Department of Mechanical Engineering, University of California, Berkeley, Calif., USA.
J Vasc Surg. 2013 Sep;58(3):804-13. doi: 10.1016/j.jvs.2013.03.052. Epub 2013 Jul 17.
The purpose of this study was to review the available literature regarding the biomechanics of the superficial femoral artery (SFA) and popliteal artery (PA) in patients with peripheral arterial disease (PAD). Stents are one of many available therapies used to treat patients with PAD. Because stents are permanent implants, they undergo a variety of deformations as patients go about their daily activities such as walking, sitting in a chair, or climbing stairs. As a part of the marketing application for United States Food and Drug Administration approval, stents need to be evaluated for long-term durability under a variety of loading modes. The information available in the literature provides direction for such evaluation.
We performed a literature search of the PubMed database looking for "key vessel" and "mechanics" (all fields) or "deformation" (all fields) or "flexion" (all fields) or "mechanical environment" (all fields) or "tortuosity" (all fields) or "dynamics" (all fields) or "forces" (all fields), where the "key vessel" was "Femoral Artery," "Superficial Femoral Artery," "Popliteal Artery," and "Femoropopliteal."
Using a decision tree, we found 12 relevant articles that focused solely on the nonradial cyclic deformations associated with musculoskeletal motion. Despite the many limitations associated with combining these studies, we learned that under walking conditions, the proximal and mid-SFA deforms, on average, by shortening in the axial direction 4.0%, by twisting 2.1°/cm, and by bending 72.1 mm; the distal SFA and proximal PA deform by shortening in the axial direction 13.9%, by twisting 3.5°/cm, and by being pinched such that the aspect ratio of the lumen changes 4.6%. The distal PA deforms by shortening in the axial direction 12.3%, by twisting 3.5°/cm, by bending 22.1 mm, and by being pinched such that the aspect ratio of the lumen changes 12.5%.
A review of the current literature reveals heterogeneous study designs that confound interpretation. Studies included different physiologic settings from young to mature participants, participants with and without disease, and cadavers. Investigators used a range of imaging modalities and definitions of arterial segments, which affected our ability to compile the data as we learned that deformations vary according to the specific anatomic location within the SFA/PA. As a result of this analysis, we identified design considerations for future studies, because although this work has been valuable and significant, there are many limitations with the currently available data such that all we know about the SFA/PA environment is that we don't know.
本研究旨在回顾有关周围动脉疾病（PAD）患者股浅动脉（SFA）和腘动脉（PA）生物力学的现有文献。支架是治疗 PAD 患者的众多可用疗法之一。由于支架是永久性植入物，因此患者在进行日常活动（如行走、坐在椅子上或爬楼梯）时会经历各种变形。作为美国食品和药物管理局批准的营销申请的一部分，需要根据各种加载模式评估支架的长期耐用性。文献中提供的信息为这种评估提供了方向。
我们对 PubMed 数据库进行了文献检索，使用“关键血管”和“力学”（所有字段）或“变形”（所有字段）或“弯曲”（所有字段）或“机械环境”（所有字段）或“扭曲”（所有字段）或“动力学”（所有字段）或“力”（所有字段），其中“关键血管”为“股动脉”、“股浅动脉”、“腘动脉”和“股腘动脉”。
使用决策树，我们找到了 12 篇仅关注与骨骼肌肉运动相关的非径向循环变形的相关文章。尽管结合这些研究存在许多限制，但我们了解到，在行走条件下，近端和中段 SFA 分别轴向缩短 4.0%，扭曲 2.1°/cm，弯曲 72.1mm；远端 SFA 和近端 PA 轴向缩短 13.9%，扭曲 3.5°/cm，被夹扁，使管腔的纵横比变化 4.6%。远端 PA 轴向缩短 12.3%，扭曲 3.5°/cm，弯曲 22.1mm，管腔的纵横比变化 12.5%。
对当前文献的回顾揭示了混淆解释的异质研究设计。研究包括来自年轻到成熟参与者、有和没有疾病的参与者以及尸体的不同生理环境。研究人员使用了一系列成像方式和动脉节段的定义，这影响了我们编译数据的能力，因为我们了解到变形根据 SFA/PA 内的特定解剖位置而变化。由于这项分析，我们确定了未来研究的设计考虑因素，因为尽管这项工作具有价值和重要性，但目前可用数据存在许多限制，以至于我们对 SFA/PA 环境的了解仅限于我们不知道的内容。
