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Brendel JM, Mangold T, Pfändler M, Stenzl B, Andic M, Mück J, Schmehl J, Krumm P, Artzner C, Grözinger G, Estler A. Viabahn endoprosthesis for femoropopliteal aneurysm repair: safety, success rates, and long-term patency. CVIR Endovasc 2024; 7:53. [PMID: 38976091 PMCID: PMC11231120 DOI: 10.1186/s42155-024-00465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The Viabahn endoprosthesis has become a vital option for endovascular therapy, yet there is limited long-term data on its effectiveness for peripheral aneurysm repair. This study aimed to evaluate the safety, technical and clinical success, and long-term patency of the Viabahn endoprosthesis for treating femoropopliteal aneurysms. METHODS This retrospective tertiary single-center study analyzed patients who underwent a Viabahn endoprosthesis procedure for femoropopliteal aneurysm repair from 2010 to 2020. Intraoperative complications, technical and clinical success rates, and major adverse events (MAE, including acute thrombotic occlusion, major amputation, myocardial infarction, and device- or procedure-related death) at 30 days were assessed. Incidence of clinically-driven target lesion revascularisation (cdTLR) was noted. Patency rates were evaluated by Kaplan-Meier analysis. RESULTS Among 19 patients (mean age, 72 ± 12 years; 18 male, 1 female) who underwent aneurysm repair using the Viabahn endoprosthesis, there were no intraoperative adverse events, with 100% technical and clinical success rates. At the 30-day mark, all patients (19/19, 100%) were free of MAE. The median follow-up duration was 1,009 days [IQR, 462-1,466]. Popliteal stent graft occlusion occurred in 2/19 patients (10.5%) after 27 and 45 months, respectively. Consequently, the primary patency rates were 100%, 90%, 74% at 12, 24, and 36-72 months, respectively. Endovascular cdTLR was successful in both cases, resulting in sustained secondary patency at 100%. CONCLUSION The use of Viabahn endoprostheses for femoropopliteal aneurysm repair demonstrated technical and clinical success rates of 100%, a 0% 30-day MAE rate, and excellent long-term patency.
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Affiliation(s)
- Jan M Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Tobias Mangold
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany
| | - Markus Pfändler
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Benedikt Stenzl
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Mateja Andic
- Department of Thoracic and Cardiovascular Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Jonas Mück
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Jörg Schmehl
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | | | - Gerd Grözinger
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Arne Estler
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
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Brendel JM, Mangold T, Lescan M, Schmehl J, Ghibes P, Grimm A, Greulich S, Krumm P, Artzner C, Grözinger G, Estler A. Viabahn stent graft for arterial injury management: safety, technical success, and long-term outcome. CVIR Endovasc 2024; 7:23. [PMID: 38416319 PMCID: PMC10900043 DOI: 10.1186/s42155-024-00435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The Viabahn stent graft has emerged as an integral tool for managing vascular diseases, but there is limited long-term data on its performance in emergency endovascular treatment. This study aimed to assess safety, technical success, and long-term efficacy of the Viabahn stent graft in emergency treatment of arterial injury. METHODS We conducted a retrospective single tertiary centre analysis of patients who underwent Viabahn emergency arterial injury treatment between 2015 and 2020. Indication, intraoperative complications, technical and clinical success, and major adverse events at 30 days were evaluated. Secondary efficacy endpoints were the primary and secondary patency rates assessed by Kaplan-Meier analysis. RESULTS Forty patients (71 ± 13 years, 19 women) were analyzed. Indications for Viabahn emergency treatment were extravasation (65.0%), arterio-venous fistula (22.5%), pseudoaneurysm (10.0%), and arterio-ureteral fistula (2.5%). No intraoperative adverse events occurred, technical and clinical success rates were 100%. One acute stent graft occlusion occurred in the popliteal artery on day 9, resulting in a 30-day device-related major-adverse-event rate of 2.5%. Median follow-up was 402 days [IQR, 43-1093]. Primary patency rate was 97% (95% CI: 94-100) in year 1, and 92% (95% CI: 86-98) from years 2 to 6. One stent graft occlusion occurred in the external iliac artery at 18 months; successful revascularization resulted in secondary patency rates of 97% (95% CI: 94-100) from years 1 to 6. CONCLUSION Using Viabahn stent graft in emergency arterial injury treatment had 100% technical and clinical success rates, a low 30-day major-adverse-event rate of 2.5%, and excellent long-term patency rates.
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Affiliation(s)
- Jan M Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Tobias Mangold
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Jörg Schmehl
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Patrick Ghibes
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Antonia Grimm
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Simon Greulich
- Department of Cardiology and Angiology, Tübingen University Hospital, Tübingen, Germany
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | | | - Gerd Grözinger
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany.
| | - Arne Estler
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
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Warburton TM, Thomas SD, Holden A, Katib N, Varcoe RL. A Cost-Consequence Analysis Comparing Balloon-Expandable Covered Stents for the Management of Aortoiliac Occlusive Disease. J Endovasc Ther 2024:15266028241234001. [PMID: 38410837 DOI: 10.1177/15266028241234001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE To compare procedural and long-term costs associated with the use of Balloon-Expandable Covered Stents (BECS) in the management of Aortoiliac Occlusive Disease (AIOD). MATERIALS AND METHODS A cost-consequence model was developed to simulate the intra- and post-operative management of patients with AIOD from the perspective of private health-payers. The study assessed the costs of the LifeStream (BD, Franklin Lakes, New Jersey), iCAST/Advanta V12 (Getinge, Goteborg, Sweden), BeGraft Peripheral (Bentley, Hechingen, Germany), and Viabahn Balloon Expandable (VBX) (W.L. Gore, Flagstaff, Arizona) BECS devices. Device costs were identified from the Australian Prosthesis List, whereas clinical outcomes of BECS were estimated from a systematic review of the literature. Costs were calculated over 24 and 36 month time horizons and reported in US dollars. RESULTS Long-term, per-patient cost of each device at 24 and 36 months was $6253/$6634 for the LifeStream; $6359/$6869 for the iCAST/Advanta V12; $4806 (data available to 24 months) for the BeGraft Peripheral; and $4839/$5046 for the Viabahn VBX, respectively. Most of the cost difference was attributed to the number of stents required per treated limb and frequency of clinically-driven target lesion revascularization events. CONCLUSIONS Best-available clinical evidence and economic modeling demonstrates that the BeGraft Peripheral and Viabahn VBX were of similar cost and the least costly options at 24 months, whereas at 36 months, the lowest cost BECS option for the treatment of AIOD was the Viabahn VBX. CLINICAL IMPACT This analysis supports economically informed decision-making for health-payers managing systems that care for patients with AIOD. Stent length and avoiding reintervention were identified as key areas of cost-saving for future BECS development.
