array:24 [
  "pii" => "S0211699520301764"
  "issn" => "02116995"
  "doi" => "10.1016/j.nefro.2020.08.013"
  "estado" => "S300"
  "fechaPublicacion" => "2021-09-01"
  "aid" => "796"
  "copyright" => "Sociedad Española de Nefrología"
  "copyrightAnyo" => "2020"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "cor"
  "cita" => "Nefrologia. 2021;41:593-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0211699520301855"
    "issn" => "02116995"
    "doi" => "10.1016/j.nefro.2020.09.006"
    "estado" => "S300"
    "fechaPublicacion" => "2021-09-01"
    "aid" => "804"
    "copyright" => "Sociedad Española de Nefrología"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Nefrologia. 2021;41:595-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "C3 glomerulonephritis accompanied with lupus nephritis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "595"
          "paginaFinal" => "597"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Lomerulonefritis C3 acompa&#241;ada de nefritis l&#250;pica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 678
              "Ancho" => 900
              "Tamanyo" => 139066
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Renal biopsy which shows diffuse global basal membrane thickening&#44; lymphocyte dominant tubulointerstitial inflammation&#44; increased fibrosis&#44; and tubular atrophy by light microscopy&#44; H&#46;E&#46; 400&#215;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Kubra Kaynar, Beyhan G&#252;vercin, Sahile Safarl&#305;, Sevdeg&#252;l Mungan, Mustafa &#350;ahin"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Kubra"
              "apellidos" => "Kaynar"
            ]
            1 => array:2 [
              "nombre" => "Beyhan"
              "apellidos" => "G&#252;vercin"
            ]
            2 => array:2 [
              "nombre" => "Sahile"
              "apellidos" => "Safarl&#305;"
            ]
            3 => array:2 [
              "nombre" => "Sevdeg&#252;l"
              "apellidos" => "Mungan"
            ]
            4 => array:2 [
              "nombre" => "Mustafa"
              "apellidos" => "&#350;ahin"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2013251421001115"
        "doi" => "10.1016/j.nefroe.2021.11.006"
        "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/S2013251421001115?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699520301855?idApp=UINPBA000064"
    "url" => "/02116995/0000004100000005/v1_202109170826/S0211699520301855/v1_202109170826/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S021169952030134X"
    "issn" => "02116995"
    "doi" => "10.1016/j.nefro.2020.07.006"
    "estado" => "S300"
    "fechaPublicacion" => "2021-09-01"
    "aid" => "768"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Nefrologia. 2021;41:590-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>"
      "titulo" => "Ictus isqu&#233;mico asociado a COVID-19 en pacientes en di&#225;lisis"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "590"
          "paginaFinal" => "593"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Ischaemic stroke associated with COVID-19 in dialysis patients"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1505
              "Ancho" => 2175
              "Tamanyo" => 222776
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Im&#225;genes de Neurorradiolog&#237;a&#46; A&#41; RM del paciente 2&#46; Lesi&#243;n hiperintensa en secuencias T2 localizada en n&#250;cleos laterales del t&#225;lamo&#47;brazo posterior de la c&#225;psula interna derecha&#44; compatible infarto lacunar&#46; B&#41; RM del paciente 2&#46; Imagen de restricci&#243;n en secuencias de difusi&#243;n que confirma ictus de imagen previa de evoluci&#243;n aguda&#47;subaguda&#46; C&#41; TAC del paciente 2&#46; Hipodensidad c&#243;rtico-subcortical en la regi&#243;n temporal izquierda compatible con lesi&#243;n isqu&#233;mica&#46; D&#41; RM del paciente 3&#46; Lesi&#243;n hiperintensa en secuencias T2 localizada en el v&#233;rmix cerebeloso compatible con infarto&#46; E&#41; RM del paciente 3&#46; Imagen en secuencia de difusi&#243;n que identifica un foco de alteraci&#243;n de la se&#241;al a nivel del v&#233;rmix cerebeloso&#44; la cual restringe en mapa ADC&#44; compatible con infarto agudo&#47;subagudo en la localizaci&#243;n descrita en T2 en la imagen previa&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alberto de Lorenzo, Laura Espinel, &#193;ngela Revilla, Teresa Corbal&#225;n, Judith Martins, Mar&#237;a Teresa Naya, Alfonso Cubas"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "de Lorenzo"
            ]
            1 => array:2 [
              "nombre" => "Laura"
              "apellidos" => "Espinel"
            ]
            2 => array:2 [
              "nombre" => "&#193;ngela"
              "apellidos" => "Revilla"
            ]
            3 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Corbal&#225;n"
            ]
            4 => array:2 [
              "nombre" => "Judith"
              "apellidos" => "Martins"
            ]
            5 => array:2 [
              "nombre" => "Mar&#237;a Teresa"
              "apellidos" => "Naya"
            ]
            6 => array:2 [
              "nombre" => "Alfonso"
              "apellidos" => "Cubas"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2013251421001012"
        "doi" => "10.1016/j.nefroe.2021.11.002"
        "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/S2013251421001012?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021169952030134X?idApp=UINPBA000064"
