Pavarino Felipe L, Figueroa Andres V, Tanenbaum Mira T, Pizano Alejandro, Porras-Colon Jesus, Baig Mirza S, Kirkwood Melissa, Timaran Carlos H
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
J Vasc Surg. 2025 Jan;81(1):38-45. doi: 10.1016/j.jvs.2024.08.063. Epub 2024 Sep 5.
The optimal bridging stent for fenestrations during complex endovascular aortic aneurysm repair (EVAR) has not been defined. At our institution, the Viabahn VBX is frequently used given its availability and mechanical and heparin-bonding characteristics. This study aimed to assess the performance of the Viabahn VBX vs the iCast balloon-expandable covered stents as bridging stents for fenestrations during complex EVAR.
A retrospective study of consecutive patients undergoing complex EVAR between 2015 and 2021 was performed. Celiac arteries (CAs), superior mesenteric arteries (SMAs), left renal arteries, and right renal arteries stented with fenestrations were grouped according to the type of bridging stent, VBX vs iCast. Target vessels (TV) stented with a branch or scallop were excluded. The primary end points included primary patency and freedom from TV instability.
A total of 292 patients undergoing complex EVAR were treated using VBX or iCast with a mean follow-up of 190 days (interquartile range, 36-384 days) for the VBX cohort and 804 days (interquartile range, 384-1507 days) for the iCast cohort. A total of 677 TVs were stented, including 134 CAs (20%), 175 SMAs (26%), 182 left RAs (27%), 186 right RAs (27%), and 12 additional vessels (2%). Proximal reinforcement was more frequent with VBX than with iCast stent (23% vs 2.4%; P < .0001). There was no difference in primary patency rates at 2 years between VBX and iCast stent for CA (100% vs 96.4%; P = .32), SMA (97.8% vs 100%; P = .14), and the RAs (96.7% vs 99.4%; P = .11). There was no difference between VBX and iCast in the cumulative incidence of type Ic and type IIIc endoleaks (3.2% vs 5.6%; P = .69) or freedom from TV instability at 2 years.
Viabahn VBX stents are a safe and effective option as bridging stents in fenestrations during complex EVAR with comparable midterm outcomes to iCast stents. However, proximal stent reinforcement may be required with VBX stent to ensure adequate sealing at the fenestrations. Longer follow-ups and larger series are required to assess long-term outcomes and durability.
在复杂的血管腔内主动脉瘤修复术（EVAR）中，用于开窗的最佳桥接支架尚未明确。在我们机构，鉴于Viabahn VBX的可得性及其机械和肝素结合特性，其被频繁使用。本研究旨在评估Viabahn VBX与iCast球囊扩张式覆膜支架作为复杂EVAR开窗桥接支架的性能。
对2015年至2021年间连续接受复杂EVAR的患者进行回顾性研究。根据桥接支架类型（VBX与iCast），将有开窗的腹腔干动脉（CAs）、肠系膜上动脉（SMAs）、左肾动脉和右肾动脉进行分组。排除使用分支或扇贝形支架的目标血管（TV）。主要终点包括初始通畅率和无TV不稳定。
共有292例接受复杂EVAR的患者使用了VBX或iCast，VBX队列的平均随访时间为190天（四分位间距，36 - 384天），iCast队列的平均随访时间为804天（四分位间距，384 - 1507天）。共对677条TV进行了支架置入，包括134条CAs（20%）、175条SMAs（26%）、182条左肾动脉（27%）、186条右肾动脉（27%）以及另外12条血管（2%）。VBX近端强化比iCast支架更频繁（23%对2.4%；P <.0001）。在2年时，VBX和iCast支架在CA（100%对96.4%；P =.32）、SMA（97.8%对100%；P =.14）和肾动脉（96.7%对99.4%；P =.11）的初始通畅率上没有差异。VBX和iCast在Ic型和IIIc型内漏的累积发生率（3.2%对5.6%；P =.69）或2年时无TV不稳定方面没有差异。
Viabahn VBX支架作为复杂EVAR开窗桥接支架是一种安全有效的选择，中期结果与iCast支架相当。然而，VBX支架可能需要近端支架强化以确保开窗处的充分密封。需要更长时间的随访和更大规模的系列研究来评估长期结果和耐久性。