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Affiliation(s)
- Thomas M Warburton
- Department of Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Shannon D Thomas
- Department of Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Andrew Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Nedal Katib
- Department of Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, NSW, Australia
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Kirkwood ML, Armstrong EJ, Ansari MM, Holden A, Reijnen MMPJ, Steinbauer M, Crannell Z, Novoa H, Phillips A, Schneider DB. FORWARD Study of GORE VIABAHN Balloon-Expandable Endoprostheses and Bare Metal Stents in the United States, European Union, United Kingdom, Australia, and New Zealand When Placed to Treat Complex Iliac Occlusive Disease: Protocol for a Randomized Superiority Trial. JMIR Res Protoc 2023; 12:e51480. [PMID: 38048145 PMCID: PMC10728789 DOI: 10.2196/51480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The recommendations for the use of and selection of covered stent grafts in patients with aortoiliac occlusive disease are limited. OBJECTIVE The GORE VBX FORWARD clinical study aims to demonstrate the superiority of the GORE VIABAHN VBX Balloon Expandable Endoprosthesis (VBX device) for primary patency when compared to bare metal stenting (BMS) for the treatment of complex iliac artery occlusive disease. METHODS A prospective, multicenter, randomized control study in the United States, European Union, United Kingdom, Australia, and New Zealand will enroll patients with symptomatic, complex iliac artery occlusive disease. In this study, iliac artery occlusive disease is defined as a unilateral or bilateral disease with single or multiple lesions (with >50% stenosis or chronic total occlusion) each between 4 and 11 cm in length. In an attempt to more closely match real-world practices, patients with minor tissue loss (Rutherford class 5) and patients requiring hemodialysis will be included. Baseline aortoiliac angiography will be performed to assess target lesion characteristics and determine final patient eligibility. Once the patient is confirmed and guidewires are in place across the target lesions, the patient will be randomized in a 1:1 format to treatment with either the VBX device or a BMS. The BMS can be balloon- or self-expanding and must be approved for the iliac artery occlusive disease indication. Patients, the independent core laboratory reviewers, and Clinical Events Committee members will be blinded from the assigned treatment. Dual antithrombotic medical therapy is required through a minimum of 3 months post procedure. The primary end point is 12‑month primary patency and will be adjudicated by an independent imaging core laboratory and Clinical Events Committee. Key secondary end points will be tested for superiority and include technical, acute procedural, and clinical success; changes in Ankle-brachial index; patient quality of life; primary patency; freedom from restenosis; primary-assisted patency; secondary patency; freedom from target lesion revascularizations; cumulative reintervention rate; amputation-free survival; survival; and change in Rutherford category. Study follow-up will continue through 5 years. RESULTS Outcomes will be reported following study completion. Enrollment is anticipated to start in October 2023. CONCLUSIONS The results of this study will provide definitive, level 1 clinical evidence to clinicians on the optimal choice of stent device to use for the treatment of complex iliac artery occlusive disease. The FORWARD study is powered for superiority and includes only complex, unilateral, or bilateral lesions involving the common or external iliac arteries. This study is a multidisciplinary endeavor involving vascular surgery, interventional cardiology, and interventional radiology across multiple countries with a blinded core laboratory review of end points in hopes that the outcomes will be widely accepted and incorporated into practice guidelines for optimal treatment of patients with complex iliac artery occlusive disease. TRIAL REGISTRATION ClinicalTrials.gov NCT05811364; https://clinicaltrials.gov/study/NCT05811364. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/51480.
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Affiliation(s)
- Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | | | - Mohammad M Ansari
- Texas Tech University Health Science Center, Lubbock, TX, United States
| | - Andrew Holden
- Vascular Intervention Research Unit, Auckland City Hospital, Auckland, New Zealand
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate, Arnhem, Netherlands
- Multi-Modality Medical Imaging Group, University of Twente, Enschede, Netherlands
| | - Markus Steinbauer
- Vascular and Endovascular Surgery, University of Regensburg, Regensburg, Germany
| | | | - Hector Novoa
- W L Gore & Associates, Inc, Flagstaff, AZ, United States
| | | | - Darren B Schneider
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, PA, United States
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Ryu DS, Won DS, Kim JW, Park Y, Kim SH, Kang JM, Zeng CH, Lim D, Choi H, Park JH. Efficacy of closed cell self expandable metallic stent for peripheral arterial disease in the porcine iliac artery. Sci Rep 2023; 13:8601. [PMID: 37237009 DOI: 10.1038/s41598-023-35878-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/25/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to investigate the efficacy of a closed-cell self-expandable metallic stent (SEMS) with or without expanded-polytetrafluoroethylene (e-PTFE)-covering membrane in a porcine iliac artery model. Twelve Yorkshire domestic pigs were divided into a bare closed-cell SEMS (B-SEMS) group (n = 6) and covered closed-cell SEMS (C-SEMS) group (n = 6). Both closed-cell SEMSs were placed in the right or left iliac artery. Thrombogenicity score in the C-SEMS group was significantly higher than that in the B-SEMS group (p = 0.004) after 4 weeks. Angiographic findings of mean luminal diameters at 4 weeks follow-up did not differ significantly between B-SEMS and C-SEMS groups. Neointimal hyperplasia thickness as well as degree of inflammatory cell infiltration and collagen deposition in the C-SEMS group was significantly greater than that in the B-SEMS group (p < 0.001). Closed-cell SEMSs successfully maintained patency for 4 weeks without stent-related complications in the porcine iliac artery. Although mild thrombus with neointimal hyperplasia was observed in the C-SEMS group, subsequent occlusion, and in-stent stenosis did not occur in any of the pigs until the end of the study. Closed-cell SEMS with or without the e-PTFE covering membrane is effective and safe for the porcine iliac artery.
