Long-term results of the heparin-bonded Viabahn stent graft in femoropopliteal TASC C and D lesions with a covered stent length of minimum 25 cm

Abstract

Background Heparin-bonded covered stent grafts (Viabahn) are used to treat femoropopliteal long-segment arteriosclerotic lesions. The aim of this study was to evaluate the long-term outcome of Viabahn grafts with a covered stent length of minimum 25 cm. Methods We conducted a retrospective analysis of patients receiving a heparin-bonded stent graft in our clinic who met the length criteria between July 2010 and March 2018. Primary endpoints were patency rates, limb salvage and survival after five years. Secondary endpoint was the 30-day outcome including early complications. Results A total of 62 patients (45 male, median age 70.5 years) were included. The median arteriosclerotic lesion length was 25 cm (22.0–41.3 cm), the minimum covered stent length was 25 cm (25–46 cm). All lesions were TASC C and D lesions. The 30-day mortality was 0%, an early stent graft occlusion occurred in 8.1%. A major amputation was performed in 1.6%. Primary patency, primary assisted patency, secondary patency, limb salvage and survival were 38.5%, 45.7%, 52.4%, 92.8% and 68.9% after five years. Distal stent graft end below the femoral condyles and critical limb ischemia was associated with a significant decreased survival. The diameter of the stent had no influence on the outcome. Conclusion The Viabahn stent graft for long segment arteriosclerotic lesions is a feasible treatment with adequate long-term results.

Distal Endarterectomy Combined With Endovascular Proximal Treatment: The Hybrid DEEP Retrograde Technique for High-Complexity Infrainguinal Disease

“…Heparin-bonded stent-graft (Viabahn, Gore) has the advantages of better patency than bare stents and a noticeable biodynamic performance. 17 –19 However, it shares the general limitations of all EVT and worse results have been described when facing long lesions (>25 cm-Viabahn), 17 heavily calcified, 20 or if the distal end of the VB lands below femoral condyles (39.7% BK vs 82.5% AK) 17 1-year patency and 34% BK vs 10% AK amputation rate. 21…”

“…Heparin-bonded stent-graft (Viabahn, Gore) has the advantages of better patency than bare stents and a noticeable biodynamic performance. [17][18][19] However, it shares the general limitations of all EVT and worse results have been described when facing long lesions (>25 cm-Viabahn), 17 heavily calcified, 20 or if the distal end of the VB lands below femoral condyles (39.7% BK vs 82.5% AK) 17 1-year patency and 34% BK vs 10% AK amputation rate. 21 We decided to use the VB endoprosthesis to apply the endo-bypass concept, because the possibility of performing the ¨pave and crack¨ technique and due to its ease of handling that allows us to tailoring its distal end.…”

Trans-popliteal hybrid retrograde technique for revascularization of chronic total occlusions of the superficial femoral artery

“…VB has shown excellent results in the femoropopliteal sector but shares common EVT limitations: When 25-cm-length endoprosthesis is used in TASC C and D lesions, its patency rates decrease to 67% at one year 19 , 20 and to 38.5% at five years of follow-up. 21 It is also remarkably associated with significant residual stenosis rates related to severe calcification (24.1% of stenosis between 30 and 50%). 4 , 22…”