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Park JI, Ko YG, Lee SJ, Ahn CM, Rha SW, Yu CW, Park JK, Park SH, Lee JH, Kim SH, Lee YJ, Hong SJ, Kim JS, Kim BK, Hong MK, Choi D. Clinical Outcomes After Drug-Coated Balloon Treatment in Popliteal Artery Disease: K-POP Registry 12-Month Results. Korean Circ J 2024; 54:54.e49. [PMID: 38767445 DOI: 10.4070/kcj.2024.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/01/2024] [Accepted: 04/04/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The popliteal artery is generally regarded as a "no-stent zone". Limited data are available on the outcomes of drug-coated balloons (DCBs) for popliteal artery disease. This study aimed to evaluate the 12-month clinical outcomes among patients who received DCB treatment for atherosclerotic popliteal artery disease. METHODS This prospective, multicenter registry study enrolled 100 patients from 7 Korean endovascular centers who underwent endovascular therapy using IN.PACT DCB (Medtronic) for symptomatic atherosclerotic popliteal artery disease. The primary endpoint was 12-month clinical primary patency and the secondary endpoint was clinically driven target lesion revascularization (TLR)-free rate. RESULTS The mean age of the study cohort was 65.7±10.8 years, and 77% of enrolled patients were men. The mean lesion length was 93.7±53.7 mm, and total occlusions were present in 45% of patients. Technical success was achieved in all patients. Combined atherectomy was performed in 17% and provisional stenting was required in 11%. Out of the enrolled patients, 91 patients completed the 12-month follow-up. Clinical primary patency and TLR-free survival rates at 12 months were 76.0% and 87.2%, respectively. A multivariate Cox regression analysis identified female and longer lesion length as the significant independent predictors of loss of patency. CONCLUSIONS DCB treatment yielded favorable 12-month clinical primary patency and TLR-free survival outcomes in patients with popliteal artery disease. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02698345.
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Affiliation(s)
- Jong-Il Park
- Division of Cardiology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Seung-Jun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Division of Cardiology, Korea University Guro Hospital, Seoul, Korea
| | - Cheol-Woong Yu
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Jong Kwan Park
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Ho Park
- Division of Cardiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Su-Hong Kim
- Division of Cardiology, Busan Veterans Hospital, Busan, Korea
| | - Yong-Joon Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Shivgulam ME, O'Brien MW, Wu Y, Liu H, Petterson JL, Schwartz BD, Kimmerly DS. Sitting knee-flexion angle does not influence endothelial-dependent vasodilation in laboratory or free-living conditions. Vasc Med 2024:1358863X241238702. [PMID: 38594895 DOI: 10.1177/1358863x241238702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Single bouts of prolonged bent-legged sitting attenuate popliteal endothelial-dependent vasodilation (as assessed via flow-mediated dilation [FMD]), which is partially attributed to arterial 'kinking'. However, the impact of knee-flexion angle on sitting-induced popliteal FMD is unknown. The objective of this study was to perform separate laboratory and free-living studies to test the hypotheses that: (1) popliteal FMD impairments would be graded between knee flexions at 90° (bent-legged sitting) > 45° > 0° (straight-legged sitting) following a 3-hour bout of sitting; and (2) more habitual time spent bent-legged sitting (< 45°) would be associated with lower FMD. METHODS The laboratory study included eight young, healthy adults (24 ± 2 years; four women) who underwent two sitting bouts over 2 days with one leg positioned at a knee-flexion angle of 0° or 90° and the opposite leg at 45° knee flexion. Popliteal FMD was assessed at pre- and postsitting timepoints. RESULTS Sitting-induced reductions in FMD were similar between all knee-flexion angles (all, p > 0.674). The free-living study included 35 young, healthy adults (23 ± 3 years; 16 women) who wore three activPAL monitors (torso, thigh, shin) to determine detailed sedentary postures. Time spent sedentary (624 ± 127 min/day), straight-legged sitting (112 ± 98 min/day), and bent-legged sitting (442 ± 106 min/day) were not related to relative FMD (5.3 ± 1.8%; all, p > 0.240). CONCLUSION These findings suggest that knee-flexion angle-mediated arterial 'kinking' during sitting is not a major contributor toward sitting-induced popliteal endothelial-dependent vasodilatory dysfunction.
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Affiliation(s)
| | - Myles W O'Brien
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale Du Nouveau-Brunswick, Université de Sherbrooke, Moncton, NB, Canada
| | - Yanlin Wu
- Autonomic Cardiovascular Control and Exercise Laboratory, Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Haoxuan Liu
- Autonomic Cardiovascular Control and Exercise Laboratory, Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Jennifer L Petterson
- Autonomic Cardiovascular Control and Exercise Laboratory, Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Beverly D Schwartz
- Autonomic Cardiovascular Control and Exercise Laboratory, Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Derek S Kimmerly
- Autonomic Cardiovascular Control and Exercise Laboratory, Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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van Zandwijk JK, Simmering JA, Schuurmann RCL, Simonis FFJ, Ten Haken B, de Vries JPPM, Geelkerken RH. Position- and posture-dependent vascular imaging-a scoping review. Eur Radiol 2024; 34:2334-2351. [PMID: 37672051 PMCID: PMC10957623 DOI: 10.1007/s00330-023-10154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/17/2023] [Accepted: 07/29/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES Position- and posture-dependent deformation of the vascular system is a relatively unexplored field. The goal of this scoping review was to create an overview of existing vascular imaging modalities in different body positions and postures and address the subsequent changes in vascular anatomy. METHODS Scopus, Medline, and Cochrane were searched for literature published between January 1, 2000, and June 30, 2022, incorporating the following categories: image modality, anatomy, orientation, and outcomes. RESULTS Out of 2446 screened articles, we included 108. The majority of papers used ultrasound (US, n = 74) in different body positions and postures with diameter and cross-sectional area (CSA) as outcome measures. Magnetic resonance imaging (n = 22) and computed tomography (n = 8) were less frequently used but allowed for investigation of other geometrical measures such as vessel curvature and length. The venous system proved more sensitive to postural changes than the arterial system, which was seen as increasing diameters of veins below the level of the heart when going from supine to prone to standing positions, and vice versa. CONCLUSIONS The influence of body positions and postures on vasculature was predominantly explored with US for vessel diameter and CSA. Posture-induced deformation and additional geometrical features that may be of interest for the (endovascular) treatment of vascular pathologies have been limitedly reported, such as length and curvature of an atherosclerotic popliteal artery during bending of the knee after stent placement. The most important clinical implications of positional changes are found in diagnosis, surgical planning, and follow-up after stent placement. CLINICAL RELEVANCE STATEMENT This scoping review presents the current state and opportunities of position- and posture-dependent imaging of vascular structures using various imaging modalities that are relevant in the fields of clinical diagnosis, surgical planning, and follow-up after stent placement. KEY POINTS • The influence of body positions and postures on the vasculature was predominantly investigated with US for vessel diameter and cross-sectional area. • Research into geometrical deformation, such as vessel length and curvature adaptation, that may be of interest for the (endovascular) treatment of vascular pathologies is limited in different positions and postures. • The most important clinical implications of postural changes are found in diagnosis, surgical planning, and follow-up after stent placement.