    "url" => "/02116995/0000004100000005/v1_202109170826/S021169952030134X/v1_202109170826/es/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Digital embolization from a thrombosed aneurysmal hemodialysis arteriovenous fistula"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "593"
        "paginaFinal" => "594"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Godoy Alejandro, Ferrero Guadagnoli Adolfo, Tabares Aldo Hugo"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Godoy"
            "apellidos" => "Alejandro"
            "email" => array:1 [
              0 => "ale_nano@hotmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ferrero Guadagnoli"
            "apellidos" => "Adolfo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Tabares Aldo"
            "apellidos" => "Hugo"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Vascular Medicine Service&#44; Argentina"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Angioradiology Service&#44; Argentina"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Instituto Universitario de Ciencias Biom&#233;dicas de C&#243;rdoba&#44; Argentina"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Embolismo digital desde aneurisma en f&#237;stula arteriovenosa para hemodi&#225;lisis trombosada"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 525
            "Ancho" => 1255
            "Tamanyo" => 136725
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Day of the hospital admission&#46; &#40;b&#41; Hospital discharge&#46; &#40;c&#41;&#58; Outpatient follow-up&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We describe a 46-year-old man who presented to the emergency room complaining of pain and paresthesia of the left upper limb of 7 days of evolution&#46; The day before the admission&#44; the patient had also developed palmar and digital cyanosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The patient had a kidney transplantation six years prior&#46; Before the transplantation&#44; the patient had undergone hemodialysis through a proximal AVF of the left upper limb&#46; The dialysis sessions were discontinued shortly after the transplant was carried out&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">On physical examination cardiac sounds were normal&#44; the radial and ulnar pulses were present and symmetrical&#46; The AVF appeared occluded without bruits or thrills&#46; An electrocardiogram was normal and a transthoracic echocardiogram did not reveal sources of embolism&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Doppler ultrasound of the left upper limb showed a partially thrombosed brachial artery aneurysm with a length of 25<span class="elsevierStyleHsp" style=""></span>mm&#46; An arteriogram showed a fusiform aneurysm in the brachial artery at the level of the elbow joint&#46; The radial and ulnar arteries&#44; as well as the deep palmar arch&#44; were patent&#46; The digital arteries of the thumb&#44; index and middle fingers were patent&#44; and occlusion&#44; probably embolic&#44; of the digital arteries corresponding to the 4th and 5th fingers was seen&#46; Ligation and resection of the aneurysm was performed&#44; and a brachial to radial bypass was carried out &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">After the surgery&#44; the patient presented marked deterioration in the perfusion of the hand with an increase in pain and cyanosis of the palm and digits &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>b&#41;&#46; An arterial Doppler ultrasound showed bypass patency&#46; Anticoagulation with enoxaparin&#44; aspirin&#44; and statins was initiated with marked improvement with minimal tissue loss over the following 3 weeks &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>c&#41;&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Upper limb ischemia due to embolization caused by thrombosed aneurysmal hemodialysis AVF has been reported scarcely in the medical literature mostly due to underreporting&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The pathophysiological mechanisms leading to aneurysm formation in patients with AVF are controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We suspect that the patient had atherothrombotic embolization to the and palmar aspect and fingers&#46; The spatial resolution of the angiogram does not allow visualization of skin small vessels thrombotic or embolic disease&#46; The fact that the patient had almost a full recovery with minimal skin damage suggests that this was probably the case&#46; We can only speculate why deterioration occurred following surgery&#46; Embolism from thrombus inside the aneurysm is a possibility&#46; Other sources of embolism were excluded and clinical course suggests that no other sources of embolism were present&#46; We cannot rule out aggravation of hand ischemia during brachial artery cross-clamping&#46; Unfortunately follow up angiogram was not performed since bypass patency was documented by Doppler ultrasound&#44; the patient had improved clinically&#44; and therefore it was decided no to expose the patient to a potentially nephrotoxic iodinated contrast&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">When distal upper extremity ischemia resulting from emboli occurs&#44; urgent intervention by thrombolysis or surgical embolectomy has been suggested to avoid a significant risk of limb loss or finger amputation&#46; However&#44; in our case a rather conservative