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Affiliation(s)
- Dae Sung Ryu
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dong-Sung Won
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ji Won Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yubeen Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Song Hee Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jeon Min Kang
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Chu Hui Zeng
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, 209, Neungdong-ro, Gwangjin-gu, Seoul, 05006, Republic of Korea
| | - Hyun Choi
- Department of Mechanical Engineering, Sejong University, 209, Neungdong-ro, Gwangjin-gu, Seoul, 05006, Republic of Korea.
| | - Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Squizzato F, Mosquera-Rey V, Zanabili Al-Sibbai A, Camblor Santervas LA, Pasqui E, Palasciano G, de Donato G, Alonso Pérez M, Antonello M, Piazza M. Outcomes of Self-Expanding Covered Stents for the Treatment of External ILIAC Artery Obstructive Disease. Cardiovasc Intervent Radiol 2023; 46:579-587. [PMID: 36826489 PMCID: PMC10156894 DOI: 10.1007/s00270-023-03370-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To describe the early results and mid-term patency rates of external iliac artery (EIA) stenting using self-expanding covered stents. METHODS We conducted a multicenter retrospective study (2015-2021), including patients receiving primary endovascular treatment of external iliac artery occlusive disease with self-expanding covered stents. All patients were treated with the Viabahn (W.L Gore & Associates, Inc., Flagstaff, AZ-USA) stent. Patency and limb salvage rates were estimated with Kaplan-Meier curves. RESULTS Ninety-three patients (mean age, 69 ± 9 years; 81% males) were treated for disabling claudication in 44%, rest pain in 28%, and tissue loss in 28%. TASC C/D lesions were present in 72% and iliac complete occlusion in 30%. Mean lesion length was 6.9 ± 2.4 cm; 30% had moderate/severe EIA calcifications; and the mean iliac tortuosity index was 1.17 ± 0.13. Technical success was 100%. There was one perioperative death (1.4%) and procedural complication rate was 6.5%. At 42 months (mean, 25 months), primary patency was 89.8% (95%CI 83-98); the presence of EIA tortuosity (tortuosity index > 1.25, 87.7 ± 11% vs 89.9 ± 8%; P = .6) or severe calcifications (87.6 ± 9% vs 96.0 ± 8%; P = .400) had no significant impact. After univariate analysis, the use of a stent with diameter < 8 mm (HR 8.5, 95%CI 3.24-14.22; P < .001) was negatively associated with primary patency. CONCLUSIONS The use of self-expanding covered stents provided excellent early and mid-term results in the treatment of obstructive disease of the EIA, also in cases of high EIA tortuosity and high grade of calcifications. The use of a < 8 mm-diameter stent was associated with a reduced primary patency.
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Affiliation(s)
- Francesco Squizzato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Vicente Mosquera-Rey
- Angiology and Vascular Surgery Department, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Amer Zanabili Al-Sibbai
- Angiology and Vascular Surgery Department, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | | | - Edoardo Pasqui
- Division of Vascular Surgery, University of Siena, Siena, Italy
| | | | | | - Manuel Alonso Pérez
- Angiology and Vascular Surgery Department, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Michele Antonello
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Piazza
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Mann N, El Sayed H, Panneton J. Stent Grafting for Aortoiliac Occlusive Disease: Review of the VBX FLEX Study. VASCULAR AND ENDOVASCULAR REVIEW 2022. [DOI: 10.15420/ver.2021.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Endovascular treatment has become an accepted method in the treatment of aortoiliac occlusive disease. Bare metal stents have been used in the treatment of aortoiliac disease since the early 1990s. More recently, the use of covered stent grafts in the aortoiliac segment has shown clinical benefit in terms of patency, freedom from reintervention and quality of life. The VBX FLEX study evaluated the safety and efficacy of the Gore VBX stent graft for use in the aortoiliac segment. The early and mid-term data on the Gore VBX stent graft have shown it to be a safe device for use in the treatment of aortoiliac occlusive disease. This review examines the use of stents in aortoiliac occlusive disease with specific focus on the VBX FLEX Study.
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Affiliation(s)
- Nolan Mann
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA, US
| | - Hosam El Sayed
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA, US
| | - Jean Panneton
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA, US
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Shah P, Chandra S. Review on emergence of nanomaterial coatings in bio-engineered cardiovascular stents. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Pickney CC, Rowse J, Quatromoni J, Kirksey L, Caputo FJ, Lyden SP, Smolock CJ. Outcomes of Gore ® Iliac Branch Endoprosthesis with Internal Iliac Component versus Gore ® Viabahn ® VBX. J Vasc Surg 2022; 76:733-740.e2. [DOI: 10.1016/j.jvs.2022.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
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Mejia E, Kish EC, Bocks ML, Lozier JS. Stretched to the Limit: Comparing Polytetrafluoroethylene-Covered Endovascular Stents Through Serial Dilations. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100035. [PMID: 39132561 PMCID: PMC11307785 DOI: 10.1016/j.jscai.2022.100035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 08/13/2024]
Abstract
Background Covered stents are used during congenital cardiac interventions to treat stenotic or injured vessels or to exclude unwanted vascular connections. The ability to postdilate a stented vessel to keep pace with somatic growth is critical in children. In this study, we aimed to compare in vitro performance of 2 brands of covered stents during serial dilations to demonstrate the threshold for stent fracture and polytetrafluoroethylene tear and define recoil and foreshortening characteristics. Methods iCast and VBX stents of various sizes were measured before and after expansion and through serial dilations. Dilations were performed at 2-mm increments until stent fracture, polytetrafluoroethylene tear, and "napkin-ring" formation, to a maximum of 22-mm diameter. Results The 5- and 6-mm VBX stents fractured during dilation with 10-mm balloon; the 7-mm VBX stents fractured on the 14-mm balloon; and the largest VBX stents fractured on the 20- or 22-mm balloons. iCast stents experienced partial fracture during dilation with the 14- or 16-mm balloons and complete fracture past dilation with 16-mm balloons. VBX stents recoiled less at nominal diameters. Both stents had similar foreshortening at nominal diameters, although VBX stents had more significant foreshortening with postdilation. Conclusions All iCast stents experienced partial fracture with dilation between 14- and 16-mm diameter and had unpredictable fracturing patterns. VBX stents showed a more predictable fracture pattern and had less recoil with nominal inflation but more foreshortening with postdilation. These findings may add clinical benefit and empower physicians to make optimal decisions regarding future planning of interventions in children with congenital heart disease.
