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Abstract

Purpose:

To report an unusual case of dramatic nitinol stent strut fractures with resultant complete loss of stent integrity in a cadaveric lower limb graft.

Case Report:

A 73-year-old man had the clinical stigmata of graft versus host response to a cadaveric femoral-tibioperoneal graft and suspected inflammation-induced stent corrosion culminating in fracture. The long continuous stented segment and station of the distal anastomosis below the knee resulted in preferential displacement of force to the proximal stent edge as the knee bends, making mechanical stress the most likely primary cause for these findings.

Conclusion:

This case provides insight into some of the unique mechanical issues in vessels traversing the knee joint and how the problem is amplified by increasing the distance between the knee (fulcrum) and the stented vessel (lever arm). This lever-arm effect would also apply to the native superficial femoral artery when vessel compliance is changed by multiple stents.

Keywords

femoral-tibioperoneal graft cadaveric graft graft failure nitinol stent stent fracture

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References

Gray

Sullivan

Childs

. High incidence of restenosis/reocclusion of stents in the percutaneous treatment of long-segment superficial femoral artery disease after suboptimal angioplasty. J Vasc Surg. 1997; 25: 74–83.

Sabeti

Mlekusch

Amighi

. Primary patency of long-segment self-expanding nitinol stents in the femoropopliteal arteries. J Endovasc Ther. 2005; 12: 6–12.

Schillinger

Sabeti

Loewe

. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006; 354: 1879–1888.

Duda

Pusich

Richter

. Sirolimus-eluting stents for the treatment of obstructive superficial femoral artery disease: Six-month results. Circulation. 2002; 106: 1505–1509.

Duda

Bosiers

Lammer

. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: Long-term results from the SIROCCO trial. J Endovasc Ther. 2006; 13: 701–710.

Stoeckel

Pelton

Duerig

. Self-expanding nitinol stents: Material and design considerations. Eur Radiol. 2004; 14: 292–301.

Heintz

Riepe

Birken

. Corroded nitinol wires in explanted aortic endografts: An important mechanism of failure? J Endovasc Ther. 2001; 8: 248–253.

Guidoin

Marois

Douville

. First-generation aortic endografts: Analysis of explanted Stentor devices from the EUROSTAR Registry. J Endovasc Ther. 2000; 7: 105–122.

Cragg

De Jong

Barnhart

. Nitinol intravascular stent: Results of preclinical evaluation. Radiology. 1993; 189: 775–778.

10.

Shih

Lin

Chen

. The cytotoxicity of corrosion products of nitinol stent wire on cultured smooth muscle cells. J Biomed Mater Res. 2000; 52: 395–403.

11.

van Rij

Solomon

Packer

. Chelation therapy for intermittent claudication. A double-blind, randomized, controlled trial. Circulation. 1994; 90: 1194–1199.

12.

Scheinert

Sax

. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol. 2005; 45: 312–315.

13.

Iida

Nanto

Uematsu

. Effect of exercise on frequency of stent fracture in the superficial femoral artery. Am J Cardiol. 2006; 98: 272–274.

14.

Arena

. Arterial kink and damage in normal segments of the superficial femoral and popliteal arteries abutting nitinol stents—a common cause of late occlusion and restenosis? A single-center experience. J Invasive Cardiol. 2005; 17: 482–486.

15.

Cheng

Wilson

Hallett

. In vivo MR angiographic quantification of axial and twisting deformations of the superficial femoral artery resulting from maximum hip and knee flexion. J Vasc Interv Radiol. 2006; 17: 979–987.

Late Complication of Stent Fragmentation Related to the “Lever-Arm Effect”