approach with aneurysm ligation followed by anticoagulation with low-molecular weight heparin was successful in preserving hand function with minimal tissue loss&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Since 25&#8211;40&#37; of patients undergoing renal transplantation will return to hemodialysis&#44; vascular access is tipically left in place&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Most AVF thrombose over time with minimal consequences&#44; and therefore AVF ligation in asymptomatic patients with preserved renal function is controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">We conclude that distal embolism from a thrombosed AVF or aneurysm should be considered in the differential diagnosis of acute upper limb ischemia in patients with an AVF&#46; Treatment should be tailored to the degree of digital ischemia&#44; risk of bleeding and other comorbidities&#44; and should include anticoagulation&#44; catheter-directed thrombolysis and surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research&#44; authorship&#44; and&#47;or publication of this article&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declared no potential conflicts of interest with respect to the research&#44; authorship&#44; and&#47;or publication of this article&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Discussion"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Funding"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflict of interests"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 525
            "Ancho" => 1255
            "Tamanyo" => 136725
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Day of the hospital admission&#46; &#40;b&#41; Hospital discharge&#46; &#40;c&#41;&#58; Outpatient follow-up&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 639
            "Ancho" => 755
            "Tamanyo" => 14566
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fusiform aneurysm&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Digital infarction in a hemodialysis patient due to embolism from a thrombosed brachial arteriovenous fistula"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Yj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/hdi.12256"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hemodial Int"
                        "fecha" => "2015"
                        "volumen" => "19"
                        "paginaInicial" => "E6"
                        "paginaFinal" => "E9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25545123"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aneurysms and pseudoaneurysms in dialysis access"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Mudoni"
                            1 => "M&#46; Cornacchiari"
                            2 => "M&#46; Gallieni"
                            3 => "C&#46; Guastoni"
                            4 => "D&#46; McGrogan"
                            5 => "F&#46; Logias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ckj/sfv042"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Kidney J"
                        "fecha" => "2015"
                        "volumen" => "8"
                        "paginaInicial" => "363"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26251700"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Distal digital embolization from a thrombosed aneurysmal hemodialysis arteriovenous fistula&#58; the benefit of a hybrid approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;F&#46; Simosa"
                            1 => "S&#46;V&#46; Mudumbi"
                            2 => "F&#46;B&#46; Pomposelli"
                            3 => "M&#46;L&#46; Schermerhorn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1525-139X.2008.00517.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Dial"
                        "fecha" => "2009"
                        "volumen" => "22"
                        "paginaInicial" => "93"
                        "paginaFinal" => "96"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19175538"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Access ligation in transplant patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Wilmink"
                            1 => "L&#46; Hollingworth"
                            2 => "I&#46; Dasgupta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5301/jva.5000537"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Vasc Access"
                        "fecha" => "2016"
                        "volumen" => "17"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "S64"
                        "paginaFinal" => "S68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26951908"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/02116995/0000004100000005/v1_202109170826/S0211699520301764/v1_202109170826/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "48186"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Cartas al Director"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/02116995/0000004100000005/v1_202109170826/S0211699520301764/v1_202109170826/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699520301764?idApp=UINPBA000064"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Letter to the Editor
Digital embolization from a thrombosed aneurysmal hemodialysis arteriovenous fistula
Embolismo digital desde aneurisma en fístula arteriovenosa para hemodiálisis trombosada
Godoy Alejandroa,
Autor para correspondencia
ale_nano@hotmail.com

Corresponding author.
, Ferrero Guadagnoli Adolfob, Tabares Aldo Hugoa,c
a Vascular Medicine Service, Argentina
b Angioradiology Service, Argentina
c Instituto Universitario de Ciencias Biomédicas de Córdoba, Argentina
Leído
3528
Veces
se ha leído el artículo
1716
Total PDF
1812
Total HTML
Compartir estadísticas
 array:24 [
  "pii" => "S0211699520301764"
  "issn" => "02116995"
  "doi" => "10.1016/j.nefro.2020.08.013"
  "estado" => "S300"
  "fechaPublicacion" => "2021-09-01"
  "aid" => "796"
  "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
  "copyrightAnyo" => "2020"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "cor"
  "cita" => "Nefrologia. 2021;41:593-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0211699520301855"
    "issn" => "02116995"
    "doi" => "10.1016/j.nefro.2020.09.006"
    "estado" => "S300"
    "fechaPublicacion" => "2021-09-01"
    "aid" => "804"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Nefrologia. 2021;41:595-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "C3 glomerulonephritis accompanied with lupus nephritis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "595"
          "paginaFinal" => "597"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Lomerulonefritis C3 acompa&#241;ada de nefritis l&#250;pica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 678
              "Ancho" => 900
              "Tamanyo" => 139066
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Renal biopsy which shows diffuse global basal membrane thickening&#44; lymphocyte dominant tubulointerstitial inflammation&#44; increased fibrosis&#44; and tubular atrophy by light microscopy&#44; H&#46;E&#46; 400&#215;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Kubra Kaynar, Beyhan G&#252;vercin, Sahile Safarl&#305;, Sevdeg&#252;l Mungan, Mustafa &#350;ahin"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Kubra"
              "apellidos" => "Kaynar"
            ]
            1 => array:2 [
              "nombre" => "Beyhan"
              "apellidos" => "G&#252;vercin"
            ]
            2 => array:2 [
              "nombre" => "Sahile"
              "apellidos" => "Safarl&#305;"
            ]
            3 => array:2 [
              "nombre" => "Sevdeg&#252;l"
              "apellidos" => "Mungan"
            ]
            4 => array:2 [
              "nombre" => "Mustafa"
              "apellidos" => "&#350;ahin"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2013251421001115"
        "doi" => "10.1016/j.nefroe.2021.11.006"
        "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/S2013251421001115?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699520301855?idApp=UINPBA000064"
    "url" => "/02116995/0000004100000005/v1_202109170826/S0211699520301855/v1_202109170826/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S021169952030134X"
    "issn" => "02116995"
    "doi" => "10.1016/j.nefro.2020.07.006"
    "estado" => "S300"
    "fechaPublicacion" => "2021-09-01"
    "aid" => "768"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Nefrologia. 2021;41:590-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>"
      "titulo" => "Ictus isqu&#233;mico asociado a COVID-19 en pacientes en di&#225;lisis"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "590"
          "paginaFinal" => "593"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Ischaemic stroke associated with COVID-19 in dialysis patients"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1505
              "Ancho" => 2175
              "Tamanyo" => 222776
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Im&#225;genes de Neurorradiolog&#237;a&#46; A&#41; RM del paciente 2&#46; Lesi&#243;n hiperintensa en secuencias T2 localizada en n&#250;cleos laterales del t&#225;lamo&#47;brazo posterior de la c&#225;psula interna derecha&#44; compatible infarto lacunar&#46; B&#41; RM del paciente 2&#46; Imagen de restricci&#243;n en secuencias de difusi&#243;n que confirma ictus de imagen previa de evoluci&#243;n aguda&#47;subaguda&#46; C&#41; TAC del paciente 2&#46; Hipodensidad c&#243;rtico-subcortical en la regi&#243;n temporal izquierda compatible con lesi&#243;n isqu&#233;mica&#46; D&#41; RM del paciente 3&#46; Lesi&#243;n hiperintensa en secuencias T2 localizada en el v&#233;rmix cerebeloso compatible con infarto&#46; E&#41; RM del paciente 3&#46; Imagen en secuencia de difusi&#243;n que identifica un foco de alteraci&#243;n de la se&#241;al a nivel del v&#233;rmix cerebeloso&#44; la cual restringe en mapa ADC&#44; compatible con infarto agudo&#47;subagudo en la localizaci&#243;n descrita en T2 en la imagen previa&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alberto de Lorenzo, Laura Espinel, &#193;ngela Revilla, Teresa Corbal&#225;n, Judith Martins, Mar&#237;a Teresa Naya, Alfonso Cubas"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "de Lorenzo"