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Affiliation(s)
- Ernesto Mejia
- Division of Pediatric Cardiology, University Hospitals, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Emily C. Kish
- Division of Pediatric Cardiology, University Hospitals, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Martin L. Bocks
- Division of Pediatric Cardiology, University Hospitals, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - John S. Lozier
- Division of Pediatric Cardiology, University Hospitals, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
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Parra JR, Bertino FJ, Shin DS, Chick JFB, Koo KSH, Monroe EJ. Portomesenteric and portosystemic venous reconstructions in children using balloon-expandable endoprostheses. Pediatr Radiol 2022; 52:493-500. [PMID: 34751814 DOI: 10.1007/s00247-021-05229-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/24/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Portomesenteric and portosystemic venous occlusive disease may lead to portomesenteric hypertension, variceal bleeding, ascites and hypersplenism. Data regarding endovascular reconstructive strategies in children, however, are limited. OBJECTIVE To report technical success, outcome and patency of portomesenteric and portosystemic venous reconstruction using VIABAHN VBX balloon-expandable endoprostheses in pediatric patients. MATERIALS AND METHODS Five pediatric patients (median age: 15 years, range: 4-18 years), including 3 (60%) boys and 2 (40%) girls, with portomesenteric or portosystemic venous occlusion or recurrent stenosis, underwent balloon-expandable stent graft reconstruction. Presenting symptoms included acute variceal bleeding, without (n = 2, 40%) or with (n = 1, 20%) splenomegaly, and transfusion-dependent chronic melena (n = 1, 20%). One patient was asymptomatic (n = 1, 20%). Preprocedural imaging included Doppler ultrasound and contrast-enhanced computed tomography (CT) in all patients. Initial imaging showed 4 (80%) occlusions and 1 (20%) recurrent stenosis greater than 50%. Technical aspects of the reconstructions, technical successes, clinical outcomes and adverse events were recorded. Technical success was defined as completion of stent graft reconstruction. Adverse events were categorized according to Society of Interventional Radiology criteria. Clinical success was defined as resolution of the presenting symptoms and/or prevention of portal hypertensive sequela. RESULTS Venous reconstruction was technically successful in all five patients. Stent graft locations included the main portal vein in 2 (40%), the superior mesenteric vein in 1 (20%), autologous Meso-Rex shunt in 1 (20%) and splenocaval shunt in 1 (20%). Six stent grafts were placed (two stent grafts placed in a single patient). Stent grafts had a median diameter of 7 mm (range: 6-10 mm) and a median length of 59 mm (range: 19-79 mm). Median fluoroscopy time was 36.6 min (range: 13.4-95.8 min) and median air kerma was 301.0 mGy (range: 218.0-1,148.2 mGy). No adverse events occurred. Median clinical follow-up was 18 months (range: 6-29 months). Median imaging follow-up was 17 months (range: 2-29 months). Clinical success was achieved in all patients and maintained during the follow-up period. One patient required follow-up intervention with superior mesenteric vein side extension with a self-expanding bare metal stent due to perigraft stenosis detected on CT 3 months after stent placement. There were no stent graft occlusions. CONCLUSION Portomesenteric and portosystemic venous reconstruction using balloon-expandable stent grafts in pediatric patients was feasible and clinically successful in this preliminary experience. Additional studies are warranted.
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Affiliation(s)
- Jorge R Parra
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | - Frederic J Bertino
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, WA, USA
| | - David S Shin
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, WA, USA
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, WA, USA.,Department of Radiology, Section of Vascular and Interventional Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Kevin S H Koo
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, WA, USA.,Department of Radiology, Section of Vascular and Interventional Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Eric J Monroe
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, Madison, WI, USA. .,Department of Radiology, Section of Vascular and Interventional Radiology, American Family Children's Hospital, 1675 Highland Ave., Madison, WI, 53792, USA.
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12
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Fujihara M, Takahara M, Yamaoka T, Iida O, Kojima T, Tobita K, Nakama T, Kyuragi R, Ichihashi S, Soga Y. Clinical outcomes of endovascular procedure using VIABAHN® VBX covered stent in complex aortoiliac artery disease: Result from AVOCADO study. Catheter Cardiovasc Interv 2021; 98:928-937. [PMID: 34406690 DOI: 10.1002/ccd.29920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/01/2021] [Accepted: 07/31/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the safety and efficacy of a balloon-expandable covered stent in the treatment of complex aortoiliac artery disease. BACKGROUND Peripheral intervention in complex aortoiliac disease still remains a challenge. METHODS We retrospectively analyzed symptomatic patients with aortoiliac disease who were treated with GORE® VIABAHN® VBX covered stent (W.L. Gore & Associates, Flagstaff, AZ). The primary study outcome was a 1-year primary patency without the necessity of any subsequent clinically-driven target revascularization (CD-TLR) based intervention. The proportion of technical success, defined in terms of the absence of residual stenosis, stent edge dissection, and procedure-related severe complications, was also reported. RESULTS VBX covered stent was used in 231 patients. Key patient characteristics include mean age of 73.4 ± 9 years, 77% male, 45% diabetes, and 18% suffering from end-stage renal dysfunction on dialysis. TASC II CD lesions were observed in 51% patients, which included 81% calcified lesions. Combined therapy with standard self-expandable stent was performed in 40% patients. The technical success rate was 92.6%. During median follow-up after 13.1 months, the primary patency rate was estimated to be 93.4% (95% confidence interval, 90.0%-96.8%) at 12 months, whereas the rate of freedom from TLR was 95.3% (92.5%-98.2%). As per the univariate analysis, the TASC II classification, number of diseased regions, and chronic total occlusion were significantly associated with risk of restenosis. CONCLUSIONS The results of the year-long AVOCADO study demonstrated that usage of the novel VBX covered stent has a patency-based advantage with reduced chances for subsequent revascularization procedures.
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Affiliation(s)
- Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan.,Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Osamu Iida
- Department of Cardiology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tai Kojima
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
| | - Ryoichi Kyuragi
- Division of Vascular Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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13
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Myouchin K, Takayama K, Wada T, Taguchi H, Tanaka T, Kichikawa K. Treatment of Coral Reef Aorta by Endovascular VIABAHN VBX Balloon-Expandable Stent-Graft Placement. Ann Vasc Dis 2021; 14:244-248. [PMID: 34630766 PMCID: PMC8474083 DOI: 10.3400/avd.cr.20-00168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/24/2021] [Indexed: 11/16/2022] Open
Abstract
Coral reef aorta (CRA) has been described as a rare disease characterized by the presence of dense calcifications of the aorta. In this study, we report on two patients with CRA caused by intermittent claudication (IC) who underwent endovascular VIABAHN VBX balloon-expandable stent-graft (VVBX) placement. Both patients underwent successful endovascular VVBX placement via transfemoral artery approach, and hemostasis was achieved via vascular closure device. Their symptoms were observed to disappear completely after treatment, and they were discharged without serious adverse events. No symptoms were noted at 1.5-year and 1-year follow-up.
