CardioVascular and Interventional Radiology

, Volume 42, Issue 1, pp 158–158 | Cite as

Regarding “Long-Term Evaluation of Percutaneous Groin Access for EVAR”

  • Yahua Li
  • Jiangzhuang Ren
  • Xinwei Han
Letter to the Editor

We read with great interest the important article by Dwivedi et al. [1]. The author observed that the diameter of common femoral artery (CFA) increased in long-term (49.9 ± 11.1 months) scan compared with post-operative scan at 30 days. They theorize that the dilatation of CFA is due to the underlying aneurismal disease process, given age and long follow-up time.

In the study of Grandhi [2] and colleagues, 98 patients underwent 102 repeat angiograms following closure with vascular close device (VCD), 7 cases were demonstrated with minor vessel stenoses (average stenosis, 21%), and the average time to the repeat angiogram was 73.5 days. Heo et al. [3] evaluated the puncture sites by ultrasound during the median follow-up time of 187.0 days. Intimal hyperplasia was observed as hypoechoic thickening on US follow-up, which also caused a narrowed minimal luminal diameter. These results may be explained by the fact that intimal hyperplasia tends to facilitating puncture sites be stenosis in short-term and median follow-up. The mean follow-up time of Dwivedi et al. [1] is 49.9 months, more than 4 years. The patients are growing old. Aging contributes to the development of endothelial dysfunction, which will cause arterial stiffness [4].

The two follow-up points in the study of Dwivedi et al. [1] are post-operative 30 days and a long-term follow-up point. The diameter of CFA in long-term scan is higher than in post-operative scan at 30 days. Intimal hyperplasia may be the main cause of this result.


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Dwivedi K, Regi JM, Cleveland TJ, et al. Long-term evaluation of percutaneous groin access for EVAR. Cardiovasc Interv Radiol. 2018. Scholar
  2. 2.
    Grandhi R, Zhang X, Panczykowski D, et al. Incidence of delayed angiographic femoral artery complications using the EXOSEAL vascular closure device. Interv Neuroradiol. 2015;21(3):401–6.CrossRefGoogle Scholar
  3. 3.
    Heo YJ, Jeong HW, Baek JW, et al. Ultrasound evaluation of puncture sites after deployment of two different types of vascular closure devices: a prospective comparative study. Cardiovasc Intervent Radiol. 2018;41(11):1654–63.CrossRefGoogle Scholar
  4. 4.
    Wils J, Djerada Z, Roca F, et al. Alteration in the availability of epoxyeicosatrienoic acids contributes with NO to the development of endothelial dysfunction in conduit arteries during aging. Atherosclerosis. 2018;275:239–45.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

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