            ]
            1 => array:2 [
              "nombre" => "Laura"
              "apellidos" => "Espinel"
            ]
            2 => array:2 [
              "nombre" => "&#193;ngela"
              "apellidos" => "Revilla"
            ]
            3 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Corbal&#225;n"
            ]
            4 => array:2 [
              "nombre" => "Judith"
              "apellidos" => "Martins"
            ]
            5 => array:2 [
              "nombre" => "Mar&#237;a Teresa"
              "apellidos" => "Naya"
            ]
            6 => array:2 [
              "nombre" => "Alfonso"
              "apellidos" => "Cubas"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2013251421001012"
        "doi" => "10.1016/j.nefroe.2021.11.002"
        "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/S2013251421001012?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021169952030134X?idApp=UINPBA000064"
    "url" => "/02116995/0000004100000005/v1_202109170826/S021169952030134X/v1_202109170826/es/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Digital embolization from a thrombosed aneurysmal hemodialysis arteriovenous fistula"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "593"
        "paginaFinal" => "594"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Godoy Alejandro, Ferrero Guadagnoli Adolfo, Tabares Aldo Hugo"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Godoy"
            "apellidos" => "Alejandro"
            "email" => array:1 [
              0 => "ale_nano@hotmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ferrero Guadagnoli"
            "apellidos" => "Adolfo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Tabares Aldo"
            "apellidos" => "Hugo"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Vascular Medicine Service&#44; Argentina"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Angioradiology Service&#44; Argentina"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Instituto Universitario de Ciencias Biom&#233;dicas de C&#243;rdoba&#44; Argentina"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Embolismo digital desde aneurisma en f&#237;stula arteriovenosa para hemodi&#225;lisis trombosada"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 525
            "Ancho" => 1255
            "Tamanyo" => 136725
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Day of the hospital admission&#46; &#40;b&#41; Hospital discharge&#46; &#40;c&#41;&#58; Outpatient follow-up&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We describe a 46-year-old man who presented to the emergency room complaining of pain and paresthesia of the left upper limb of 7 days of evolution&#46; The day before the admission&#44; the patient had also developed palmar and digital cyanosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The patient had a kidney transplantation six years prior&#46; Before the transplantation&#44; the patient had undergone hemodialysis through a proximal AVF of the left upper limb&#46; The dialysis sessions were discontinued shortly after the transplant was carried out&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">On physical examination cardiac sounds were normal&#44; the radial and ulnar pulses were present and symmetrical&#46; The AVF appeared occluded without bruits or thrills&#46; An electrocardiogram was normal and a transthoracic echocardiogram did not reveal sources of embolism&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Doppler ultrasound of the left upper limb showed a partially thrombosed brachial artery aneurysm with a length of 25<span class="elsevierStyleHsp" style=""></span>mm&#46; An arteriogram showed a fusiform aneurysm in the brachial artery at the level of the elbow joint&#46; The radial and ulnar arteries&#44; as well as the deep palmar arch&#44; were patent&#46; The digital arteries of the thumb&#44; index and middle fingers were patent&#44; and occlusion&#44; probably