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Exaggerated arterial curves due to endovascular interventions: Novel concept that describes how curves in the arterial wall affect the formation of neointimal hyperplasia, and explains why the long-term results of endovascular interventions are inferior to the long-term results of open surgical procedures

Amr Salem
Medical Hypotheses 2019, 125: 25-27
30902146
Despite the vast advancement made in endovascular practice, it is still lacking the long-term success of open surgery in treating critical limb ischemia. In Bypass surgery excess length of the graft is cut to straighten it between the arterial anastomoses to avoid any excess length, in order to make sure that there will be no curves, but in endovascular approach this option is not available. In endovascular procedures, there are factors affecting negatively the long-term results. These factors contribute to excess length of the arterial wall, which is exaggerated after balloon dilatation. With deployment of stent, the stent straightens the arterial segment, so any extra length shifts proximal and distal to this segment leading to exaggeration of curves in arterial wall which affect hemodynamics of blood flow leading to neointimal hyperplasia and restenosis even at the edges of stent. This explains neointimmal hyperplasia and restenosis at the edges of stent graft although its edges are landing on a normal artery. New solution for this durability problem of endovascular procedures is to avoid excess length. It can be achieved through a kind of stent that abolishes curves from the arterial tree.

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