Numerical assessment of arterial punch method and arterial reconstruction in femoral endarterectomy

Abstract

Purpose

Endarterectomy, typically in patients with peripheral artery disease, involves arteriotomy closure with a ‘patch.’ One of its most common long-term complications is restenosis due to arterial wall hyperplasia induced by excessive mechanical stimulation. Methods to reduce surgically induced stress to promote positive long-term outcomes remain an open question.

Methods

In this work, an arterial ‘punch’ approach is proposed to alleviate the stress concentration in arterial walls around the incision/patch anastomotic interface. Intraoperatively, coronary vascular punches are used to create proximal and distal circular arteriotomies for patients undergoing femoral endarterectomy. The surgical procedure is numerically simulated by first opening the vessel wall and subsequently adjusting the boundary condition of the incision to consider the patch’s effect. An optimization study is performed by investigating the impact of incision/patch combinations on arterial wall stresses. The optimal punch tip size is identified by obtaining the minimum in-plane principal stress in the arterial wall. A beveled punched hole is also considered to optimize the stress field.

Results

Simulation results show that the stress magnitude in the arterial wall with a punched hole is significantly lower than that in an artery with a sharp vertex. The stress exponentially declines with increasing punch diameter. A beveled hole can further reduce the stress values and the number of high-stress regions.

Conclusion

The arterial punch method can effectively alleviate stress concentration in arterial tissues. Importantly, stress concentration is shown to be sensitive to punched hole size and shape, suggesting potential practical implications for surgical techniques and patient outcomes.