embolic&#44; of the digital arteries corresponding to the 4th and 5th fingers was seen&#46; Ligation and resection of the aneurysm was performed&#44; and a brachial to radial bypass was carried out &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">After the surgery&#44; the patient presented marked deterioration in the perfusion of the hand with an increase in pain and cyanosis of the palm and digits &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>b&#41;&#46; An arterial Doppler ultrasound showed bypass patency&#46; Anticoagulation with enoxaparin&#44; aspirin&#44; and statins was initiated with marked improvement with minimal tissue loss over the following 3 weeks &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>c&#41;&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Upper limb ischemia due to embolization caused by thrombosed aneurysmal hemodialysis AVF has been reported scarcely in the medical literature mostly due to underreporting&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The pathophysiological mechanisms leading to aneurysm formation in patients with AVF are controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We suspect that the patient had atherothrombotic embolization to the and palmar aspect and fingers&#46; The spatial resolution of the angiogram does not allow visualization of skin small vessels thrombotic or embolic disease&#46; The fact that the patient had almost a full recovery with minimal skin damage suggests that this was probably the case&#46; We can only speculate why deterioration occurred following surgery&#46; Embolism from thrombus inside the aneurysm is a possibility&#46; Other sources of embolism were excluded and clinical course suggests that no other sources of embolism were present&#46; We cannot rule out aggravation of hand ischemia during brachial artery cross-clamping&#46; Unfortunately follow up angiogram was not performed since bypass patency was documented by Doppler ultrasound&#44; the patient had improved clinically&#44; and therefore it was decided no to expose the patient to a potentially nephrotoxic iodinated contrast&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">When distal upper extremity ischemia resulting from emboli occurs&#44; urgent intervention by thrombolysis or surgical embolectomy has been suggested to avoid a significant risk of limb loss or finger amputation&#46; However&#44; in our case a rather conservative approach with aneurysm ligation followed by anticoagulation with low-molecular weight heparin was successful in preserving hand function with minimal tissue loss&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Since 25&#8211;40&#37; of patients undergoing renal transplantation will return to hemodialysis&#44; vascular access is tipically left in place&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Most AVF thrombose over time with minimal consequences&#44; and therefore AVF ligation in asymptomatic patients with preserved renal function is controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">We conclude that distal embolism from a thrombosed AVF or aneurysm should be considered in the differential diagnosis of acute upper limb ischemia in patients with an AVF&#46; Treatment should be tailored to the degree of digital ischemia&#44; risk of bleeding and other comorbidities&#44; and should include anticoagulation&#44; catheter-directed thrombolysis and surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research&#44; authorship&#44; and&#47;or publication of this article&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declared no potential conflicts of interest with respect to the research&#44; authorship&#44; and&#47;or publication of this article&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Discussion"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Funding"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflict of interests"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 525
            "Ancho" => 1255
            "Tamanyo" => 136725
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Day of the hospital admission&#46; &#40;b&#41; Hospital discharge&#46; &#40;c&#41;&#58; Outpatient follow-up&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 639
            "Ancho" => 755
            "Tamanyo" => 14566