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Affiliation(s)
- Jordy K van Zandwijk
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
- Magnetic Detection & Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Jaimy A Simmering
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Richte C L Schuurmann
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F J Simonis
- Magnetic Detection & Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Bennie Ten Haken
- Magnetic Detection & Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jean-Paul P M de Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert H Geelkerken
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Nugteren MJ, Hazenberg CEVB, Akkersdijk GP, van den Heuvel DAF, Schreve MA, Ünlü Ç. Twelve-Month Outcomes of Intravascular Lithotripsy for Treatment of Calcified Popliteal and Infrapopliteal Lesions in Patients With Chronic Limb-Threatening Ischemia. J Endovasc Ther 2023:15266028231205421. [PMID: 37853746 DOI: 10.1177/15266028231205421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE Vessel calcification is estimated to be present in 30% to 50% of patients with peripheral arterial disease (PAD) and is one of the main challenges in endovascular treatment. The popliteal artery is unique compared with other arteries due to its exposure to significant deformation and biomechanical stress during knee motion. Intravascular lithotripsy (IVL) is a novel technique that uses acoustic pressure waves to cause microfractures within the intimal and medial wall calcification. Intravascular lithotripsy is safe in femoropopliteal and infrapopliteal lesions, but follow-up studies are lacking. Therefore, the purpose of this study was to describe the first follow-up outcomes of IVL in popliteal and infrapopliteal arterial disease. METHODS This prospective, multicenter cohort study included all patients treated with IVL in the popliteal and infrapopliteal arteries at 4 sites. Standardized follow-up with duplex ultrasonography was scheduled at 6 to 8 weeks and 12 months. The primary safety endpoint was a composite of major adverse events (MAEs) at 30 days. Primary efficacy endpoints were primary patency, limb salvage, and amputation-free survival (AFS) at 12 months. Secondary endpoints were primary-assisted patency and freedom from target lesion revascularization (TLR). Endpoints were distributed for patients with chronic limb-threatening ischemia (CLTI) and intermittent claudication (IC) and estimated using the Kaplan-Meier method. RESULTS Between April 2021 and March 2023, 29 patients with 30 limbs were treated. Diabetes mellitus (DM) and CLTI were present in 62.1% and 80.0% of patients, respectively. Within the 32 treated lesions, severe calcification was present in 84.4% and bailout stenting was necessary in 12.5% of the lesions. Four MAEs occurred within 30 days: 1 closure device failure, 1 major amputation, and 2 deaths, neither of which was related to the study device. The primary patency, primary-assisted patency, freedom from TLR, limb salvage, and AFS at 12 months were 68.8%, 90.0%, 93.3%, 83.9%, and 57.1% for CLTI patients, respectively. No events occurred in restenosis, re-occlusion, TLR, major amputation, or mortality in patients with IC. CONCLUSIONS This first-ever analysis on follow-up outcomes of IVL in the popliteal and infrapopliteal arteries demonstrated promising safety and efficacy outcomes with a low rate of bailout stenting. CLINICAL IMPACT Vessel calcification is a common feature in peripheral arterial disease (PAD) and is one of the main challenges in endovascular treatment. The popliteal artery is subjected to biomechanical stress during knee motion, which makes stenting unappealing and often leads to worse clinical outcomes. This study aimed to describe the first follow-up outcomes of IVL in popliteal and infrapopliteal arterial disease. As in line with previous studies, no relevant procedural complications were found and the rate of bail-out stenting was only 12.5%. Moreover, in a complex patient population, this study demonstrated promising safety and efficacy outcomes. The comparison of IVL with angioplasty alone or other vessel preparation devices for popliteal and infrapopliteal arterial disease is warranted.
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Affiliation(s)
- Michael J Nugteren
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - George P Akkersdijk
- Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Michiel A Schreve
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
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Gandini R, Semeraro V, Salimei F. Foot Dorsal and Plantar Flexion to Enhance Crossing of Tortuous Highly-Calcific Ankle Vessels During Lower Limb Revascularization Procedures: A Technical Note. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03436-8. [PMID: 37039865 DOI: 10.1007/s00270-023-03436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To describe a crossing technique of stenotic/occluded and tortuous highly calcific ankle vessels during complex percutaneous limb salvage intervention in diabetic patients with ischaemic foot ulcers (Rutherford 5 and 6). TECHNIQUE We propose a simple technique to achieve "straightening" of the tortuous vessel and allow safe devices passage into the foot arteries, Patients were asked to hold their foot in plantar or dorsal flexion, accordingly to the treated artery. If unable to do so, an equipe member executed the manoeuvre on their behalf. RESULTS The technique was applied in 148 cases, with a success rate of 81% (120/148). No complications related to the manoeuvre were observed. CONCLUSION Crossing of tortuous distal crural vessels can be challenging in diabetic patients; in our experience, this technique can be a useful tool to obtain a successful recanalization in complex procedures with high risk of failure.
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Affiliation(s)
- Roberto Gandini
- Department of Interventional Radiology, University Hospital "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Vittorio Semeraro
- Department of Interventional Radiology, Santissima Annunziata Hospital, Taranto, Italy
| | - Fabio Salimei
- Department of Interventional Radiology, University Hospital "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy.
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Kauser K, Warner KS, Anderson B, Keyes ED, Hayes RB, Kawamoto E, Perkins DH, Scott R, Isaacson J, Haberer B, Spaans A, Utecht R, Hauser H, Roberts AG, Greenberg M. Creating a Natural Vascular Scaffold by Photochemical Treatment of the Extracellular Matrix for Vascular Applications. Int J Mol Sci 2022; 23:ijms23020683. [PMID: 35054866 PMCID: PMC8775700 DOI: 10.3390/ijms23020683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 02/01/2023] Open
Abstract
The development of bioscaffolds for cardiovascular medical applications, such as peripheral artery disease (PAD), remains to be a challenge for tissue engineering. PAD is an increasingly common and serious cardiovascular illness characterized by progressive atherosclerotic stenosis, resulting in decreased blood perfusion to the lower extremities. Percutaneous transluminal angioplasty and stent placement are routinely performed on these patients with suboptimal outcomes. Natural Vascular Scaffolding (NVS) is a novel treatment in the development for PAD, which offers an alternative to stenting by building on the natural structural constituents in the extracellular matrix (ECM) of the blood vessel wall. During NVS treatment, blood vessels are exposed to a photoactivatable small molecule (10-8-10 Dimer) delivered locally to the vessel wall via an angioplasty balloon. When activated with 450 nm wavelength light, this therapy induces the formation of covalent protein–protein crosslinks of the ECM proteins by a photochemical mechanism, creating a natural scaffold. This therapy has the potential to reduce the need for stent placement by maintaining a larger diameter post-angioplasty and minimizing elastic recoil. Experiments were conducted to elucidate the mechanism of action of NVS, including the molecular mechanism of light activation and the impact of NVS on the ECM.
