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Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

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Page 1: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

Imaging the Stented Superficial Femoral Artery:

Fracture Analysis

John Karwowski, MDAssistant Professor

Division of Vascular Surgery

Page 2: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

The Superficial Femoral Artery

Supplies the leg below the knee

Straight line conduit

Page 3: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

The Superficial Femoral Artery

Prone to atherosclerosis and occlusion

Page 4: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

Stent Failure

In-stent restenosis De facto primary failure

mode of SFA stenting Flow Compromise Thrombosis

Page 5: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

Intimal Hyperplasia

Injury response Cellular mediated Pathologic

narrowing

J Invasive Cardiol 2003

Page 6: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

Stent Fractures

Unclear contribution Severe recoil of the

original lesion? Mobile and free

superficial femoral artery?

Cause or coincidence?

Page 7: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

Classification

Page 8: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

Current Methods

FluoroscopyHi definition X-ray

Not validatedDifficult to reproduce

Page 9: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery
Page 10: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery
Page 11: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery
Page 12: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery
Page 13: Imaging the Stented Superficial Femoral Artery: Fracture Analysis John Karwowski, MD Assistant Professor Division of Vascular Surgery

Open Cell Units