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Affiliation(s)
- Kaoru Myouchin
- Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Nara, Japan
| | - Katsutoshi Takayama
- Department of Interventional Neuroradiology/Radiology Kouseikai Takai Hospital, Kashihara, Nara, Japan
| | - Takeshi Wada
- Department of Interventional Neuroradiology/Radiology Kouseikai Takai Hospital, Kashihara, Nara, Japan
| | - Hidehiko Taguchi
- Department of Interventional Neuroradiology/Radiology Kouseikai Takai Hospital, Kashihara, Nara, Japan
| | - Toshihiro Tanaka
- Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Nara, Japan
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14
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Kishida T, Hirano K, Mori S, Yamawaki M, Kobayashi N, Tsutsumi M, Honda Y, Makino K, Shirai S, Ito Y. The feasibility of the flower stenting technique for ostial lesions of the common iliac artery. Health Sci Rep 2021; 4:e343. [PMID: 34355064 PMCID: PMC8323837 DOI: 10.1002/hsr2.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/05/2021] [Accepted: 07/18/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND AIMS A balloon-expandable stent (BES) is generally used for ostial lesions of the common iliac artery (CIA) owing to the positional ease of stent adjustment. However, there are potential risks such as vessel dissection and perforation due to vessel overstretching during. In our hospital, we performed endovascular therapy (EVT) for CIA ostial lesions via a novel method named "the flower stenting method," using a self-expandable stent. This study aimed to analyze the efficacy and safety of this method. METHODS This study was single-center, retrospective, and observational. We enrolled 83 patients (91 limbs) who underwent EVT with SMART stent (Cordis, Miami, Florida) for CIA ostial lesions from 2007 to 2014. The primary endpoint was the rate of freedom from target lesion revascularization (TLR) in 5 years, and the secondary endpoint was the success rate of stent placement for the CIA ostium. RESULTS The average patient age was 72.3 ± 9.4 years, 71% of the patients were men, 19% were receiving hemodialysis, and 60% had diabetes. Additionally, 38% of the lesions were Trans-Atlantic Inter-Society Consensus C/D lesions, while 37% were chronic total occlusion lesions. The average lesion length was 36 ± 23 mm, and the average vessel diameter was 10.7 ± 1.4 mm. The rate of freedom from TLR was 97.3% at 5 years, and the success rate of only stent placement was 90.1%. CONCLUSION The flower stenting method leads to acceptable outcomes and is useful for accurate stent deployment.
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Affiliation(s)
- Toshihiko Kishida
- Department of CardiologySaiseikai Yokohama City Eastern HospitalYokohamaJapan
| | - Keisuke Hirano
- Department of CardiologyToyohashi Heart CenterToyohashiJapan
| | - Shinsuke Mori
- Department of CardiologySaiseikai Yokohama City Eastern HospitalYokohamaJapan
| | - Masahiro Yamawaki
- Department of CardiologySaiseikai Yokohama City Eastern HospitalYokohamaJapan
| | - Norihiro Kobayashi
- Department of CardiologySaiseikai Yokohama City Eastern HospitalYokohamaJapan
| | - Masakazu Tsutsumi
- Department of CardiologySaiseikai Yokohama City Eastern HospitalYokohamaJapan
| | - Yohsuke Honda
- Department of CardiologySaiseikai Yokohama City Eastern HospitalYokohamaJapan
| | - Kenji Makino
- Department of CardiologySaiseikai Yokohama City Eastern HospitalYokohamaJapan
| | - Shigemitsu Shirai
- Department of CardiologySaiseikai Yokohama City Eastern HospitalYokohamaJapan
| | - Yoshiaki Ito
- Department of CardiologySaiseikai Yokohama City Eastern HospitalYokohamaJapan
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15
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Mezzetto L, Mastrorilli D, Leone N, Gennai S, Silingardi R, Veraldi GF, Piazza M, Squizzato F, Antonello M. Preliminary Outcomes of Viabahn Balloon-Expandable Endoprosthesis as Bridging Stent in Renal Arteries During Fenestrated Endovascular Aortic Repair. J Endovasc Ther 2021; 28:575-584. [PMID: 33973493 DOI: 10.1177/15266028211012403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report preliminary outcomes of Viabahn Balloon-Expandable Endoprosthesis (VBX) stent-graft as bridging stent for renal arteries in fenestrated endovascular aneurysm repair (FEVAR). MATERIALS AND METHODS Between 2018 and 2019, patients undergoing FEVAR at 3 referral Italian university hospitals were prospectively collected. During the study period, VBX was the first-line choice as bridging stent for renal arteries. Procedural and anatomical data were analyzed, including renal artery (RA) configuration. A dedicated software (3Mensio, Vascular Imaging, Bilthoeven, The Netherlands) was used and RA anatomy classified as follow: upward-oriented in case of any angle >30° above the horizontal or transverse axis perpendicular to the aortic axis, downward-oriented if there was an angle >30° measured below the transverse axis and downward + upward in case of an angle <30° associated with a renal artery angulation >90°. Primary endpoints were technical success, defined as complete deployment of the fenestrated endograft without target vessel (TV) loss, limb stenosis or occlusion and type I or III endoleak, and freedom from target artery instability (TAI), defined by target vessel-related death, occlusion, rupture or reintervention for stenosis, endoleak or disconnection. Secondary endpoints were target artery patency rate and freedom from reinterventions. RESULTS A total of 26 elective FEVAR for juxta/pararenal aneurysm (20), thoracoabdominal type II (3) and type IV (3) were included. Fifty-one RA were planned for revascularization. Of these, 32 were downward, 10 horizontal, 6 upward, 4 were downward + upward. Technical success was achieved in 88.5% (23/26) of patients and 94.2% (48/51) of the TVs. One occlusion (2.1%) occurred within 30 days in a patient with previous endovascular aortic repair and suprarenal fixation. During follow-up (median 10 months), there was 1 type IC endoleak after 6 months (2.1%) in a patient with upward plus downward arterial orientation. Freedom from TAI was 96.1% (CI = 0.89 to 1.04) at first month and 92.3% (CI = 0.82 to 1.03) at 6 months. No aneurysm-related mortality and renal insufficiency occurred during follow-up. CONCLUSION The use of VBX as bridging stent of RA in FEVAR is safe and feasible. Previous EVAR and tortuosity of RA may be a challenging on target vessel fate.