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Affiliation(s)
- Katalin Kauser
- Alucent Biomedical Inc., 675 Arapeen Dr, Suite #102, Salt Lake City, UT 84108, USA; (K.S.W.); (B.A.); (R.H.); (E.K.); (D.P.); (R.S.); (J.I.); (H.H.); (M.G.)
- Correspondence: ; Tel.: +1-415-527-9892
| | - Kevin S. Warner
- Alucent Biomedical Inc., 675 Arapeen Dr, Suite #102, Salt Lake City, UT 84108, USA; (K.S.W.); (B.A.); (R.H.); (E.K.); (D.P.); (R.S.); (J.I.); (H.H.); (M.G.)
| | - Blake Anderson
- Alucent Biomedical Inc., 675 Arapeen Dr, Suite #102, Salt Lake City, UT 84108, USA; (K.S.W.); (B.A.); (R.H.); (E.K.); (D.P.); (R.S.); (J.I.); (H.H.); (M.G.)
| | - Edgar Dalles Keyes
- Department of Chemistry, University of Utah, 315 South 1400 East, Salt Lake City, UT 84112, USA; (E.D.K.); (A.G.R.)
| | - RB Hayes
- Alucent Biomedical Inc., 675 Arapeen Dr, Suite #102, Salt Lake City, UT 84108, USA; (K.S.W.); (B.A.); (R.H.); (E.K.); (D.P.); (R.S.); (J.I.); (H.H.); (M.G.)
| | - Eric Kawamoto
- Alucent Biomedical Inc., 675 Arapeen Dr, Suite #102, Salt Lake City, UT 84108, USA; (K.S.W.); (B.A.); (R.H.); (E.K.); (D.P.); (R.S.); (J.I.); (H.H.); (M.G.)
| | - DH Perkins
- Alucent Biomedical Inc., 675 Arapeen Dr, Suite #102, Salt Lake City, UT 84108, USA; (K.S.W.); (B.A.); (R.H.); (E.K.); (D.P.); (R.S.); (J.I.); (H.H.); (M.G.)
| | - Robert Scott
- Alucent Biomedical Inc., 675 Arapeen Dr, Suite #102, Salt Lake City, UT 84108, USA; (K.S.W.); (B.A.); (R.H.); (E.K.); (D.P.); (R.S.); (J.I.); (H.H.); (M.G.)
| | - Jim Isaacson
- Alucent Biomedical Inc., 675 Arapeen Dr, Suite #102, Salt Lake City, UT 84108, USA; (K.S.W.); (B.A.); (R.H.); (E.K.); (D.P.); (R.S.); (J.I.); (H.H.); (M.G.)
| | - Barb Haberer
- Alumend, LLC, 4800 N. Career Avenue, Suite #108, Sioux Falls, SD 57107, USA; (B.H.); (A.S.); (R.U.)
| | - Ann Spaans
- Alumend, LLC, 4800 N. Career Avenue, Suite #108, Sioux Falls, SD 57107, USA; (B.H.); (A.S.); (R.U.)
| | - Ronald Utecht
- Alumend, LLC, 4800 N. Career Avenue, Suite #108, Sioux Falls, SD 57107, USA; (B.H.); (A.S.); (R.U.)
| | - Hank Hauser
- Alucent Biomedical Inc., 675 Arapeen Dr, Suite #102, Salt Lake City, UT 84108, USA; (K.S.W.); (B.A.); (R.H.); (E.K.); (D.P.); (R.S.); (J.I.); (H.H.); (M.G.)
| | - Andrew George Roberts
- Department of Chemistry, University of Utah, 315 South 1400 East, Salt Lake City, UT 84112, USA; (E.D.K.); (A.G.R.)
| | - Myles Greenberg
- Alucent Biomedical Inc., 675 Arapeen Dr, Suite #102, Salt Lake City, UT 84108, USA; (K.S.W.); (B.A.); (R.H.); (E.K.); (D.P.); (R.S.); (J.I.); (H.H.); (M.G.)
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Salemizadehparizi F, Mehrabi R. Determination effect of two different NiTi stents on the vessel wall and studying their flexibility using finite element method. Comput Methods Biomech Biomed Engin 2021; 25:1520-1530. [PMID: 34967243 DOI: 10.1080/10255842.2021.2019714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Finite element simulation is used to analysis stent designs, extension as well as interaction between a stent and a vessel. In this paper, two different stents with different geometries have been simulated. One is Zilver stent and the other one is Navalis stent. The aim of this study is to determine the effect of stents deployment with various designs that are made of shape memory alloy (SMA) on the distribution of vessel wall stresses by using computational modeling approach. The constitutive model which described the behavior of SMA is based on Microplane model. In addition, SMA stents have been simulated under torsion loading to compare the flexibility of various designs under different conditions. The superelastic behavior and shape memory effect of SMA stents are investigated in this paper. The numerical simulation results show the different geometries of stents have significant effect on the arterial wall. The results show the Navalis stent causes less stress on the arterial wall and it is more flexible than the Zilver stent under the same torsion loading.
