Purpose: To quantify the in vivo deformations of
the popliteal artery during leg flexion in subjects with clinically relevant
peripheral artery disease (PAD).
Methods: Five patients (4 men; mean age 69 years,
range 56–79) with varying calcification levels of the popliteal artery
undergoing endovascular revascularization underwent 3-dimensional (3D)
rotational angiography. Image acquisition was performed with the leg straight
and with a flexion of 708/208 in the knee/hip joints. The arterial centerline
and the corresponding branches in both positions were segmented to create 3D
reconstructions of the arterial trees. Axial deformation, twisting, and
curvatures were quantified. Furthermore, the relationships between the
calcification levels and the deformations were investigated.
Results: An average shortening of
5.9%±2.5% and twist rate of 3.8±2.28/cm in the
popliteal artery were observed. Maximal curvatures in the straight and flexed
positions were 0.12±0.04 cm−1 and 0.24±0.09
cm−1, respectively. As the severity of calcification
increased, the maximal curvature in the straight position increased from 0.08 to
0.17 cm−1, while an increase from 0.17 to 0.39
cm−1 was observed for the flexed position. Axial
elongations and arterial twisting were not affected by the calcification
levels.
Conclusion: The popliteal artery of patients with
symptomatic PAD is exposed to significant deformations during flexion of the
knee joint. The severity of calcification directly affects curvature, but not
arterial length or twisting angles. This pilot study also showed the ability of
rotational angiography to quantify the 3D deformations of the popliteal artery
in patients with various levels of calcification.
HirschATHaskalZJHertzerNR. ACC/AHA 2005 guidelines for the
management of patients with peripheral arterial disease (lower extremity,
renal, mesenteric, and abdominal aortic): executive summary a collaborative
report from the American Association for Vascular Surgery/Society for
Vascular Surgery, Society for Cardiovascular Angiography and Interventions,
Society for Vascular Medicine and Biology, Society of Interventional
Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing
Committee to Develop Guidelines for the Management of Patients With
Peripheral Arterial Disease) endorsed by the American Association of
Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood
Institute; Society for Vascular Nursing; TransAtlantic Inter-Society
Consensus; and Vascular Disease Foundation.
Circulation.
2006;113:e463–654.
2.
NorgrenLHiattWRDormandyJA. Inter-Society Consensus for the
Management of Peripheral Arterial Disease (TASC II).
J Vasc Surg. 2007;45 Suppl S:
S5–67.
3.
MintzGSKentKMPichardAD. Contribution of inadequate arterial
remodeling to the development of focal coronary artery stenoses. An
intravascular ultrasound study.
Circulation.
1997;95:1791–1798.
4.
SchwartzRSTopolEJSerruysPW. Artery size, neointima, and
remodeling: time for some standards. J Am Coll
Cardiol.
1998;32:2087–2094.
5.
SangiorgiGTaylorAJFarbA. Histopathology of post percutaneous
transluminal coronary angioplasty remodeling in human coronary
arteries. Am Heart J.
1999;138(4 Pt
1):681–687.
6.
SchillingerMMinarE.
Past, present, and future of femoropopliteal
stenting. J Endovasc Ther.
2009;16(Suppl
I):I147–I152.
7.
SchillingerMSabetiSLoeweC. Balloon angioplasty versus
implantation of nitinol stents in the superficial femoral
artery. N Engl J Med.
2006;354:1879–1888.
8.
DudaSHBosiersMLammerJ. Sirolimus-eluting versus bare nitinol
stent for obstructive superficial femoral artery disease: the SIROCCO II
trial. J Vasc Interv Radiol.
2005;16:331–338.
SolisJAllaqabandSBajwaT.
A case of popliteal stent fracture with pseudoaneurysm
formation. Catheter Cardiovasc Interv.
2006;67:319–322.
11.
LallyCDolanFPrendergastPJ.
Cardiovascular stent design and vessel stresses: a finite
element analysis. J Biomech.
2005;38:1574–1581.
12.
DiehmNSinSHoppeH. Computational biomechanics to
simulate the femoropopliteal intersection during knee flexion: a preliminary
study. J Endovasc Ther.
2011;18:388–396.
13.
KleinAJChenSJMessengerJC. Quantitative assessment of the
conformational change in the femoropopliteal artery with leg
movement. Catheter Cardiovasc Interv.
2009;74:787–798.
14.
ChengCPChoiGHerfkensRJ. The effect of aging on deformations
of the superficial femoral artery resulting from hip and knee flexion:
potential clinical implications. J Vasc Interv
Radiol.
2010;21:195–202.
15.
SmouseHNikanorovA.
Biomechanical forces in the femoropopliteal arterial
segment. Endovascular Today.
2005;June.
16.
NikanorovASmouseHBOsmanK. Fracture of self-expanding nitinol
stents stressed in vitro under simulated intravascular
conditions. J Vasc Surg.
2008;48:435–440.
17.
ChengCPWilsonNMHallettRL. 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.
18.
ChoiGChengCPWilsonNM. Methods for quantifying
three-dimensional deformation of arteries due to pulsatile and nonpulsatile
forces: implications for the design of stents and stent
grafts. Ann Biomed Eng.
2009;37:14–33.
19.
SpearmanC.
The proof and measurement of association between two things.
By C. Spearman, 1904. Am J Psychol.
1987;100:441–471.
20.
EarlyMKellyDJ.
The role of vessel geometry and material properties on the
mechanics of stenting in the coronary and peripheral
arteries. Proc Inst Mech Eng H.
2010;224:465–476.
21.
EarlyMKellyDJ.
The consequences of the mechanical environment of peripheral
arteries for nitinol stenting. Med Biol Eng
Comput.
2011;49:1279–1288.
22.
HarveySM.
Nitinol stent fatigue in a peripheral human artery subjected
to pulsatile and articulation loading. J Mat Eng
Perform.
2011;20:697–705.
