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Popliteal Artery Entrapment Syndrome: A Rare Cause of Interwoven Nitinol Stent Fracture After Femoropopliteal Interventions.

ABSTRACT: Stent fractures have been described after femoropopliteal interventions with relevant clinical sequelae, including restenosis and reocclusion. We report 2 cases of fractures of a novel interwoven nitinol stent with high radial strength and fracture resistance as a result of entrapment syndrome of the popliteal artery. (Level of Difficulty: Advanced.).

SUBMITTER: Wittig T

PROVIDER: S-EPMC9175198 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Popliteal Artery Entrapment Syndrome: A Rare Cause of Interwoven Nitinol Stent Fracture After Femoropopliteal Interventions.

Wittig Tim T Steiner Sabine S Schmidt Andrej A Scheinert Dierk D Branzan Daniela D

JACC. Case reports 20220406 7

Stent fractures have been described after femoropopliteal interventions with relevant clinical sequelae, including restenosis and reocclusion. We report 2 cases of fractures of a novel interwoven nitinol stent with high radial strength and fracture resistance as a result of entrapment syndrome of the popliteal artery. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 35693898

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The Supera Interwoven Nitinol Stent as a Flow Diverting Device in Popliteal Aneurysms.

Project description:PurposeThe feasibility of using a compressed interwoven Supera stent as a flow diverting device for popliteal aneurysms was recently demonstrated in patients. It is unclear, however, what the optimal flow diverting strategy is, because of the fusiform shape of popliteal aneurysms and their exposure to triphasic flow. To assess this flow diverting strategy for popliteal aneurysms, flow profiles and thrombus formation likelihood were investigated in popliteal aneurysm models.Materials and methodsSix popliteal aneurysm models were created and integrated into a pulsatile flow set-up. These models covered a bent and a straight anatomy in three configurations: control, single-lined and dual-lined Supera stents. Two-dimensional flow velocities were visualized by laser particle image velocimetry. In addition, the efficacy of the stent configurations for promoting aneurysm thrombosis was assessed by simulations of residence time and platelet activation.ResultsOn average for the two anatomies, the Supera stent led to a twofold reduction of velocities in the aneurysm for single-lined stents, and a fourfold reduction for dual-lined stents. Forward flow was optimally diverted, whereas backward flow was generally deflected into the aneurysm. The dual-lined configuration led to residence times of 15-20 s, compared to 5-15 s for the single stent configurations. Platelet activation potential was not increased by the flow diverting stents.ConclusionA compressed Supera stent was successfully able to divert flow in a popliteal aneurysm phantom. A dual-lined configuration demonstrated superior hemodynamic characteristics compared to its single-lined counterpart.

| S-EPMC9117362 | biostudies-literature

Calcified nodule progression-related stent thrombosis after polymer-based paclitaxel-eluting nitinol stent implantation for femoropopliteal artery.

Project description: Not available

| S-EPMC8358290 | biostudies-literature

Clinics in diagnostic imaging (187). Popliteal artery entrapment syndrome (PAES) Type II.

Project description:A 26-year-old male patient was referred for exercise-induced claudication that had interfered with his military duties for the past two years. He was an occasional smoker with no other significant cardiovascular risk factors. Initial Doppler ultrasonography showed narrowing of the popliteal artery. Further evaluation with magnetic resonance angiography demonstrated a short segment occlusion of the popliteal artery secondary to an anomalous origin of the medial head of the gastrocnemius muscle from the lateral femoral condyle. Based on the clinical presentation and imaging findings, he was diagnosed with popliteal artery entrapment syndrome. In this article, we discussed the typical presenting signs and symptoms of popliteal artery entrapment syndrome, the different imaging modalities available to aid diagnosis, classification of the condition and the available treatment options.

| S-EPMC6024217 | biostudies-literature

Popliteal Artery Entrapment Syndrome in a Young Baseball Pitcher: A Case Report.