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Affiliation(s)
- Fatemeh Salemizadehparizi
- Biomedical Engineering Department, Binghamton University, Binghamton, New York, USA.,Mechanical Engineering Department, Vali-e-Asr University of Rafsanjan, Rafsanjan, Kerman, Iran
| | - Reza Mehrabi
- Dynamic and Smart Systems Laboratory, Mechanical, Industrial and Manufacturing Engineering Department (MIME), University of Toledo, Toledo, Ohio, USA.,Mechanical Engineering Department, Vali-e-Asr University of Rafsanjan, Rafsanjan, Kerman, Iran
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8
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Towards a better understanding of the posttreatment hemodynamic behaviors in femoropopliteal arteries through personalized computational models based on OCT images. Sci Rep 2021; 11:16633. [PMID: 34404840 PMCID: PMC8370988 DOI: 10.1038/s41598-021-96030-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/29/2021] [Indexed: 11/08/2022] Open
Abstract
The hemodynamic behavior following endovascular treatment of patients with peripheral arterial disease plays a significant role on the occurrence of restenosis in femoro-popliteal (FP) arteries. The atheroprone flow conditions that are generally accepted to promote restenosis can be calculated by computational fluid dynamics (CFD) analyses, and these results can be used to assess individualized treatment outcomes. However, the impact of endovascular therapy on the flow behaviors of FP arteries are still poorly understood, as the imaging modalities used in existing numerical works (X-ray angiography, computed tomography angiography) are unable to accurately represent the post-treatment arterial geometry due to their low resolutions. Therefore, this study proposes a new algorithm that combines intra-arterial lumen geometry obtained from high-resolution optical coherence tomography (OCT) images with centerlines generated from X-ray images to reconstruct the FP artery with an in-plane resolution of 10 µm. This superior accuracy allows modeling characteristic geometrical structures, such as angioplasty-induced arterial dissections, that are too small to be reconstructed with other imaging modalities. The framework is applied on the clinical data of patients treated either with only-percutaneous transluminal angioplasty (PTA) (n = 4) or PTA followed by stenting (n = 4). Based on the generated models, PTA was found to cause numerous arterial dissections, covering approximately 10% of the total surface area of the lumen, whereas no dissections were identified in the stented arteries. CFD simulations were performed to investigate the hemodynamic conditions before and after treatment. Regardless of the treatment method, the areas affected by low time-averaged wall shear stress (< 0.5 Pa) were significantly higher (p < 0.05) following endovascular therapy (pre-PTA: 0.95 ± 0.59 cm2; post-PTA: 2.10 ± 1.09cm2; post-stent: 3.10 ± 0.98 cm2). There were no statistical differences between the PTA and the stent groups. However, within the PTA group, adverse hemodynamics were mainly concentrated at regions created by arterial dissections, which may negatively impact the outcomes of a leave-nothing-behind strategy. These observations show that OCT-based numerical models have great potential to guide clinicians regarding the optimal treatment approach.
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Jadidi M, Razian SA, Anttila E, Doan T, Adamson J, Pipinos M, Kamenskiy A. Comparison of morphometric, structural, mechanical, and physiologic characteristics of human superficial femoral and popliteal arteries. Acta Biomater 2021; 121:431-443. [PMID: 33227490 PMCID: PMC7855696 DOI: 10.1016/j.actbio.2020.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 01/03/2023]
Abstract
Peripheral arterial disease differentially affects the superficial femoral (SFA) and the popliteal (PA) arteries, but their morphometric, structural, mechanical, and physiologic differences are poorly understood. SFAs and PAs from 125 human subjects (age 13-92, average 52±17 years) were compared in terms of radii, wall thickness, and opening angles. Structure and vascular disease were quantified using histology, mechanical properties were determined with planar biaxial extension, and constitutive modeling was used to calculate the physiologic stress-stretch state, elastic energy, and the circumferential physiologic stiffness. SFAs had larger radii than PAs, and both segments widened with age. Young SFAs were 5% thicker, but in old subjects the PAs were thicker. Circumferential (SFA: 96→193°, PA: 105→139°) and longitudinal (SFA: 139→306°, PA: 133→320°) opening angles increased with age in both segments. PAs were more diseased than SFAs and had 11% thicker intima. With age, intimal thickness increased 8.5-fold, but medial thickness remained unchanged (620μm) in both arteries. SFAs had 30% more elastin than the PAs, and its density decreased ~50% with age. SFAs were more compliant than PAs circumferentially, but there was no difference longitudinally. Physiologic circumferential stress and stiffness were 21% and 11% higher in the SFA than in the PA across all ages. The stored elastic energy decreased with age (SFA: 1.4→0.4kPa, PA: 2.5→0.3kPa). While the SFA and PA demonstrate appreciable differences, most of them are due to vascular disease. When pathology is the same, so are the mechanical properties, but not the physiologic characteristics that remain distinct due to geometrical differences.
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Affiliation(s)
- Majid Jadidi
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Sayed Ahmadreza Razian
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska Omaha, Omaha, NE, USA
| | - Eric Anttila
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Tyler Doan
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska Omaha, Omaha, NE, USA
| | - Josiah Adamson
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska Omaha, Omaha, NE, USA
| | - Margarita Pipinos
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska Omaha, Omaha, NE, USA
| | - Alexey Kamenskiy
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska Omaha, Omaha, NE, USA.
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Wu X, Peng Z, Qin J, Yang X, Lu X, Ye K. Outcomes of Drug-Coated Balloon Angioplasty for Isolated Chronic Occlusion of the Popliteal Artery: A Retrospective Single-Institution Study. J Vasc Interv Radiol 2021; 32:593-601. [PMID: 33531180 DOI: 10.1016/j.jvir.2020.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To assess the 12-month safety and effectiveness of paclitaxel drug-coated balloon (DCB) for the treatment of patients with isolated chronic occlusions in popliteal arteries and evaluate the risk factors of lesion reocclusion. MATERIALS AND METHODS From January 2018 to December 2019, DCB angioplasty was performed in 54 limbs with isolated chronic popliteal artery occlusion of 48 patients (32 men) with a mean age of 71.5 ± 12.1 (range, 50-97) years, mean occlusive length of 6.3 ± 3.0 (range, 1-15) cm, and mean preoperative ankle-brachial index (ABI) of 0.42 ± 0.12 (range, 0.19-0.58). A total of 18.5% (10/54) of lesions were long-segment occlusions involving the entire popliteal artery from P1 to P3. Twenty seven of 54 limbs presented with critical limb ischemia (CLI) with a mean ABI of 0.33 ± 0.10 (range, 0.19-0.51). The primary endpoint was primary patency rate at 12 months. The secondary endpoints included technical success rate, 1-year secondary patency rate, limb salvage rate, and improvement in clinical symptoms. Univariate Cox regression analysis was used to determine the predictors of lesion reocclusion. RESULTS The technical success rate was 85.2% (46/54), and bailout stenting was performed in 14.8% (8/54) of lesions. The 12-month primary and secondary patency rates by the Kaplan-Meier estimate were 72.6% and 88.3%, respectively. Two thirds of the reocclusions occurred within 6 months after intervention. No 30-day mortality was observed. The limb salvage rate was 100% during a mean follow-up period of 13 months, and all minor amputations occurred in the limbs presented with CLI. The mean ABI increased from 0.42 before the procedure to 0.73 after the procedure. Patients younger than 60 years and the lesions exhibiting long-segment occlusions present as trending risk factors for lesion reocclusion. CONCLUSIONS Paclitaxel DCB angioplasty is safe and effective in managing isolated chronic occlusion of popliteal arteries. Younger patients and long-segment occlusions of the popliteal artery are associated with a relatively higher reocclusion rate after the procedure.
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Affiliation(s)
- Xiaoyu Wu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Vascular Center of Shanghai Jiaotong University, Shanghai, China, 200011
| | - Zhiyou Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Vascular Center of Shanghai Jiaotong University, Shanghai, China, 200011
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Vascular Center of Shanghai Jiaotong University, Shanghai, China, 200011
| | - Xinrui Yang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Vascular Center of Shanghai Jiaotong University, Shanghai, China, 200011
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Vascular Center of Shanghai Jiaotong University, Shanghai, China, 200011
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Vascular Center of Shanghai Jiaotong University, Shanghai, China, 200011.
