Stent Design Affects Femoropopliteal Artery Deformation

Jason N Mactaggart, William Poulson, Andreas Seas, Paul Deegan, Carol Lomneth, Anastasia Desyatova, Kaspars Maleckis, Alexey Kamenskiy

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background:Poor durability of femoropopliteal artery (FPA) stenting is multifactorial, and severe FPA deformations occurring with limb flexion are likely involved. Different stent designs result in dissimilar stent-artery interactions, but the degree of these effects in the FPA is insufficiently understood. Objectives:To determine how different stent designs affect limb flexion-induced FPA deformations.Methods:Retrievable markers were deployed into n = 28 FPAs of lightly embalmed human cadavers. Bodies were perfused and CT images were acquired with limbs in the standing, walking, sitting, and gardening postures. Image analysis allowed measurement of baseline FPA foreshortening, bending, and twisting associated with each posture. Markers were retrieved and 7 different stents were deployed across the adductor hiatus in the same limbs. Markers were then redeployed in the stented FPAs, and limbs were reimaged. Baseline and stented FPA deformations were compared to determine the influence of each stent design.Results:Proximal to the stent, Innova, Supera, and SmartFlex exacerbated foreshortening, SmartFlex exacerbated twisting, and SmartControl restricted bending of the FPA. Within the stent, all devices except Viabahn restricted foreshortening; Supera, SmartControl, and AbsolutePro restricted twisting; SmartFlex and Innova exacerbated twisting; and Supera and Viabahn restricted bending. Distal to the stents, all devices except AbsolutePro and Innova exacerbated foreshortening, and Viabahn, Supera, Zilver, and SmartControl exacerbated twisting. All stents except Supera were pinched in flexed limb postures.Conclusions:Peripheral self-expanding stents significantly affect limb flexion-induced FPA deformations, but in different ways. Although certain designs seem to accommodate some deformation modes, no device was able to match all FPA deformations.

Original languageEnglish (US)
Pages (from-to)180-187
Number of pages8
JournalAnnals of surgery
Volume270
Issue number1
DOIs
StatePublished - Jul 1 2019

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Stents
Arteries
Extremities
Posture
Equipment and Supplies
Gardening
Cadaver
Walking

Keywords

  • bending
  • deformations
  • femoropopliteal artery
  • foreshortening
  • limb flexion
  • pinching
  • stenting
  • twisting

ASJC Scopus subject areas

  • Surgery

Cite this

Stent Design Affects Femoropopliteal Artery Deformation. / Mactaggart, Jason N; Poulson, William; Seas, Andreas; Deegan, Paul; Lomneth, Carol; Desyatova, Anastasia; Maleckis, Kaspars; Kamenskiy, Alexey.

In: Annals of surgery, Vol. 270, No. 1, 01.07.2019, p. 180-187.

Research output: Contribution to journalArticle

Mactaggart, JN, Poulson, W, Seas, A, Deegan, P, Lomneth, C, Desyatova, A, Maleckis, K & Kamenskiy, A 2019, 'Stent Design Affects Femoropopliteal Artery Deformation', Annals of surgery, vol. 270, no. 1, pp. 180-187. https://doi.org/10.1097/SLA.0000000000002747
Mactaggart JN, Poulson W, Seas A, Deegan P, Lomneth C, Desyatova A et al. Stent Design Affects Femoropopliteal Artery Deformation. Annals of surgery. 2019 Jul 1;270(1):180-187. https://doi.org/10.1097/SLA.0000000000002747
Mactaggart, Jason N ; Poulson, William ; Seas, Andreas ; Deegan, Paul ; Lomneth, Carol ; Desyatova, Anastasia ; Maleckis, Kaspars ; Kamenskiy, Alexey. / Stent Design Affects Femoropopliteal Artery Deformation. In: Annals of surgery. 2019 ; Vol. 270, No. 1. pp. 180-187.
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AU - Lomneth, Carol

AU - Desyatova, Anastasia

AU - Maleckis, Kaspars

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AB - Background:Poor durability of femoropopliteal artery (FPA) stenting is multifactorial, and severe FPA deformations occurring with limb flexion are likely involved. Different stent designs result in dissimilar stent-artery interactions, but the degree of these effects in the FPA is insufficiently understood. Objectives:To determine how different stent designs affect limb flexion-induced FPA deformations.Methods:Retrievable markers were deployed into n = 28 FPAs of lightly embalmed human cadavers. Bodies were perfused and CT images were acquired with limbs in the standing, walking, sitting, and gardening postures. Image analysis allowed measurement of baseline FPA foreshortening, bending, and twisting associated with each posture. Markers were retrieved and 7 different stents were deployed across the adductor hiatus in the same limbs. Markers were then redeployed in the stented FPAs, and limbs were reimaged. Baseline and stented FPA deformations were compared to determine the influence of each stent design.Results:Proximal to the stent, Innova, Supera, and SmartFlex exacerbated foreshortening, SmartFlex exacerbated twisting, and SmartControl restricted bending of the FPA. Within the stent, all devices except Viabahn restricted foreshortening; Supera, SmartControl, and AbsolutePro restricted twisting; SmartFlex and Innova exacerbated twisting; and Supera and Viabahn restricted bending. Distal to the stents, all devices except AbsolutePro and Innova exacerbated foreshortening, and Viabahn, Supera, Zilver, and SmartControl exacerbated twisting. All stents except Supera were pinched in flexed limb postures.Conclusions:Peripheral self-expanding stents significantly affect limb flexion-induced FPA deformations, but in different ways. Although certain designs seem to accommodate some deformation modes, no device was able to match all FPA deformations.

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