Regarding “Long-Term Evaluation of Percutaneous Groin Access for EVAR”
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We read with great interest the important article by Dwivedi et al. . 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  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.  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.  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 .
The two follow-up points in the study of Dwivedi et al.  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.
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Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.