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11
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Kang T, Lee DW, Park JY, Han HS, Lee MC, Ro DH. Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury. Knee Surg Sports Traumatol Arthrosc 2020; 28:1365-1371. [PMID: 30809721 DOI: 10.1007/s00167-019-05439-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/22/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Popliteal artery injury is a rare but devastating complication of open-wedge high tibial osteotomy (OWHTO). The objectives of this study were: to document the location of the artery in the virtual osteotomy plane (VOP), to measure the minimal distance between the popliteal artery and three virtual saw-progression lines (VSLs), and to present a safe sawing technique for OWHTO. METHOD In total, 45 computed tomography angiographies were reconstructed and virtual osteotomy was simulated using 3D image-processing software. The VOP was defined as an inclined plane commencing 3.5 cm below the articular plane towards the fibular head. VSLs were defined as saw-progression guidelines that lie on the VOP: "VSL-mid" runs from the midpoint of the tibial medial cortex towards the fibular head; "VSL-ant" starts from the same point as VSL-mid, but runs 10° anterior to the fibular head; and "VSL-post" runs 10° posterior to the fibular head. The distances between the popliteal artery and the three VSLs were measured, and the risk of injury was assessed. RESULTS The popliteal artery was located 20.7° posterior to VSL-mid and 51 mm from the starting point. The minimum distance between the popliteal artery and VSL-mid was 18 mm (99% confidence interval 9-27 mm). When the saw was moved along VSL-mid, 42% of the arteries were susceptible to injury. However, when it followed VSL-ant, there was no risk of injury. CONCLUSIONS Sawing toward the fibular head carries a risk of popliteal artery injury and should not be performed. When sawing in OWHTO, the recommended target should be 10° anterior to the fibular head. This technique eliminates the risk of popliteal artery injury.
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Affiliation(s)
- Taehoon Kang
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Do Weon Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Jae Young Park
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
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12
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Desyatova A, Poulson W, MacTaggart J, Maleckis K, Kamenskiy A. Cross-sectional pinching in human femoropopliteal arteries due to limb flexion, and stent design optimization for maximum cross-sectional opening and minimum intramural stresses. J R Soc Interface 2019; 15:rsif.2018.0475. [PMID: 30135264 DOI: 10.1098/rsif.2018.0475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/25/2018] [Indexed: 12/13/2022] Open
Abstract
High failure rates of femoropopliteal artery (FPA) interventions are often attributed to severe mechanical deformations that occur with limb flexion. One of these deformations, cross-sectional pinching, has a direct effect on blood flow, but is poorly characterized. Intra-arterial markers were deployed into n = 50 in situ cadaveric FPAs (80 ± 12 years old, 14F/11M), and limbs were imaged in standing, walking, sitting and gardening postures. Image analysis was used to measure marker openings and calculate FPA pinching. Parametric finite element analysis on a stent section was used to determine the optimal combination of stent strut amplitude, thickness and the number of struts per section to maximize cross-sectional opening and minimize intramural mechanical stress and low wall shear stress. Pinching was higher distally and increased with increasing limb flexion. In the walking, sitting and gardening postures, it was 1.16-1.24, 1.17-1.26 and 1.19-1.35, respectively. Stent strut amplitude and thickness had strong effects on both intramural stresses and pinching. Stents with a strut amplitude of 3 mm, thickness of 175 µm and 20 struts per section produced pinching and intramural stresses typical for a non-stented FPA, while also minimizing low wall shear stress areas, and ensuring a stent lifespan of at least 107 cycles. These results can help guide the development of improved devices and materials to treat peripheral arterial disease.
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Affiliation(s)
- Anastasia Desyatova
- Department of Surgery, University of Nebraska Medical Center, 987690 Nebraska Medical Center, Omaha, NE 68198-7690, USA
| | - William Poulson
- Department of Surgery, University of Nebraska Medical Center, 987690 Nebraska Medical Center, Omaha, NE 68198-7690, USA
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, 987690 Nebraska Medical Center, Omaha, NE 68198-7690, USA
| | - Kaspars Maleckis
- Department of Surgery, University of Nebraska Medical Center, 987690 Nebraska Medical Center, Omaha, NE 68198-7690, USA
| | - Alexey Kamenskiy
- Department of Surgery, University of Nebraska Medical Center, 987690 Nebraska Medical Center, Omaha, NE 68198-7690, USA
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Lee R, Stoddart M, Dyson I, Cassimjee I, Handa A, Cheng CP. Length Redundancy and Twist Improve the Biomechanical Properties of Polytetrafluoroethylene Bypass Grafts. Ann Vasc Surg 2019; 61:410-415. [PMID: 31319171 PMCID: PMC6900574 DOI: 10.1016/j.avsg.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/23/2019] [Accepted: 04/18/2019] [Indexed: 10/29/2022]
Abstract
BACKGROUND The iliofemoropopliteal artery significantly changes path length during normal hip and knee flexion. Prosthetic bypass grafts, such as polytetrafluoroethylene (PTFE) grafts, are relatively stiff and thus can subject graft anastomoses to high tension when the path length increases. The aim of this study was to examine the influence of length redundancy and twist on the biomechanical properties of PTFE bypass grafts. METHODS Unreinforced and ring-reinforced PTFE grafts were loaded in an axial mechanical testing machine to measure the tensile and compressive axial forces with varying levels of length redundancy and axial twist. RESULTS Adding 5-15% length redundancy to a graft decreases the force to cause 5% extension by > 90% without substantially increasing shortening forces. Adding 4.5°/cm of axial twist imparts a corkscrew shape to the graft without increasing extension or shortening forces in the presence of length redundancy. Ring-reinforced PTFE grafts require more length redundancy to experience these reductions in forces especially in the presence of axial twist. CONCLUSIONS A modest amount of length redundancy and twist (i.e., a cork-screw condition) confers improved biomechanical properties in a PTFE graft, especially in ring-reinforced grafts. This should be taken into consideration when fashioning an arterial bypass graft in the iliofemoropopliteal segment.
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Affiliation(s)
- Regent Lee
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, Oxfordshire, UK.
| | - Miranda Stoddart
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, Oxfordshire, UK
| | - Igor Dyson
- Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
| | - Ismail Cassimjee
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, Oxfordshire, UK
| | - Ashok Handa
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, Oxfordshire, UK
| | - Christopher P Cheng
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, Oxfordshire, UK; Department of Vascular Surgery, Stanford University, Palo Alto, CA.