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Affiliation(s)
- Luca Mezzetto
- Vascular Surgery, University Hospital of Verona, University of Verona School of Medicine, Verona, Italy
| | - Davide Mastrorilli
- Vascular Surgery, University Hospital of Verona, University of Verona School of Medicine, Verona, Italy
| | - Nicola Leone
- Vascular Surgery, NOCSAE Nuovo Ospedale Civile di Baggiovara Sant'Agostino Estense, Baggiovara, Modena, Italy
| | - Stefano Gennai
- Vascular Surgery, NOCSAE Nuovo Ospedale Civile di Baggiovara Sant'Agostino Estense, Baggiovara, Modena, Italy
| | - Roberto Silingardi
- Vascular Surgery, NOCSAE Nuovo Ospedale Civile di Baggiovara Sant'Agostino Estense, Baggiovara, Modena, Italy
| | - Gian Franco Veraldi
- Vascular Surgery, University Hospital of Verona, University of Verona School of Medicine, Verona, Italy
| | - Michele Piazza
- Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Squizzato
- Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Antonello
- Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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16
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Mallory A, Giannopoulos S, Lee P, Kokkinidis DG, Armstrong EJ. Covered Stents for Endovascular Treatment of Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2021; 55:560-570. [PMID: 33902342 DOI: 10.1177/15385744211010381] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The treatment of aortoiliac occlusive disease (AIOD) has largely shifted to endovascular techniques, with primary stenting constituting the preferred treatment approach. The goal of the current study was to summarize available literature and to determine whether covered stents are superior to bare metal stents for the treatment of AIOD, in terms of both periprocedural and long-term outcomes. METHODS A meta-analysis of 47 studies was conducted with the use of random effects modeling. The incidence of adverse events during follow up among the individual included studies was synthesized. RESULTS Most of the lesions were located at the common iliac arteries and were chronic total occlusions. The procedure was technically successful in almost all cases in both groups, with a low rate of periprocedural complications observed in both groups. The reported primary patency rates for the non-covered and covered stent group during an average follow up of 24.3 months among the individual studies, were 84% and 92% respectively, while surgical or endovascular re-intervention was required in 10% of non-covered stent cases and in 6% of covered stent cases. Eight studies comparing covered vs non-covered stents in terms of patency demonstrated superiority of covered stents (OR: 2.47; 95% CI: 1.01-6.01; p = 0.047 Combining TASC C/D lesions together 12 studies reported 92% (95%CI:89%-95%) primary patency in the covered stent group, while 7 studies reported 75% (95%CI: 60%-88%) primary patency for cases treated with non-covered stents. CONCLUSION This study demonstrated that covered stents are safe and effective when utilized for the treatment of AIOD. Covered stents were associated with a statistically significant higher odds of primary patency in both the overall cohort and in more complex TASC C/D lesions. However, additional high-quality comparative analyses between covered vs bare metal stents and between several types of covered stents are needed to determine the most optimal treatment modality for AIOD.
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Affiliation(s)
- Austin Mallory
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Paul Lee
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Damianos G Kokkinidis
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
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17
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Dinh L, Hamandi M, Shutze W. Repair of renal artery aneurysm with stent angiography and coil embolization. Proc AMIA Symp 2021; 34:391-393. [PMID: 33953473 PMCID: PMC8059914 DOI: 10.1080/08998280.2020.1868244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022] Open
Abstract
Renal artery aneurysms (RAAs) are rare and are frequently discovered incidentally during the workup for other renal issues. Open surgery has been a popular approach to managing RAAs; however, endovascular techniques have recently emerged as a less invasive option. Endovascular therapy involves stent angiography and coil embolization of the aneurysm. RAA classification (type 1, 2, and 3) is determined by its anatomical location and shape, which has been demonstrated to affect whether an open or an endovascular method is most suitable. We report two patients with type 1 RAAs and a history of hypertension who were successfully repaired endovascularly using VBX stents.
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Affiliation(s)
- Lauren Dinh
- College of Medicine, Texas A&M Health Science Center, Dallas, Texas
| | - Mohanad Hamandi
- Baylor Scott & White, The Heart Hospital – Plano, Plano, Texas
| | - William Shutze
- Baylor Scott & White, The Heart Hospital – Plano, Plano, Texas
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18
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Raza M, Williams N, Barry N, Singh V. Percutaneous treatment of left ventricular assist device outflow graft obstruction. Catheter Cardiovasc Interv 2021; 97:152-156. [PMID: 32812368 DOI: 10.1002/ccd.29190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/09/2020] [Accepted: 07/19/2020] [Indexed: 11/10/2022]
Abstract
Owing to the growing population with end stage heart failure, the use of left ventricular assist devices (LVADs) have become more widely accepted. Although survival has improved with newer generation LVADs, multiple complications including pump failure due to outflow graft obstruction have become more clinically relevant. Patients with this complication will present with heart failure symptoms due to inadequate unloading of the left ventricle by LVAD. This rare complication often requires open surgical repair in an already high-risk patient population. Alternative means to relieve the obstruction via percutaneous intervention has been described in rare cases. We present two unique cases of LVAD outflow graft obstruction which were percutaneously treated successfully. This article illustrates a potential treatment strategy for outflow graft obstruction with stenting as an alternative to open-heart surgery.
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Affiliation(s)
- Munis Raza
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | - Nina Williams
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | - Neil Barry
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | - Vikas Singh
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
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19
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Clark EC, Babrowski TA, Milner R. Outcomes of chimney and fenestrated endografting using Viabahn VBX and atrium iCAST stents. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 62:136-145. [PMID: 33302612 DOI: 10.23736/s0021-9509.20.11479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Atrium iCAST balloon expandable stent is the traditional choice of stent for chimney and fenestrated endovascular aneurysm repair (ChEVAR and FEVAR respectively). Due to the iCAST's lack of flexibility, the Gore Viabahn balloon-expandable stent (VBX; W. L. Gore & Associates, Inc., Newark, DE, USA) has arisen as a flexible alternative for parallel or branch graft placement during complex EVAR. Our purpose was to analyze patients' outcomes after undergoing ChEVAR or FEVAR using VBX or iCAST stents with the major outcome of assessing stent graft patency. The secondary outcome was residual aneurysm sac behavior. METHODS We retrospectively reviewed patients who were treated by ChEVAR or FEVAR with placement of iCAST or VBX stents from July 2012 to August 2018. Patients received follow-up CT scan and/or aortic duplex imaging. RESULTS We examined 53 cases (70% ChEVAR and 30% FEVAR) with 15.6 months (0-76.5 months) mean follow-up period. Placement of stents included renal (65 iCAST and 38 VBX), superior mesenteric (12 iCAST and 13 VBX), celiac (4 iCAST and 5 VBX), and iliac arteries (1 iCAST and 5 VBX). A total of 143 stents (57% iCAST and 43% VBX) were successfully deployed with 100% initial patency. Follow-up patency was similar for both stent types (100% VBX vs 98.7% iCAST). VBX and iCAST had the same follow-up Type 1a endoleak occurrence (9%). Average aneurysm sac sizes for iCAST decreased more than VBX (9% iCAST and 4% VBX, P=0.21), however, the iCAST group had longer follow-up. CONCLUSIONS Our experience demonstrates that the use of VBX stents for ChEVAR and FEVAR is a safe and effective alternative to iCAST stents with excellent mid-term patency without a negative impact on endoleak frequency.
