Limb flexion-induced axial compression and bending in human femoropopliteal artery segments

Poulson, William; Kamenskiy, Alexey; Seas, Andreas; Deegan, Paul; Lomneth, Carol; MacTaggart, Jason N.

doi:10.1016/j.jvs.2017.01.071

Cited by 77 publications

(71 citation statements)

References 26 publications

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“…In addition, FPA deformation magnitudes experienced with limb flexion, and therefore the loading conditions for the benchtop tests, have not been completely understood and quantified. Recent data on axial compression, bending and torsion of the FPA in walking, sitting and gardening postures (Desyatova et al, 2017; MacTaggart et al, 2014; Poulson et al, 2017), demonstrate that values of FPA deformations used for current stent design and preclinical testing(Ansari et al, 2013), may be significantly underestimated, potentially contributing to poor clinical performance of many FPA stents.…”

Section: Introductionmentioning

confidence: 99%

Comparison of femoropopliteal artery stents under axial and radial compression, axial tension, bending, and torsion deformations

Maleckis

Deegan

Poulson

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

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High failure rates of Peripheral Arterial Disease (PAD) stenting appear to be associated with the inability of certain stent designs to accommodate severe biomechanical environment of the femoropopliteal artery (FPA) that bends, twists, and axially compresses during limb flexion. Twelve Nitinol stents (Absolute Pro, Supera, Lifestent, Innova, Zilver, Smart Control, Smart Flex, EverFlex, Viabahn, Tigris, Misago, and Complete SE) were quasi-statically tested under bench-top axial and radial compression, axial tension, bending, and torsional deformations. Stents were compared in terms of force-strain behavior, stiffness, and geometrical shape under each deformation mode. Tigris was the least stiff stent under axial compression (6.6, N/m axial stiffness) and bending (0.1 N/m) deformations, while Smart Control was the stiffest (575.3 N/m and 105.4 N/m, respectively). Under radial compression Complete SE was the stiffest (892.8 N/m), while Smart Control had the lowest radial stiffness (211.0 N/m). Viabahn and Supera had the lowest and highest torsional stiffness (2.2 µN·m/° and 959.2 µN·m/°), respectively. None of the 12 PAD stents demonstrated superior characteristics under all deformation modes and many experienced global buckling and diameter pinching. Though it is yet to be determined which of these deformation modes might have greater clinical impact, results of the current analysis may help guide development of new stents with improved mechanical characteristics.

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Section: Introductionmentioning

confidence: 99%

Comparison of femoropopliteal artery stents under axial and radial compression, axial tension, bending, and torsion deformations

Maleckis

Deegan

Poulson

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

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“…4 Poulson et al . 99 reported 9–25% axial compression and 8–27 mm bending radii of the FPA as a result of limb flexion, and Desyatova et al . 30 reported 8– 26°/cm twist depending on posture.…”

Section: Femoropopliteal Artery Obstructive Diseasementioning

confidence: 98%

“…1c) were endovascularly deployed in the limbs of human cadavers without disturbing the surrounding tissues, and used to measure axial compression, bending, and twist of the artery with limb flexion. 73,99 Markers did not have any sizable effect on FPA deformations, yet allowed accurate and repeatable measurements. The advantage of using markers as opposed to arterial side branches was that branches are frequently small and difficult to identify using clinical CT or MR, which leaves large segments of the FPA with unknown deformations.…”

Section: Femoropopliteal Artery Obstructive Diseasementioning

confidence: 99%

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Nitinol Stents in the Femoropopliteal Artery: A Mechanical Perspective on Material, Design, and Performance

et al. 2018

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Endovascular stenting has matured into a commonly used treatment for peripheral arterial disease (PAD) due to its minimally invasive nature and associated reductions in short-termmorbidity and mortality. The mechanical properties of the superelastic Nitinol alloy have played a major role in the explosion of peripheral artery stenting, with modern stents demonstrating reasonable resilience and durability. Yet in the superficial femoral and popliteal arteries, even the newest generation Nitinol stents continue to demonstrate clinical outcomes that leave significant room for improvement. Restenosis and progression of native arterial disease often lead to recurrence of symptoms and reinterventions that increase morbidity and health care expenditures. One of the main factors thought to be associated with stent failure in the femoropopliteal artery (FPA) is the unique and highly dynamic mechanical environment of the lower limb. Clinical and experimental data demonstrate that the FPA undergoes significant deformations with limb flexion. It is hypothesized that the inability of many existing stent designs to conform to these deformations likely plays a role in reconstruction failure, as repetitive movements of the leg and thigh combine with mechanical mismatch between the artery and the stent and result in mechanical damage to both the artery and the stent. In this review we will identify challenges and provide a mechanical perspective of FPA stenting, and then discuss current research directions with promise to provide a better understanding of Nitinol, specific features of stent design, and improved characterization of the biomechanical environment of the FPA to facilitate development of better stents for patients with PAD.

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“…Previously characterized modes of FPA deformation include radial and longitudinal compression, bending and torsion [14,16]. A recent study [9] summarized the historical values of these deformations, data largely based on the analysis of in vivo three-dimensional measurements with magnetic resonance imaging (MRI) [17,18] and angiography with threedimensional modelling [19].…”

Section: Introductionmentioning

confidence: 99%

Limb flexion-induced twist and associated intramural stresses in the human femoropopliteal artery

Desyatova

Poulson

Deegan

et al. 2017

J. R. Soc. Interface.

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High failure rates of femoropopliteal artery (FPA) interventions are often attributed to severe mechanical deformations that occur with limb movement. Torsion of the FPA likely plays a significant role, but is poorly characterized and the associated intramural stresses are currently unknown. FPA torsion in the walking, sitting and gardening postures was characterized in n ¼ 28 in situ FPAs using intra-arterial markers. Principal mechanical stresses and strains were quantified in the superficial femoral artery (SFA), adductor hiatus segment (AH) and the popliteal artery (PA) using analytical modelling. The FPA experienced significant torsion during limb flexion that was most severe in the gardening posture. The associated mechanical stresses were non-uniformly distributed along the length of the artery, increasing distally and achieving maximum values in the PA. Maximum twist in the SFA ranged 10-138 cm 21, at the AH 8-168 cm 21, and in the PA 14-268 cm 21 in the walking, sitting and gardening postures. Maximum principal stresses were 30-35 kPa in the SFA, 27-37 kPa at the AH and 39-43 kPa in the PA. Understanding torsional deformations and intramural stresses in the FPA can assist with device selection for peripheral arterial disease interventions and may help guide the development of devices with improved characteristics.

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Limb flexion-induced axial compression and bending in human femoropopliteal artery segments

Cited by 77 publications

References 26 publications

Comparison of femoropopliteal artery stents under axial and radial compression, axial tension, bending, and torsion deformations

Comparison of femoropopliteal artery stents under axial and radial compression, axial tension, bending, and torsion deformations

Nitinol Stents in the Femoropopliteal Artery: A Mechanical Perspective on Material, Design, and Performance

Limb flexion-induced twist and associated intramural stresses in the human femoropopliteal artery

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