Invited commentary

Abstract

Given that the superficial femoral and popliteal arteries look fairly straight when a patient is lying supine on a fluoroscopy table, the temptation to view this arterial segment as one long biomechanical continuum seems somewhat understandable. However, Poulson et al have adeptly reminded us that this is not necessarily the case. With the use of an innovative system of nitinol markers deployed along the course of cadaveric femoral and popliteal arteries, these authors have depicted the significant deformations that take place during the course of normal daily activities. Poulson et al are not the first to demonstrate that the femoropopliteal arteries shorten, elongate, bend, buckle, and twist. Numerous prior researchers have done that using three-dimensional magnetic resonance angiography, three-dimensional computed tomography angiography, and fluoroscopy, in combination with finite-element analysis.1Ansari F. Pack L.K. Brooks S.S. Morrison T.M. Designed considerations for studies of the biomechanical environment of the femoropopliteal arteries.J Vasc Surg. 2013; 58: 804-813Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 2Ghriallais R.N. Bruzzi M. Effects of knee flexion on the femoropopliteal artery: a computation of study.Med Eng Phys. 2013; 35: 1620-1628Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 3Fortier A. Gullapalli V. Mirshams R.A. Review of biomechanical studies of arteries and their effect on stent performance.IJC Heart Vessels. 2014; 4: 12-18Abstract Full Text Full Text PDF Scopus (52) Google Scholar However, the current study does emphasize just how inhomogeneous and severe these strains can be, particularly at sites where arteries are fixed to surrounding structures, such as descending geniculate branches, the adductor canal, and popliteal bifurcation. Although the femoropopliteal arteries in the current study came from older donors, the arteries were relatively free of atherosclerosis. It would be quite interesting to see the effect of calcification, atherosclerotic thickening, and the presence of one or even multiple overlapping stents on the motion of these arteries. Manufacturers have made some progress with regard to stents specifically designed for the femoropopliteal environment. However, we also need to advance our clinical knowledge (eg, the correct stent for the correct segment, the optimal degree of overlap, if any), because there is much room for improvement in the way we use these stents. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Limb flexion-induced axial compression and bending in human femoropopliteal artery segmentsJournal of Vascular SurgeryVol. 67Issue 2PreviewHigh failure rates of femoropopliteal artery (FPA) interventions are often attributed in part to severe mechanical deformations that occur with limb movement. Axial compression and bending of the FPA likely play significant roles in FPA disease development and reconstruction failure, but these deformations are poorly characterized. The goal of this study was to quantify axial compression and bending of human FPAs that are placed in positions commonly assumed during the normal course of daily activities. Full-Text PDF Open Archive