Unit of Vascular Surgery, University Hospital of Verona, Verona, Italy -
Division of Vascular and Endovascular Surgery, Department of Cardiovascular Surgery, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Trieste, Italy.
J Cardiovasc Surg (Torino). 2024 Aug;65(4):358-369. doi: 10.23736/S0021-9509.24.12977-1. Epub 2024 Apr 15.
Endovascular treatment is nowadays accepted as first-line treatment for most patients with aorto-iliac obstructive disease (AIOD), including those with Trans-Atlantic Inter-Society Consensus II (TASC-II) lesion types C and D. Aim of the study was to evaluate the role of Viabahn VBX (W. L. Gore and Associates, Flagstaff, AZ, USA), in patients with chronic occlusive aorto-iliac disease (ChO).
A retrospective review of patients undergone elective endovascular repair with VBX (W. L. Gore and Associates) for ChO at five referral vascular institutions in Italy from 2018 to 2022 was conducted. Primary endpoints were technical success and the incidence of any early and midterm procedure-related reintervention. Secondary endpoints were clinical success, primary and secondary patency.
Among 89 included patients, technical success was obtained in 87 patients (97.8%). Postoperative complication requiring early surgical reintervention was necessary in 5 (6%), all but one for arterial bleeding. Clinical improvement of at least 3 classes was observed in 49 (55%). After a mean follow-up of 24.1 months ±14.1, primary patency and freedom from any procedure-related reintervention at 12, 24 and 36 months was 83.0% and 94.8%, 80.0% and 91.5%, 77.9% and 89.3%, respectively. Secondary patency was 100%. TASC-II D lesion (OR=3.67, 95% CI: 1.1289-11.9823, P=0.03) and Grade III iliac calcification (OR=3.41, 95% CI: 1.0944-10.6428, P=0.03) were identified as independent predictors for procedure-related reintervention.
Use of VBX (W. L. Gore and Associates) in ChO was safe and effective with low rate of stenosis/occlusion in the early and mid-term follow-up. TASC-II D and Grade III calcifications resulted as independent predictors for procedure-related reintervention.
目前，血管内治疗被认为是大多数主动脉髂动脉阻塞性疾病（AIOD）患者的一线治疗方法，包括 Trans-Atlantic Inter-Society Consensus II（TASC-II）病变类型 C 和 D 的患者。本研究旨在评估 Viabahn VBX（W. L. Gore and Associates，Flagstaff，AZ，USA）在慢性阻塞性主动脉髂动脉疾病（ChO）患者中的作用。
对 2018 年至 2022 年期间，意大利五家转诊血管机构对 89 例接受 VBX（W. L. Gore and Associates）择期血管内修复治疗的 ChO 患者进行回顾性分析。主要终点是技术成功率和任何早期和中期与程序相关的再干预的发生率。次要终点是临床成功率、主、次通畅率。
在 89 例纳入的患者中，87 例（97.8%）获得了技术成功。术后需要早期手术再干预的并发症有 5 例（6%），均因动脉出血所致。49 例（55%）观察到至少 3 级的临床改善。平均随访 24.1 个月±14.1 后，12、24 和 36 个月时的主通畅率和无任何与程序相关的再干预的通畅率分别为 83.0%和 94.8%、80.0%和 91.5%、77.9%和 89.3%。次通畅率为 100%。TASC-II D 病变（OR=3.67，95%CI：1.1289-11.9823，P=0.03）和 III 级髂动脉钙化（OR=3.41，95%CI：1.0944-10.6428，P=0.03）被确定为与程序相关的再干预的独立预测因素。
在 ChO 中使用 VBX（W. L. Gore and Associates）是安全有效的，在早期和中期随访中狭窄/闭塞的发生率较低。TASC-II D 和 III 级钙化是与程序相关的再干预的独立预测因素。