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Affiliation(s)
- Emma C Clark
- Section of Vascular Surgery and Endovascular Therapy, The University of Chicago Medicine, Chicago, IL, USA -
| | - Trissa A Babrowski
- Section of Vascular Surgery and Endovascular Therapy, The University of Chicago Medicine, Chicago, IL, USA
| | - Ross Milner
- Section of Vascular Surgery and Endovascular Therapy, The University of Chicago Medicine, Chicago, IL, USA
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20
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Feldman DN, Armstrong EJ, Aronow HD, Banerjee S, Díaz-Sandoval LJ, Jaff MR, Jayasuriya S, Khan SU, Klein AJ, Parikh SA, Rosenfield K, Shishehbor MH, Swaminathan RV, White CJ. SCAI guidelines on device selection in Aorto-Iliac arterial interventions. Catheter Cardiovasc Interv 2020; 96:915-929. [PMID: 32406565 PMCID: PMC7578005 DOI: 10.1002/ccd.28947] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 01/18/2023]
Affiliation(s)
| | | | - Herbert D. Aronow
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | | | | | - Safi U. Khan
- West Virginia University, Morgantown, West Virginia
| | | | | | | | - Mehdi H. Shishehbor
- Univeristy Hospitals Cleveland Medical Center and Case Western Reserve, University School of Medicine, Cleveland, Ohio
| | - Rajesh V. Swaminathan
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | - Christopher J. White
- Ochsner Clinical School, University of Queensland, AU, Ochsner Health System, New Orleans, Louisiana
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21
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Yoshioka N, Takagi K, Morita Y, Kawase M, Morishima I. Endovascular treatment of arterio-ureteral fistula with new-generation balloon-expandable stent graft using a 7-French system. SAGE Open Med Case Rep 2020; 8:2050313X20959219. [PMID: 33062280 PMCID: PMC7534066 DOI: 10.1177/2050313x20959219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022] Open
Abstract
Arterio-ureteral fistulas are relatively rare, but a potentially life-threatening condition because of the possible massive bleeding. An 82-year-old woman with a history of hysterectomy and irradiation for uterine cancer was treated with ureteric stents for recurrent bilateral ureteral stenosis. During the adjustments of the stent, removing the right ureteric stent immediately resulted in massive hematuria. Computed tomography showed that the right ureter coursed above and seemed to be connected to the right external iliac artery. From the clinical history and computed tomography findings, an arterio-ureteral fistula between the right external iliac artery and right ureter was strongly suspected. The GORE® VIABAHN® VBX Stent Graft was deployed from the common iliac artery to the external iliac artery via a 7-French femoral system, followed by post-dilatation. The patient did not develop any complications or recurrence of hematuria after the procedure during the 11-month follow-up. The VBX is a useful device, with a low- profile device and a size-adjustable balloon-expandable stent that depended on the individual vessel size for post-dilatation. However, there are several concerns, such as risk of infection, stent thrombosis/stenosis, and chronic outcome while using stent grafts for treatment. Patients with arterio-ureteral fistulas who were treated using stent grafts should be carefully followed up.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Makoto Kawase
- Department of Urology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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Torsello GF, Beropoulis E, Munaò R, Trimarchi S, Torsello GB, Austermann M. Outcomes of bridging stent grafts in fenestrated and branched endovascular aortic repair. J Vasc Surg 2020; 72:859-865. [DOI: 10.1016/j.jvs.2019.10.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/24/2019] [Indexed: 11/29/2022]
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Isoda R, Morita I, Mano M, Ishida A. Balloon-expandable stent graft for coral reef aorta. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:422-424. [PMID: 32760873 PMCID: PMC7390775 DOI: 10.1016/j.jvscit.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/08/2020] [Indexed: 11/05/2022]
Abstract
Coral reef aorta (CRA) is a rare aortic occlusive disease with calcified intraluminal lesions. We report the case of a patient with CRA who underwent endovascular treatment (EVT). A 78-year-old woman presented with intermittent claudication. A computed tomography scan showed a preocclusive calcified lesion in the infrarenal aorta. EVT with a balloon-expandable stent graft was successfully performed, and her intermittent claudication improved. Compared with the conventional surgical treatments for CRA, EVT with a balloon-expandable stent graft is less invasive. This procedure is an effective option for the treatment of CRA.
