title: Stent fractures in the Hemobahn/Viabahn stent graft after endovascular popliteal aneurysm repair.
abstract: OBJECTIVE
  During the last decade, endovascular repair of popliteal artery aneurysms (PAAs) has become a valid alternative to open repair. This study analyzes the incidence and origin of stent graft fractures after endovascular repair, its impact on patency, and strategies to prevent fractures.
  
  
  METHODS
  Data of 78 atherosclerotic PAAs in 64 patients were gathered in a prospectively-held database from 1998 to 2009. All x-rays were reviewed to detect stent fractures. Only circumferential fractures were included for analysis; localized strut fractures were excluded. Clinical endpoints were circumferential stent fracture, occlusion, and clinical status of the patient.
  
  
  RESULTS
  Mean follow-up time was 50 months (range, 1-127 months). Fifteen circumferential stent fractures occurred in 13 (16.7%) patients. The majority of stent fractures (93.3%) were associated with the use of multiple stent grafts. At univariate analysis, younger age was identified as the only significant predictor for stent fracture (P = .007). The cumulative stent fracture-free survival was estimated at 78% and 73% at 5- and 10-year follow-up, respectively. The cumulative primary patency rate, defined as time to occlusion, was not different for the fracture group compared with the nonfracture group (P = .284).
  
  
  CONCLUSIONS
  The incidence of stent fractures after endovascular PAA repair is probably underreported in the literature. Stent graft fractures mainly occur at overlap zones and are associated with younger age of the patient. Fracture of the stent did not significantly influence patency of the stent graft.
authors.affiliation: Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, Groningen, The Netherlands. i.tielliu@chir.umcg.nl
authors.forename: Ignace F J
authors.initials: IF
authors.lastname: Tielliu
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
authors.forename: George
authors.initials: G
authors.lastname: Vourliotakis
authors.forename: Foppe
authors.initials: F
authors.lastname: Bekkema
authors.forename: Jan J A M
authors.initials: JJ
authors.lastname: van den Dungen
authors.forename: Ted R
authors.initials: TR
authors.lastname: Prins
authors.forename: Eric L G
authors.initials: EL
authors.lastname: Verhoeven
mesh_terms: D000367:Age Factors; D000368:Aged; D000783:Aneurysm / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011150:Popliteal Artery / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency