tent implantation in the peripheral arteries is a safe and effective treatment not only for obstructive diseases, but also non-obstructive conditions such as aneurysm formation. 1,2 More than 50% of all obstructive lesions are located in the femoropopliteal segment where they tend to be longer and have multiple coexisting atherosclerotic lesions at different levels. Surgical revascularization is the treatment of choice for these diffuse femoropopliteal stenoses and although percutaneous transluminal angioplasty (PTA) has a high risk of occlusion, it is the recommended primary treatment. Stent implantation for femoropopliteal occlusions is not recommended because of poor patency rates, and should only be considered for major dissections after PTA because stenting has been associated with acute thrombosis, stent embolization or migration, distal embolization by plaque contents, vessel rupture or dissection. [3][4][5][6] In addition to these acute complications, late stent restenosis remains an unresolved clinical problem. Although stent fracture occurs rarely, it may contribute to or cause late stent failure when implanted in arteries near or at flexion points in the peripheral arteries. Stent fracture has occurred after iliac arterial stenting 7 and we describe a case of fracture in overlapping stents implanted in the left popliteal artery.
Case ReportA 48-year-old man was referred for coronary and peripheral arteriography. He reported left calf claudication of 3 years' duration that had progressively worsened in the past few months. His complaints were pain and numbness with mild exercise. He had had non-insulin dependent diabetes mellitus for 1 year and had smoked 1 pack of cigarettes per day for 33 years. On physical examination, both his lower limbs were pale and cool. His left femoral pulse was present, but the left popliteal and left lower extremity pulses were absent. Right femoral and popliteal pulses were present, and the distal pulses in right lower extremity were also palpable. The ankle -brachial index was 0.32 for the left limb. There was not any ulcer formation related to occlusive arterial disease on either leg.The diagnostic coronary and peripheral arteriography revealed 2-vessel coronary artery disease: a severe stenosis in the proximal segment of the left popliteal artery and 50% narrowing of the right popliteal artery. There was late filling of the vasculature distal to the severely narrowed left popliteal artery (Fig 1). We used a standard angioplasty technique from an antegrade, ipsilateral puncture of the left common femoral artery with an 8F sheath. The lesion was crossed Circ J 2003; 67: 643 -645 (Received November 14, 2001; revised manuscript received January 21, 2002; accepted February 15, 2002
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