The Use of Stents in the Treatment of Intimal Flaps: An Experimental Study

Abstract

The routine use of arteriography and duplex scan in arterial trauma has improved the diagnosis of asymptomatic arterial lesions. Specifically, in cases of blunt arterial lesions, intimal flap is the most frequent type of occult arterial trauma and usually follows an arterial contusion. Treatment of traumatic intimal lesions is controversial owing to its unknown natural history. Current therapeutic options include arterial reconstruction and clinical observation. The development of angioplasty catheters and stents has opened a new venue for the treatment of intimal flaps. The goal of this study was to evaluate the efficacy of endoprosthesis in the prevention of arterial thrombosis following traumatic intimal flap. The study was performed on 12 female mongrel dogs weighing more than 15 kg each. The common (CF) and superficial (SF) femoral arteries were exposed from the inguinal region to the midportion of the thigh in both posterior limbs. The SF was first crushed with a hemostatic forceps to induce a severe arterial contusion. A longitudinal arteriotomy of 2 cm was performed distal to the clamp site. A 5 mm deep intimal flap was than created along the 2 cm segment. The arterial wall was than sutured with prolene 7-0. The same procedure was performed on both SF. One of the arteries was randomized to receive a Palmaz Stent while the other was kept untreated for control. After 3 weeks, palpation, ultrasound Doppler and macroscopic studies were performed on both arteries to determine whether the arterial lumen was occluded or not. All arteries treated with stents were patent after 3 weeks, while five of the 12 untreated arteries were occluded (p < 0.05). Large intimal flaps are potentially thrombogenic. The use of stents is a good alternative in this situation, preventing arterial thrombosis, in the first 3 weeks after the trauma.