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fusiform aneurysm&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Digital infarction in a hemodialysis patient due to embolism from a thrombosed brachial arteriovenous fistula"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Yj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/hdi.12256"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hemodial Int"
                        "fecha" => "2015"
                        "volumen" => "19"
                        "paginaInicial" => "E6"
                        "paginaFinal" => "E9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25545123"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aneurysms and pseudoaneurysms in dialysis access"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Mudoni"
                            1 => "M&#46; Cornacchiari"
                            2 => "M&#46; Gallieni"
                            3 => "C&#46; Guastoni"
                            4 => "D&#46; McGrogan"
                            5 => "F&#46; Logias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ckj/sfv042"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Kidney J"
                        "fecha" => "2015"
                        "volumen" => "8"
                        "paginaInicial" => "363"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26251700"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Distal digital embolization from a thrombosed aneurysmal hemodialysis arteriovenous fistula&#58; the benefit of a hybrid approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;F&#46; Simosa"
                            1 => "S&#46;V&#46; Mudumbi"
                            2 => "F&#46;B&#46; Pomposelli"
                            3 => "M&#46;L&#46; Schermerhorn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1525-139X.2008.00517.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Dial"
                        "fecha" => "2009"
                        "volumen" => "22"
                        "paginaInicial" => "93"
                        "paginaFinal" => "96"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19175538"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Access ligation in transplant patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Wilmink"
                            1 => "L&#46; Hollingworth"
                            2 => "I&#46; Dasgupta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5301/jva.5000537"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Vasc Access"
                        "fecha" => "2016"
                        "volumen" => "17"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "S64"
                        "paginaFinal" => "S68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26951908"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/02116995/0000004100000005/v1_202109170826/S0211699520301764/v1_202109170826/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "48186"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Cartas al Director"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/02116995/0000004100000005/v1_202109170826/S0211699520301764/v1_202109170826/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699520301764?idApp=UINPBA000064"
]
Información del artículo
ISSN: 02116995
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 7 7 14
2024 Octubre 38 48 86
2024 Septiembre 34 23 57
2024 Agosto 45 61 106
2024 Julio 38 25 63
2024 Junio 41 36 77
2024 Mayo 49 39 88
2024 Abril 43 35 78
2024 Marzo 34 26 60
2024 Febrero 28 37 65
2024 Enero 31 30 61
2023 Diciembre 39 21 60
2023 Noviembre 51 44 95
2023 Octubre 44 42 86
2023 Septiembre 50 32 82
2023 Agosto 38 25 63
2023 Julio 50 29 79
2023 Junio 41 21 62
2023 Mayo 42 33 75
2023 Abril 35 22 57
2023 Marzo 39 23 62
2023 Febrero 26 17 43
2023 Enero 33 30 63
2022 Diciembre 53 28 81
2022 Noviembre 40 36 76
2022 Octubre 75 44 119
2022 Septiembre 46 40 86
2022 Agosto 32 52 84
2022 Julio 50 58 108
2022 Junio 34 44 78
2022 Mayo 27 36 63
2022 Abril 40 63 103
2022 Marzo 62 66 128
2022 Febrero 47 57 104
2022 Enero 48 42 90
2021 Diciembre 36 34 70
2021 Noviembre 39 41 80
2021 Octubre 74 63 137
2021 Septiembre 44 38 82
2021 Agosto 19 27 46
2021 Julio 16 27 43
2021 Junio 14 25 39
2021 Mayo 18 45 63
2021 Abril 44 60 104
2021 Marzo 26 28 54
2021 Febrero 30 31 61
2021 Enero 9 18 27
2020 Diciembre 13 7 20
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Nefrología
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?