Project description:Background:Popliteal artery entrapment syndrome (PAES) is a rare disease in young adults and is thought to be under-diagnosed, and its main cause is the abnormal structure between the popliteal artery and gastrocnemius muscle. The patients experience symptoms after the blood vessels are compressed. Failure to diagnose and treat PAES can cause serious sequelae. Case:A 19-year-old male baseball pitcher with PAES type 2 suffered from left calf muscle tension and foot numbness and was mis-diagnosed for nearly a year. Finally, the lesion was detected by ultrasonography and confirmed by magnetic resonance imaging. After surgical intervention, he quickly returned to sport. Discussion/Conclusion:PAES has 6 types. Type 2 (25%) and type 3 (30%) are the most common. Patients with this syndrome suffer from aching pain, numbness, and cramping in the calf area when they exercise. It is necessary to include this disease in differential diagnosis to implement early diagnosis, and ultrasonography is a more cheap and simple method for early detection.

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Femoropopliteal Artery Stent Thrombosis: Report From the Excellence in Peripheral Artery Disease Registry.

Project description:BackgroundThere are limited data on femoropopliteal artery stent thrombosis (ST), which is a serious adverse outcome of peripheral artery interventions.Methods and resultsIndex procedures resulting in femoropopliteal ST were compared with stent procedures without subsequent ST in the Excellence in Peripheral Artery Disease registry. The study data had a total of 724 cases of stent procedures and 604 unique patients. Femoropopliteal ST occurred in 26 of 604 patients (4.3%) over a median follow-up of 6 months post procedure. ST was more likely to occur in men (96.3% versus 82.2%; P=0.026) and to have an initial intervention for chronic total occlusions (88.5% versus 64.0%; P=0.01). There was no significant difference in ST between drug-coated and bare-metal stents (4.4% versus 3.4%; P=0.55), but the rate of ST was significantly higher with self-expanding covered stent grafts compared with bare-metal stents (10.6% versus 3.4%; P=0.02). ST was significantly associated with an increased risk of 12-month major adverse limb events (hazard ratio, 4.99; 95% confidence interval, 2.31-10.77; P<0.001) compared with no ST. On multivariate analysis, treatment of chronic total occlusion lesions (odds ratio, 3.46; 95% confidence interval, 0.98-12.20; P=0.05) and in-stent restenosis lesions (odds ratio, 5.30; 95% confidence interval, 1.83-15.32; P=0.002) were independently associated with an increased risk of ST.ConclusionsIn a multicenter peripheral interventional registry, femoropopliteal ST occurred in 4.3% of patients who underwent stent procedures, and it was associated with treatment of chronic total occlusions and in-stent restenosis lesions, and had higher 12-month major adverse limb events.Clinical trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01904851.

| S-EPMC4743556 | biostudies-literature

Axillary Artery Entrapment After Neck of Humerus Fracture.

Project description: Not available

| S-EPMC6265522 | biostudies-literature

Heterogeneous vascular response after implantation of bare nitinol self-expanding stents in the swine femoropopliteal artery.

Project description:BackgroundMechanism of femoropopliteal in-stent restenosis has been underappreciated.AimThe aim of this animal study was to elucidate vascular response after femoropopliteal bare nitinol self-expanding stents (SESs) implantation.MethodsMisago, Smart Flex, or Innova stent was randomly implanted in 36 swine femoropopliteal arteries. At week 4, quantitative vessel analysis (QVA) was performed on 36 legs, of which 18 underwent histological evaluation after angiography. The remaining 18 legs underwent QVA and histological evaluation at week 13.ResultsFibrin deposition was excessive at week 4. Internal elastic lamina (IEL) progressively enlarged over time, and vessel injury developed from mild level at week 4 to moderate level at week 13. Vessel inflammatory reaction was mild to moderate at week 4, and was moderate to severe at week 13. Increased fibrin deposition was an early-acting, IEL enlargement and increased vessel inflammation were long-acting, and increased vessel injury and giant cells infiltration were late-acting contributors to neointimal hyperplasia (NIH). Stent type altered time-dependent process of vessel injury, vessel inflammation, eosinophils and giant cells infiltration. Misago had less fibrin deposition and vessel enlargement, and less progressive vessel injury, vessel inflammation, and eosinophils and giant cells infiltration. Net lumen as assessed by percent diameter stenosis or minimum lumen diameter was preserved with Misago, but was not preserved with the other stents.ConclusionsIn the context of bare nitinol SES platform with less progressive mechanical stress and inflammatory reaction, the advantage of less NIH outweighed the disadvantage of less vessel enlargement, leading to net lumen preservation.

| S-EPMC10020252 | biostudies-literature

Multiple Stent Delivery System "Multi-LOC": Focal self-expanding nitinol stenting of complex femoropopliteal lesions-A monocenter feasibility pilot study.