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Sato K, Emura S, Tomiyoshi H, Morita S. Morphologic Changes of the Femoropopliteal Arterial Segment with Knee Flexion after Endovascular Therapy. Ann Vasc Dis 2019; 12:210-215. [PMID: 31275476 PMCID: PMC6600111 DOI: 10.3400/avd.oa.18-00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: The purpose of this study is to investigate morphologic changes of the femoropopliteal arterial segment (FPAS) with knee flexion after endovascular therapy (EVT). Methods: From July 2012 to January 2015, EVT was performed on 12 limbs in 12 consecutive patients who had obliterative lesions in the FPAS. After the implantation of nitinol stents, angiography was performed with the knee in both extension and flexion to investigate morphologic changes of the FPAS. Results: On angiography, the distal end of the implanted stent was placed at various distances (5–10 cm in two cases, 10–15 cm in nine cases, and 15–20 cm in one case) above the knee joint line with the knee in extension. In all cases, although the popliteal artery was highly bent with the knee in flexion, the FPAS morphology was highly variable. However, the most proximal bending point of the FPAS was about 10 cm above the knee joint line. In one case, the artery was occluded at the distal part of the stent 16 months later, probably due to EVT. Conclusion: In EVT of the FPAS, it is important to consider the characteristics and position of the stent to prevent complications.
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Affiliation(s)
- Katsutoshi Sato
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Shogo Emura
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Hideki Tomiyoshi
- Department of Radiology, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Satoru Morita
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
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15
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Spinella G, Finotello A, Pane B, Salsano G, Mambrini S, Kamenskiy A, Gazzola V, Cittadini G, Auricchio F, Palombo D, Conti M. In Vivo Morphological Changes of the Femoropopliteal Arteries due to Knee Flexion After Endovascular Treatment of Popliteal Aneurysm. J Endovasc Ther 2019; 26:496-504. [PMID: 31198084 DOI: 10.1177/1526602819855441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose: To evaluate morphological changes of the femoropopliteal (FP) arteries due to limb flexion in patients undergoing endovascular treatment of popliteal artery aneurysms (PAAs). Materials and Methods: Seven male patients (mean age 68 years) underwent endovascular treatment of PAA with a Viabahn stent-graft between January 2013 and December 2017. During follow-up, one contrast-enhanced computed tomography angiography (CTA) scan of the lower limbs was acquired for each recruited patient. A standardized CTA protocol for acquisitions in both straight-leg and bent-leg positions was used to visualize changes in artery shape due to limb flexion. Three-dimensional reconstruction of the FP segment was performed to compute mean diameter and eccentricity of the vascular lumen and to measure length, tortuosity, and curvature of the vessel centerline in 3 arterial zones: (A) between the origin of the superficial femoral artery and the proximal end of the stent-graft, (B) within the stent-graft, and (C) from the distal end of the stent-graft to the origin of the anterior tibial artery. Results: After limb flexion, all zones of the FP segment foreshortened: 6% in zone A (p=0.001), 4% in zone B (p=0.001), and 8% in zone C (p=0.07), which was the shortest (mean 4.5±3.6 cm compared with 23.8±5.7 cm in zone A and 23.6±7.4 cm in zone B). Tortuosity increased in zone A (mean 0.03 to 0.05, p=0.03), in zone B (0.06 to 0.15, p=0.005), and in zone C (0.027 to 0.031, p=0.1). Mean curvature increased 15% (p=0.05) in zone A, 27% (p=0.005) in zone B, and 95% (p=0.06) in zone C. In all zones, the mean artery diameter and eccentricity were not significantly affected by limb flexion. Conclusion: Limb flexion induces vessel foreshortening and increases mean curvature and tortuosity of the FP segment both within and outside the area of the stent-graft.
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Affiliation(s)
- Giovanni Spinella
- 1 Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - Alice Finotello
- 2 Department of Experimental Medicine, University of Genoa, Italy
| | - Bianca Pane
- 1 Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - Giancarlo Salsano
- 3 Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Mambrini
- 1 Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Italy
| | | | - Valerio Gazzola
- 1 Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - Giuseppe Cittadini
- 3 Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Domenico Palombo
- 1 Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - Michele Conti
- 5 Department of Civil Engineering and Architecture, University of Pavia, Italy
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Prediction of restenosis based on hemodynamical markers in revascularized femoro-popliteal arteries during leg flexion. Biomech Model Mechanobiol 2019; 18:1883-1893. [PMID: 31197509 PMCID: PMC6825029 DOI: 10.1007/s10237-019-01183-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/05/2019] [Indexed: 12/04/2022]
Abstract
Endovascular therapy in patients suffering from peripheral arterial disease shows high rates of restenosis. The poor clinical outcomes are commonly explained by the demanding mechanical environment due to leg movements, but the mechanisms responsible for restenosis remain unknown. In this study, we hypothesized that restenosis following revascularization is associated with hemodynamical markers derived from blood flow during leg flexion. Therefore, we performed personalized computational fluid dynamics (CFD) analyses of 20 patients, who underwent routine endovascular femoro-popliteal interventions. The CFD analyses were conducted using 3D models of the arterial geometry in straight and flexed positions, which were reconstructed from 2D angiographic images. Based on restenosis rates reported at 6-month follow-up, logistic regression analyses were performed to predict restenosis from hemodynamical parameters. Results showed that severe arterial deformations, such as kinking, induced by leg flexion in stented arteries led to adverse hemodynamic conditions that may trigger restenosis. A logistic regression analysis based solely on hemodynamical markers had an accuracy of 75%, which showed that flow parameters are sufficient to predict restenosis (p = 0.031). However, better predictions were achieved by adding the treatment method in the model. This suggests that a more accurate image acquisition technique is required to capture the localized modifications of blood flow following intervention, especially around the stented artery. This approach, based on the immediate postoperative configuration of the artery, has the potential to identify patients at increased risk of restenosis. Based on this information, clinicians could take preventive measures and more closely follow these patients to avoid complications.
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El Khoury R, Nikanorov A, McCarroll E, LeClerc G, Guy LG, Laflamme M, Mailloux A, Schwartz LB. An Animal Model of Human Peripheral Arterial Bending and Deformation. J Surg Res 2019; 241:240-246. [PMID: 31035138 DOI: 10.1016/j.jss.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/02/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Designing peripheral arterial stents has proved challenging, as implanted devices will repetitively and unpredictably deform and fatigue during movement. Preclinical testing is often inadequate, given the lack of relevant animal models. The purpose of this study was to test the hypothesis that deformation of the human peripheral vasculature could be qualitatively and quantitatively modeled using an experimental animal. METHODS Anteroposterior contrast angiography was performed in domestic Landrace-Yorkshire farm pigs. Images were obtained with the hind limbs naturally extended then repeated, (1) flexed approximately 90° at the hip and knee, (2) overflexed in a nonphysiological fashion. Quantitative vascular angiographic analysis was utilized to measure arterial diameter, length, and deformation. Percent axial arterial compression and bending were assessed. RESULTS Eight iliofemoral arteries in four animals were imaged. Mean luminal diameters of the iliac and femoral segments in the neutral position were 5.4 ± 0.5 mm and 4.6 ± 0.5 mm. Hind limb physiologic flexion induced profound arterial compression, 17 ± 8% and 29 ± 6% and bending, 36°±10° and 76° ± 13° within the iliac and femoral segments, respectively. With extreme flexion, the femoral artery could be reliably bent >90°. The observed findings exceeded the deformation observed historically within the human superficial femoral (∼5% compression and 10° bending) and popliteal artery (∼10% compression and 70° bending). CONCLUSIONS Significant nonradial deformation of the porcine iliofemoral arteries was observed during manual hind limb flexion and exceeded that typically observed in humans. This model constitutes a "worst case" scenario for testing deformation and fatigue of intravascular devices indicated for the human peripheral vasculature.
