PMC6541903_01
Pre-operative imaging. Radiographs showing (A) the posterior dislocation of the polyethylene insert (green star) and (B) computed tomography angiography cross section, showing the polyethylene insert in the popliteal fossa, surrounded by fluid, and compressing the popliteal artery, which is occluded (red arrowhead).
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Radiographs (Fig. 1A) showed posterior dislocation of the polyethylene insert. Computed tomography angiography (Fig. 1B) revealed occlusion of the popliteal artery (PA) due to the compression by the polyethylene component.
Peripheral artery images pre- and post-endovascular therapy (EVT) and after removal. Angiography (A) after thrombectomy showing suboptimal result and hypoperfusion. Angiography after popliteal stenting (B) and anterior tibial angioplasty. Post-operative radiograph (C) showing the stent implantation. Gross picture (D) and high resolution Faxitron radiographic image (E) of the left popliteal artery seven days after EVT (the sample was fixed in 10% buffered formalin.
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Tigris  vascular stent (Gore , Flagstaff USA) 5 mm diameter, 100 mm long stent and a 5 mm diameter, 100 mm long Ultraverse  Bard  balloon catheter was used to post-dilate the stent (Fig. 2A-C). Following amputation, the stent and PA were removed and submitted for histological analysis to rule out compression (Fig. 2D and E).
Pathological findings of stented segment in the superficial femoral artery (haematoxylin and eosin stain). The vessel with the stent was dehydrated and embedded in Spurr resin, sectioned every 3-4 mm, ground by the Exakt method, and stained with haematoxylin and eosin. Multiple sections were examined by light microscopy. Low power images of sequential sections (A-E) of the stent are shown in the top row, whereas the high power images are shown from A-1 - E-1 in the bottom row. The stent is well expanded with a round shape in all sections (A-E). Moderate luminal thrombus is observed in photomicrographs A-1 - E-1, whereas extraluminal thrombus is seen in photomicrographs (A-1 - D-1). Inflammation within the thrombus was present focally (as seen in E-1). Grey arrowheads point to the fluoropolymer mesh (A-1 - E-1). Focal malapposition was observed in sections A - D and shown with blue double arrows in sections A-1 - D-1. The underlying plaque showed dissection (A, B, and B-1) due to endovascular treatment with trapped blood (green arrowhead). The vessel wall showed the presence of focal areas of medial calcifications (C1). Ca = calcium; Th = thrombus.
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Malapposed struts were observed in the proximal portion of the vessel, with almost 50% of struts malapposed (Fig. 3).