Performance of the Gore VBX Balloon Expandable Endoprosthesis as Bridging Stent-Graft in Branched Endovascular Aortic Repair for Thoracoabdominal Aneurysms

Abstract

Purpose Bridging stent stability is crucial for efficacy and safety of branched aortic endovascular repair (bEVAR) of thoracoabdominal aortic aneurysms (TAAAs). In this study, we assess the performance of the new Viabahn Balloon-Expandable endoprosthesis (VBX) in bEVAR. Based on our learning curve we give recommendations for a safe and effective use of the device. Materials and Methods We prospectively collected the data of patients with TAAAs undergoing bEVAR between December 2017 and December 2019. All patients with implantation of at least 1 VBX stent-graft as bridging stent were included in our single-center analysis. Demographic, comorbidity, and computed tomography angiography (CTA) data of 112 patients were retrospectively evaluated. Primary endpoint was a composite of branch-related technical success and freedom from target vessel instability. Secondary endpoints were clinical and ongoing clinical success. Results Primary endpoint: technical success was achieved in all patients (100%) with a freedom from target vessel instability of 96.3% after a median follow-up of 18 months. Overall mortality was 13.4% (n=15) and 13 patients underwent secondary interventions, 12 of them are still alive and 1 suffered from aneurysm sac expansion, consequently an ongoing clinical success of 75.9% was reached. After modification of the implantation technique during the course of the study by selecting longer stent lengths after accurate estimation of vessel curvature and expected adaptation of the flexible endoskeleton to the specific anatomical conditions, no type Ic endoleaks were observed in the last 70 cases. Conclusions The VBX stent-graft can be safely used as bridging stent for branched thoracoabdominal repair. However, learning curve should be considered to avoid type Ic endoleak and edge stenosis. Based on this experience longer landing zones and 2-step deployment of VBX are useful for successful bridging also of challenging target vessels.

Meta-analysis of Comparative Studies Between Self- and Balloon-Expandable Bridging Stent Grafts in Branched Endovascular Aneurysm Repair

“…34 Regarding BESGs, the available experience has shown high primary patency rate achieving 100% with low endoleak and re-intervention rate. 18,35 Currently available literature has shown that both stent types can be safely and effectively applied during BEVAR, and this meta-analysis is in accordance with the primary patency and endoleak rates of the literature in both stent types. However, the role of relining and its impact on patency need further investigation.…”

“…6 TV instability was defined a composite outcome used to define any death or rupture related to side branch complication, including occlusion, device migration affecting any branch, branch-related sac growth or any secondary intervention indicated to treat a branch-related complication, including endoleak, disconnection, kink, stenosis, occlusion, or rupture. 16 -18 Re-intervention was considered any secondary intervention after the completion of the main intervention that was related to TV complications.…”

Efficacy and Safety of Endovascular Fenestrated and Branched Grafts vs open Surgery in Thoracoabdominal Aortic Aneurysm Repair

“…After removing duplicates, 606 records were retrieved. Papers were screened and selected, as illustrated in Figure 1 (477 records were excluded after the title and abstract screening, 6 reports were not retrieved in full text, and 59 were excluded with reasons), resulting in 64 papers meeting our defined inclusion criteria 10,23–85 . Characteristics of the included studies are reported in Supplemental Table S1 (Supplemental Digital Content 1, http://links.lww.com/SLA/E987).…”

“…Studies (n = 64) were published between 2006 and 2021, with over 15% (n = 11, 17,2%) published in the last 3 years. 29,37,49,51,54,60,65,72,74,81,82 The majority of the studies (n = 28, 43,8%) were conducted in Europe (Italy, n = 12; Germany, n = 7; Netherlands, n = 3; Portugal, n = 1; France, n = 3; United Kingdom, n = 2) 23,[26][27][28][29]31,43,[45][46][47][48][49][50][51]54,[56][57][58][59]64,66,70,72,76,82,84 and in the USA (n = 27, 42,2%). 10,24,25,32,33,35--40,52,53,60-63,65,67,68,71,73,75,77,79,81,85 Five studies were conducted in Japan, 44,69,78,80,83 two in Brazil, 41,42 one in Canada, 74 and one in Serbia.…”

One-year results of a balloon expandable endoprosthesis as a bridging stent for branched endovascular aortic repair

“…A previous study about the employment of VBX stents in BEVAR demonstrated the existence of a learning curve to achieve the best results, and thus, reducing the risk of stent dislodgement and type Ic endoleak. 12 This subcohort assessment from the post-market, multicenter, prospective registry aims to assess the performance of the VBX stent used as a BSG for the treatment of visceral vessels during BEVAR.…”