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Affiliation(s)
- Rym El Khoury
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | | | | | | | | | | | | | - Lewis B Schwartz
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois; Efemoral Medical, L.L.C, Los Altos, California.
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Saito S, Bise R, Yoshikawa A, Sekiguchi H, Tsuge I, Toi M. Digital artery deformation on movement of the proximal interphalangeal joint. J Hand Surg Eur Vol 2019; 44:187-195. [PMID: 30335597 DOI: 10.1177/1753193418807833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to characterize in vivo human digital arteries in three-dimensions using photoacoustic tomography in order to understand the specific mechanism underlying arterial deformation associated with movement of the proximal interphalangeal joint. Three-dimensional morphological data were obtained on the radialis indicis artery (radial artery of the index finger) at different angles of the joint. The association between increased curvature of the deformation and the anatomical region was assessed. Characteristic morphological deformations in areas of major deformation were determined. The deformation of the artery was characterized by three consecutive curves in juxta-articular regions, which were particularly noticeable when the joint was flexed at an angle of ≥ 60°. The change in the curvature of the deformation during 30°-90° of flexion was lower in middle-aged individuals than in young individuals. Better understanding of the mechanism underlying deformation of the digital arteries may contribute to advancements in flap procedures and rehabilitation strategies after digital artery repair.
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Affiliation(s)
- Susumu Saito
- 1 Department of Plastic and Reconstructive Surgery, Kyoto University, Kyoto, Japan
| | - Ryoma Bise
- 2 Department of Advanced Information Technology, Kyushu University, Fukuoka, Japan
| | - Aya Yoshikawa
- 3 Department of Breast Surgery, Kyoto University, Kyoto, Japan
| | - Hiroyuki Sekiguchi
- 4 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Itaru Tsuge
- 1 Department of Plastic and Reconstructive Surgery, Kyoto University, Kyoto, Japan
| | - Masakazu Toi
- 3 Department of Breast Surgery, Kyoto University, Kyoto, Japan
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Poulson W, Kamenskiy A, Seas A, Deegan P, Lomneth C, MacTaggart J. Limb flexion-induced axial compression and bending in human femoropopliteal artery segments. J Vasc Surg 2018; 67:607-613. [PMID: 28526560 PMCID: PMC5690897 DOI: 10.1016/j.jvs.2017.01.071] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND High failure rates of femoropopliteal artery (FPA) interventions are often attributed in part to severe mechanical deformations that occur with limb movement. Axial compression and bending of the FPA likely play significant roles in FPA disease development and reconstruction failure, but these deformations are poorly characterized. The goal of this study was to quantify axial compression and bending of human FPAs that are placed in positions commonly assumed during the normal course of daily activities. METHODS Retrievable nitinol markers were deployed using a custom-made catheter system into 28 in situ FPAs of 14 human cadavers. Contrast-enhanced, thin-section computed tomography images were acquired with each limb in the standing (180 degrees), walking (110 degrees), sitting (90 degrees), and gardening (60 degrees) postures. Image segmentation and analysis allowed relative comparison of spatial locations of each intra-arterial marker to determine axial compression and bending using the arterial centerlines. RESULTS Axial compression in the popliteal artery (PA) was greater than in the proximal superficial femoral artery (SFA) or the adductor hiatus (AH) segments in all postures (P = .02). Average compression in the SFA, AH, and PA ranged from 9% to 15%, 11% to 19%, and 13% to 25%, respectively. The FPA experienced significantly more acute bending in the AH and PA segments compared with the proximal SFA (P < .05) in all postures. In the walking, sitting, and gardening postures, average sphere radii in the SFA, AH, and PA ranged from 21 to 27 mm, 10 to 18 mm, and 8 to 19 mm, whereas bending angles ranged from 150 to 157 degrees, 136 to 147 degrees, and 137 to 148 degrees, respectively. CONCLUSIONS The FPA experiences significant axial compression and bending during limb flexion that occur at even modest limb angles. Moreover, different segments of the FPA appear to undergo significantly different degrees of deformation. Understanding the effects of limb flexion on axial compression and bending might assist with reconstructive device selection for patients requiring peripheral arterial disease intervention and may also help guide the development of devices with improved characteristics that can better adapt to the dynamic environment of the lower extremity vasculature.
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Affiliation(s)
- William Poulson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Alexey Kamenskiy
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Andreas Seas
- Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County
| | - Paul Deegan
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Carol Lomneth
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
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Rastan A, McKinsey JF, Garcia LA, Rocha-Singh KJ, Jaff MR, Harlin S, Kamat S, Janzer S, Zeller T. One-Year Outcomes Following Directional Atherectomy of Popliteal Artery Lesions: Subgroup Analysis of the Prospective, Multicenter DEFINITIVE LE Trial. J Endovasc Ther 2017; 25:100-108. [PMID: 29117818 PMCID: PMC5774616 DOI: 10.1177/1526602817740133] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose: To report the effectiveness of directional atherectomy for the treatment of popliteal artery occlusive disease. Methods: This subset of the prospective, multicenter, single-arm DEFINITIVE LE trial included 158 patients (mean age 72.0±10.9 years; 82 men) who underwent directional atherectomy in 162 popliteal artery lesions between 2009 and 2011. Forty-eight (30.4%) patients were suffering from critical limb ischemia (CLI). The mean lesion length was 5.8±3.9 cm; 38 (23.5%) arteries were occluded. The primary outcome measure for patients with intermittent claudication (IC) was duplex ultrasound–defined primary patency at 1 year; the outcome for subjects with CLI was freedom from major amputation of the target limb at 1 year. Outcomes and adverse events were independently assessed. Results: Procedure success (≤30% residual stenosis) was achieved in 84.4% of treated lesions; adjunctive stenting was required in 6 (3.7%) of the 162 lesions. The 1-year primary patency rate was 75.0% (IC patients 78.2% and CLI patients 67.5%, p=0.118). The freedom from major amputation in both cohorts was 100%. In both IC and CLI patients, significant improvements were demonstrated at 1 year in the Rutherford category, walking distance, and quality of life in comparison to baseline. Conclusion: This study indicates that directional atherectomy in popliteal arteries leads to favorable technical and clinical results at 1 year for claudicant as well as CLI patients.
