft interposition&#46;<span class="elsevierStyleSup">1&#44;8</span> To conclude&#44; we would like to point out that aneurysmal dilations are complications that can jeopardise both the viability of the vascular access and the life of the patient&#46; As such&#44; it is essential to make a correct differential diagnosis between aneurysms &#40;arterial and venous&#41; and pseudoaneurysms for proper treatment planning&#44; since the appropriate treatment varies with each case&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11347&#95;16025&#95;30607&#95;en&#95;f1&#95;811347&#46;jpg" class="elsevierStyleCrossRefs"><img src="11347_16025_30607_en_f1_811347.jpg" alt="Physical examination"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Physical examination</p><p class="elsevierStylePara"><a href="grande&#47;11347&#95;16025&#95;30608&#95;en&#95;f2&#95;811347&#46;jpg" class="elsevierStyleCrossRefs"><img src="11347_16025_30608_en_f2_811347.jpg" alt="Surgical treatment"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Surgical treatment</p>"
    "pdfFichero" => "P1-E536-S3514-A11347-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11347_16025_30607_en_f1_811347.jpg"
            "Alto" => 472
            "Ancho" => 1386
            "Tamanyo" => 291973
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Physical examination"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11347_16025_30608_en_f2_811347.jpg"
            "Alto" => 449
            "Ancho" => 660
            "Tamanyo" => 216553
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Surgical treatment"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bohórquez Sierra JC, Doiz Artázcoz E, Arribas Aguilar F, Bohórquez Sierra C. Accesos vasculares para hemodiálisis. Complicaciones: aneurismas verdaderos y falsos, hemorragias y roturas del acceso vascular. Angiología 2005;57(Supl 2):S117-27."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "2.\u{A0}Rodríguez Hernández JA,\u{A0}González Parra E,\u{A0}Gutiérrez Julián JM,\u{A0}Segarra Medrano A,\u{A0}Almirante B, Martínez MT,\u{A0}et al. Guías de acceso vascular en hemodiálisis. Nefrologia 2005;25 Suppl 1:3-95."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "3.\u{A0}López Baena JA,\u{A0}Daniel Vega MD, Jorge Polo MD, García Pajares R,\u{A0}Echenagusía A,\u{A0}Polo JR. Aneurisma verdadero de la arteria braquial relacionado con acceso vascular en el pliegue del codo. Patología Vascular 2000;7:489-92."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lamb W,\u{A0}Betal D,\u{A0}Morsy M,\u{A0}Chelma ES. Enormous brachio-cephalic arteriovenous fistula aneurysm after renal trasnplatation: case report and review of the literature. Nephrol Dial Transplant 2009;24:3542-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19592597" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0163834311001162"
                          "estado" => "S300"
                          "issn" => "01638343"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "5.\u{A0}Rosales Jiménez JM,\u{A0}Guzmán Rico SM,\u{A0}Fernández Ramírez Lizárraga P. Aneurisma cubital proximal de origen ateroescleroso: reporte del caso y revisión de la literatura. Revista Mexicana de Angiología 2009;37(2):62-5."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "6.\u{A0}Del Río Prego A,\u{A0}Aparicio Martínez C,\u{A0}González García A. Accesos vasculares para hemodiálisis. En: Vaquero-Morillo, F. Tratado de las enfermedades vasculares. Vol. II. Barcelona: Viguera;\u{A0}2006.\u{A0}p. 1255-67."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Maynar M, Sánchez Álvarez E, Quian Z, López Benítez R, Long D, Zerolo I. Percutaneous endovascular treatment of brachial artery aneurysm. EJVES 2003;6:15-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mora BN, Whitman ED. Accesos vasculares. En: Doherty GM. Washington Manual de Cirugía. 2ª ed. Madrid: Marbán Libros; 2001. p. 359-69."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001125/v0_201502091614/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35437"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor - Brief Case Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000003/v0_201502091613/X2013251412001125/v0_201502091614/en/P1-E536-S3514-A11347-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001125?idApp=UINPBA000064"
]