The Role of Endovascular Stents in an Experimental Model of Traumatic Arterial Occlusion – the Temporary Endo-Shunt

Abstract

Background: The aim of this study was to evaluate patency following the deployment of a bare-metal stent (BMS) or covered stent (CS) across a traumatic occlusive peripheral arterial lesion and to estimate the feasibility of urgent stent placement for temporary endovascular shunting. Methods: Fifteen sheep (25–45 kg) underwent laparoscopic creation of a left external iliac artery (EIA) thrombosis by means of repeated clamping. Sixty minutes after achievement of thrombotic occlusion, animals were randomized into one of three groups: no-treatment (control group), a BMS group, or CS group. Animals were followed up for 30 days with no anticoagulants or anti-platelet drugs administered postoperatively. Doppler ultrasound, computed tomography angiography (CTA), and digital subtraction angiography (DSA) were used to evaluate EIA patency. Results: Stent implantation resulted in the restoration of in-line flow through the EIA in all cases. The peak systolic velocity (PSV) in the injured limb increased from 10 (0–16) to 31 (28–37) cm/s in the BMS group (p < 0.0001) and from 15 (7–18) to 24 (21–29) cm/s in the CS group (p = 0.043) immediately after stent deployment (both p = 0.001 compared with the control group). There was no difference in the PSV between the groups at post-injury day 3, and thereafter. Day-14 CTA and day-30 DSA demonstrated only one patent stent in each study group. Conclusions: Urgent stent (BMS or CS) implantation can restore arterial patency of a traumatic occlusion for a short period of time and serve as a temporary endovascular shunt. Distal embolization can complicate this procedure and worsen long-term patency.

Keywords

• Vascular Trauma
• Occlusion
• Covered Stent
• Bare Metal Stent
• Recanalization
• Endovascular Trauma Management