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Affiliation(s)
- Aljoscha Rastan
- 1 Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - James F McKinsey
- 2 Division of Vascular Surgery, Mount Sinai Health Care System, New York, NY, USA
| | - Lawrence A Garcia
- 3 Sections of Interventional Cardiology and Vascular Medicine, Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Michael R Jaff
- 5 VasCore, Massachusetts General Hospital, Boston, MA, USA
| | - Stuart Harlin
- 6 Santa Rosa Medical Center, Vascular and Interventional Radiology, Pensacola, FL, USA
| | - Suraj Kamat
- 7 Alice Heart and Vascular Center, Alice, TX, USA
| | - Sean Janzer
- 8 Einstein Heart and Vascular Institute, Philadelphia, PA, USA
| | - Thomas Zeller
- 1 Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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21
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Endovascular treatment of atherosclerotic popliteal artery disease based on dynamic angiography findings. J Vasc Surg 2017; 65:82-90. [DOI: 10.1016/j.jvs.2016.05.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/02/2016] [Indexed: 11/19/2022]
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Schumann S, Gökgöl C, Diehm N, Büchler P, Zheng G. Effect of Stent Implantation on the Deformations of the Superficial Femoral Artery and Popliteal Artery: In Vivo Three-Dimensional Deformational Analysis from Two-Dimensional Radiographs. J Vasc Interv Radiol 2017; 28:142-146. [DOI: 10.1016/j.jvir.2016.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/31/2016] [Accepted: 04/19/2016] [Indexed: 12/22/2022] Open
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Gökgöl C, Schumann S, Diehm N, Zheng G, Büchler P. In Vivo Quantification of the Deformations of the Femoropopliteal Segment: Percutaneous Transluminal Angioplasty vs Nitinol Stent Placement. J Endovasc Ther 2016; 24:27-34. [PMID: 28095767 DOI: 10.1177/1526602816677530] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To quantify the deformations of the femoropopliteal (FP) segment in patients undergoing endovascular revascularization and to compare the posttreatment deformations caused by primary nitinol stent implantation to those produced by percutaneous transluminal angioplasty (PTA). METHODS Thirty-five patients (mean age 69±10 years; 20 men) scheduled for endovascular therapy were recruited for the study. During endovascular interventions, angiographic images were acquired with the legs straight and with a hip/knee flexion of 20°/70°. Image acquisition was performed before PTA for all patients, after PTA in 17 patients receiving this treatment only, and after primary stent implantation in the remaining 18 patients. A semiautomatic approach was used to reconstruct the 3-dimensional patient-specific artery models from 2-dimensional radiographs. Axial shortening and curvature changes in the arteries in vivo were calculated for the calcified, dilated, and stented regions, as well as the regions that were distal and proximal to the diseased and treated segments. RESULTS Leg flexion resulted in shortening of the artery in all investigated FP segments. The dilated arteries exhibited greater shortening compared with their stented counterparts (post-PTA 7.6%±4.9%, poststent 3.2%±2.9%; p=0.004). Leg flexion also led to an increase in the curvatures of all the sections of the FP segment. While stented arteries had significantly higher curvature values than PTA within the regions proximal to the treated sections, the choice of the treatment method did not affect the curvature of the other segments. Despite this, 40% of the stented arteries exhibited kinking during leg flexion. CONCLUSION The choice of the treatment method affects the postinterventional axial deformations of the FP segment but does not influence the curvature behavior. While PTA results in a more flexible artery, stents restrict the arteries' shortening capabilities. Depending on the anatomical position of the stents, this axial stiffening of the arteries may lead to chronic kinking, which may cause occlusions and, consequently, affect the long-term success of the procedure.
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Affiliation(s)
- Can Gökgöl
- 1 Institute for Surgical Technology & Biomechanics, University of Bern, Switzerland
| | - Steffen Schumann
- 1 Institute for Surgical Technology & Biomechanics, University of Bern, Switzerland
| | - Nicolas Diehm
- 2 Clinical and Interventional Angiology, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Guoyan Zheng
- 1 Institute for Surgical Technology & Biomechanics, University of Bern, Switzerland
| | - Philippe Büchler
- 1 Institute for Surgical Technology & Biomechanics, University of Bern, Switzerland
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Choi G, Cheng CP. Quantification of In Vivo Kinematics of Superficial Femoral Artery due to Hip and Knee Flexion Using Magnetic Resonance Imaging. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0116-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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Gökgöl C, Diehm N, Nezami FR, Büchler P. Nitinol Stent Oversizing in Patients Undergoing Popliteal Artery Revascularization: A Finite Element Study. Ann Biomed Eng 2015; 43:2868-80. [PMID: 26101031 DOI: 10.1007/s10439-015-1358-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/09/2015] [Indexed: 11/26/2022]
Abstract
Nitinol stent oversizing is frequently performed in peripheral arteries to ensure a desirable lumen gain. However, the clinical effect of mis-sizing remains controversial. The goal of this study was to provide a better understanding of the structural and hemodynamic effects of Nitinol stent oversizing. Five patient-specific numerical models of non-calcified popliteal arteries were developed to simulate the deployment of Nitinol stents with oversizing ratios ranging from 1.1 to 1.8. In addition to arterial biomechanics, computational fluid dynamics methods were adopted to simulate the physiological blood flow inside the stented arteries. Results showed that stent oversizing led to a limited increase in the acute lumen gain, albeit at the cost of a significant increase in arterial wall stresses. Furthermore, localized areas affected by low Wall Shear Stress increased with higher oversizing ratios. Stents were also negatively impacted by the procedure as their fatigue safety factors gradually decreased with oversizing. These adverse effects to both the artery walls and stents may create circumstances for restenosis. Although the ideal oversizing ratio is stent-specific, this study showed that Nitinol stent oversizing has a very small impact on the immediate lumen gain, which contradicts the clinical motivations of the procedure.
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Affiliation(s)
- Can Gökgöl
- Institute for Surgical Technology & Biomechanics, University of Bern, Bern, Switzerland
| | - Nicolas Diehm
- Clinical and Interventional Angiology, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
- University of Applied Sciences Furtwangen, Villingen-Schwenningen, Germany.
| | - Farhad Rikhtegar Nezami
- Institute for Surgical Technology & Biomechanics, University of Bern, Bern, Switzerland
- Harvard-MIT Biomedical Engineering Center, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Philippe Büchler
- Institute for Surgical Technology & Biomechanics, University of Bern, Bern, Switzerland
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