Unit of Vascular and Endovascular Surgery, San Giovanni - Addolorata Hospital, Rome, Italy -
Unit of Vascular and Endovascular Surgery, San Giovanni - Addolorata Hospital, Rome, Italy.
J Cardiovasc Surg (Torino). 2024 Oct;65(5):482-489. doi: 10.23736/S0021-9509.24.13071-6. Epub 2024 Sep 17.
The aim of this study was to report the results of a single-centre experience with a new generation balloon expandable stent-graft (Viabahn VBX; W. L. Gore & Associates, Flagstaff, AZ, USA) as bridging stent in branched endovascular aortic repair (B-EVAR).
This is a retrospective single institution analysis of a prospectively maintained database. All patients undergone implantation of at least one VBX as bridging stent in B-EVAR over the last 5 years (from July 1, 2018, to November 31, 2023) were included. Primary outcomes were technical success, primary and secondary stent patency rate, branch-related reinterventions, and branch instability. Secondary outcomes were clinical success, mortality, and rate of aortic-related reinterventions.
This study involved 40 patients for a total of 147 VBX stent-grafts implanted in 141 target vessels as bridging stents in B-EVAR (62.5% off-the-shelf and 37.5% custom made devices; 65% with outer branches and 35% with inner branches) for the treatment of 38 (95%) degenerative and 2 (5%) postdissection aneurysms. In 28 cases (70%) a total transfemoral approach was used to deliver the bridging stents. Technical success was 100%. No target vessel was lost intraoperatively. Over a median follow-up of 26.5 months (range 0-74), primary and secondary patency, branch-related reintervention, and branch instability were 98.5% (139/141), 99.3% (140/141), 15% (6/40), and 4.9% (7/141), respectively. Four of the 7 cases of branch instability, all requiring an endovascular correction, were secondary to type Ic endoleak. Clinical success was 97.5% as effect of 1 perioperative death. During the follow-up other 6 patients died, contributing to an overall survival rate of 82.5%. The overall rate of aortic-related reinterventions was 20%.
Despite further evaluation is mandatory to determine durability of the VBX in the long-term after B-EVAR, in our experience VBX demonstrated a high flexibility and trackability, excellent stent retention, and outstanding patency over time. A generous distal landing of the bridging stent into the target vessel should be always achieved, whereas possible, to reduce the risk of type Ic endoleak, which seems to be the main cause of branch instability.
本研究旨在报告新一代球囊扩张式覆膜支架（Viabahn VBX；W. L. Gore & Associates，Flagstaff，AZ，美国）作为分支腔内主动脉修复（B-EVAR）中的分支支架的单中心经验结果。
这是一项回顾性单中心前瞻性数据库分析。纳入过去 5 年（2018 年 7 月 1 日至 2023 年 11 月 31 日）期间，至少植入 1 枚 VBX 作为 B-EVAR 中分支支架的所有患者。主要结局为技术成功率、一级和二级支架通畅率、分支相关再干预和分支不稳定。次要结局为临床成功率、死亡率和主动脉相关再干预率。
本研究共纳入 40 例患者，共植入 147 枚 VBX 覆膜支架，作为 B-EVAR 中的分支支架（62.5%为现成产品，37.5%为定制产品；65%为外分支，35%为内分支），治疗 38 例（95%）退行性和 2 例（5%）夹层后动脉瘤。28 例（70%）采用全股动脉入路输送分支支架。技术成功率为 100%。术中无靶血管丢失。中位随访 26.5 个月（0-74 个月），一级和二级通畅率、分支相关再干预率和分支不稳定率分别为 98.5%（141/141）、99.3%（140/141）、15%（6/40）和 4.9%（7/141）。4 例（7/141）分支不稳定，均需血管内矫正，均为 Ic 型内漏所致。临床成功率为 97.5%，1 例围手术期死亡。随访期间其他 6 例患者死亡，总体生存率为 82.5%。主动脉相关再干预率为 20%。
尽管进一步评估是必要的，以确定 VBX 在 B-EVAR 后的长期通畅性，但根据我们的经验，VBX 表现出高度的灵活性和可跟踪性、优异的支架保留和随时间推移的出色通畅性。应始终将分支支架的远侧端充分植入靶血管，以降低 Ic 型内漏的风险，这似乎是分支不稳定的主要原因。