Project description:AimsThe Multiple Stent Delivery System (VascuFlex® Multi-LOC) is a novel stent delivery system with six short stents (13 mm long each) mounted on one wire-guided catheter, designed for the treatment of femoropopliteal arteries. The aim of the present study is to evaluate the safety and the feasibility of the VascuFlex® "Multi-LOC" stent delivery system, which enables spot stenting without changing the delivery system.Methods and resultsAfter proof of concept in a porcine model and after European Conformity marking, first clinical experiences were gathered in 20 patients with severe intermittent claudication or critical limb ischemia. First-in-human data are presented. The study included 20 limbs that underwent femoropopliteal revascularization for claudication (n = 14) or critical limb ischemia (n = 6). "Multi-LOC" provisional spot stenting resulted in acute technical success in all lesions with resolution of flow-limiting dissection and elastic recoil after balloon dilatation of the femoropopliteal artery. There were no device-related complications. Follow-up examinations after 30 to 40 days revealed no major adverse events, and six months' results were encouraging.ConclusionsFirst clinical use of the novel Multiple Stent Delivery System (Multi-LOC) after balloon dilatation of the femoropopliteal artery was safe and feasible in this early study.

| S-EPMC6322090 | biostudies-literature

A case complicated by floating fractured stent 141 months after nitinol stent implantation in the superficial femoral artery.

Project description:An 80-year-old man received the implantation of a self-expanding stent (Luminexx, Bard, Inc., Murray Hill, NJ, USA) for an in-stent restenosis (ISR) lesion in the superficial femoral artery. However, angiography 141 months after the Luminexx stent implantation showed 90% ISR and a floating fractured stent in the Luminexx site. Furthermore, the floating fractured stent strut itself was completely separated and flowed toward the posterior tibial artery. The stent strut was removed by a catheter for removing intravascular foreign substances. <Learning objective: We report a case of a floating fractured stent 141 months after stent implantation in the superficial femoral artery (SFA). Although this case is rare, in endovascular therapy with stenting for SFA, it is necessary to consider the risk of stent fracture in the very late phase.>.

| S-EPMC6334535 | biostudies-literature

Korean Multicenter Registry of ELUVIA Stent for Femoropopliteal Artery Disease: K-ELUVIA Registry.

Project description:Background and objectivesThe K-ELUVIA study aimed to investigate the clinical effectiveness and safety of Eluvia™, a polymer-coated, paclitaxel-eluting stent, for femoropopliteal artery disease using data from a prospective Korean multicenter registry.MethodsA total of 105 patients with femoropopliteal artery disease who received endovascular treatment (EVT) with Eluvia™ stents at 7 Korean sites were enrolled in a prospective cohort and followed for 2 years. The primary endpoint was the 2-year clinical patency. The secondary endpoint was 2-year freedom from clinically driven target lesion revascularization (TLR).ResultsMean patient age was 68.2±10.4 years, and most patients (82.7%) were male. Mean lesion length was 168.3±117.6 mm. Chronic total occlusion was found in 57.7% of patients. Trans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) type C or D lesions were present in 46.1% of patients. Procedural success was achieved in 99.0% of patients. The clinical patency rate was 84.4% at 1 year after EVT and 76.3% at 2 years post-EVT. The freedom from TLR rate was 89.1% at 1 year after EVT and 79.1% at 2 years post-EVT. Chronic total occlusion (hazard ratio [HR], 3.53; 95% confidence interval [CI], 1.08-11.67; p=0.039) and smaller mean stent diameter (HR, 0.40; 95% CI, 0.16-0.98; p=0.044) were identified as independent predictors of loss of clinical patency at 2 years.ConclusionsThe K-ELUVIA study demonstrated favorable 2-year clinical effectiveness and safety outcomes of Eluvia stent for femoropopliteal artery lesions in real-world practice.

| S-EPMC11361770 | biostudies-literature

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