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Affiliation(s)
- Ryutaro Isoda
- Department of Surgery, Kawasaki Medical School General Medical Center, Okayama City, Okayama, Japan
| | - Ichiro Morita
- Department of Surgery, Kawasaki Medical School General Medical Center, Okayama City, Okayama, Japan
| | - Masayuki Mano
- Department of Surgery, Kawasaki Medical School General Medical Center, Okayama City, Okayama, Japan
| | - Atsuhisa Ishida
- Department of Surgery, Kawasaki Medical School General Medical Center, Okayama City, Okayama, Japan
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Piazza M, Squizzato F, Saviane G, Grego F, Antonello M. Geometrical Analysis and Preliminary Results for the Endovascular Reconstruction of Aortic Bifurcation Using New-Generation Balloon-Expandable Covered Stents in the Kissing Conformation. Ann Vasc Surg 2020; 67:148-157. [DOI: 10.1016/j.avsg.2020.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/31/2020] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
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Collapse of VBX Balloon-Expandable Endoprosthesis in Bilateral Common Iliac Arteries in a Lean, Elderly Patient with Bent Back. Ann Vasc Surg 2020; 66:670.e5-670.e8. [PMID: 32018024 DOI: 10.1016/j.avsg.2020.01.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/05/2020] [Indexed: 11/24/2022]
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Piazza M. Commentary: Excellent Midterm Results for the Viabahn Balloon-Expandable Endoprosthesis in Iliac Lesions. J Endovasc Ther 2020; 27:737-738. [PMID: 32567963 DOI: 10.1177/1526602820934595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michele Piazza
- Department of Cardiac, Thoracic, and Vascular Sciences, Clinic of Vascular and Endovascular Surgery, Padua University School of Medicine, Padua, Italy
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Antonello M, Squizzato F, Piazza M. The Viabahn balloon expandable stent for endovascular reconstruction of the infrarenal aorta and its bifurcation in cases of severe obstructive disease. Vascular 2020; 29:40-44. [PMID: 32522137 DOI: 10.1177/1708538120927847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The covered endovascular reconstruction of the aortic bifurcation (CERAB) represents a promising technique for the treatment obstructive lesions involving the aortic bifurcation. The aim of this report is to describe the use of a new generation balloon-expandable stent-graft (Viabahn VBX, W.L. Gore&Associates, AZ, USA), in the CERAB configuration for the treatment of aorto-iliac obstructive lesions involving the infrarenal aorta and bifurcation.Technical note: This technique was adopted in two patients with severe aorto-iliac obstructive lesions. After bilateral iliac recanalization, an 11 mm diameter VBX stent was deployed in the infrarenal aorta; a post-dilatation up to 16 mm with a non-compliant balloon was performed to adapt the proximal edge of the stent to the aortic diameter. Two 8 mm diameter VBX stents were then deployed at the aortic bifurcation in a kissing conformation, overlapping with the previously positioned aortic stent for 15 mm. A post-ballooning with two kissing 12 × 20 mm compliant balloons (Powerflex Pro PTA, Cordis, CA, USA) was performed to adapt the parallel stents to the aortic cuff. A post-operative angio-CT demonstrated optimal conformability of the aortic cuff to the aortic wall, and apposition of the kissing stents to the aortic cuff. CONCLUSIONS This preliminary experience shows that the VBX stent may allow an effective reconstruction of the aortic bifurcation; the conformability and flaring capability may allow to overcome the diameter mismatch between the aorta and the iliac arteries.
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Affiliation(s)
- Michele Antonello
- Vascular and Endovascular Surgery Division, Padua University, Padua, Italy
| | | | - Michele Piazza
- Vascular and Endovascular Surgery Division, Padua University, Padua, Italy
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A systematic review of covered balloon-expandable stents for treating aortoiliac occlusive disease. J Vasc Surg 2020; 72:1473-1486.e2. [PMID: 32360678 DOI: 10.1016/j.jvs.2020.01.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/25/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate and compare studies reporting the outcomes of the use of covered balloon-expandable (CBE) stents for the treatment of aortoiliac occlusive disease. METHODS A systematic literature search was conducted to identify studies that investigated the use of CBE stents for the treatment of aortoiliac occlusive disease and were published between 2000 and 2019. Baseline demographic data, procedural variables, and long-term outcomes were extracted from publications for analysis. RESULTS A total of 15 published articles about 14 studies were included in the review. Of these, eight studies were prospective clinical trials and six studies were retrospective real-world studies. The articles included data regarding five different CBE stents, namely, the iCast/Advanta V12, Viabahn VBX, BeGraft, LifeStream, and JOSTENT. Lesion severity was higher in real-world studies, with more TransAtlantic Inter-Society Consensus Classification class D lesions and a higher percentage of occlusions. All studies showed high rates of technical success and patency over the course of 12 months. Long-term data were only available for the iCast/Advanta V12 device, which had a primary patency rate of 74.7% at 5 years. CONCLUSIONS CBE stents are a viable treatment option for patients with complex aortoiliac lesions because of their high rates of technical success and favorable patency across all devices at 12 months. However, long-term data are only available for a single device, the iCast/Advanta V12. The results of using this device were favorable over the course of 5 years.
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Panneton JM, Bismuth J, Gray BH, Holden A. Three-Year Follow-up of Patients With Iliac Occlusive Disease Treated With the Viabahn Balloon- Expandable Endoprosthesis. J Endovasc Ther 2020; 27:728-736. [DOI: 10.1177/1526602820920569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To assess the midterm safety and effectiveness of the Gore Viabahn Balloon-Expandable Endoprosthesis (VBX Stent-Graft) in the treatment of patients with de novo or restenotic aortoiliac lesions. Materials and Methods: The prospective, multicenter, nonrandomized, single-arm VBX FLEX clinical study ( ClinicalTrials.gov identifier: NCT02080871) evaluated 134 patients (mean age 66±9.5 years; 79 men) up to 3 years after treatment with the VBX Stent-Graft. A total of 213 lesions were treated with 234 stent-grafts. The primary safety endpoint was a composite of major adverse events (MAEs), which were evaluated through 30 days and 9 months. Secondary outcomes collected through 3 years included freedom from target lesion revascularization (TLR), target vessel revascularization (TVR), clinically-driven TLR (CD-TLR), and CD-TVR as well as Rutherford category, resting ankle-brachial index (ABI), and functional status. A univariate analysis determined any correlation between baseline variables and TLR. Results: The observed composite percentage of MAEs was 2.3%, well below the 17% performance goal (p<0.001). Of the 134 patients in the per protocol analysis, 107 (80%) completed the study. The 1-year Kaplan-Meier estimate of primary patency was 94.5% and primary assisted patency was 99.0%. The estimate of freedom from TLR per-lesion/vessel was 97.6% at 9 months and 91.2% at 3 years. The 9-month estimate of freedom from CD-TLR was 98.6% and the 3-year estimate was 98.1%. The 3-year mean resting ABI was 0.93±0.19, an improvement of 0.17±0.26 from baseline (p<0.001). At 3 years, 82 patients (92.1%) improved ≥1 Rutherford category from baseline, and 77 patients (86.5%) maintained or improved upon their baseline functional status. Conclusion: The VBX Stent-Graft is a robust and durable treatment option for aortoiliac occlusive disease as evidenced by the sustained 3-year safety and effectiveness outcomes.
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Affiliation(s)
| | - Jean Bismuth
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Bruce H. Gray
- University of South Carolina School of Medicine, Greenville, SC, USA
| | - Andrew Holden
- Auckland University School of Medicine, Auckland, New Zealand
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Klein AJ, Nasir A. Iliac Artery Intervention. Interv Cardiol Clin 2020; 9:187-196. [PMID: 32147119 DOI: 10.1016/j.iccl.2019.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Endovascular revascularization for aortoiliac occlusive disease (AIOD) is now considered first-line therapy for patients with claudication and critical limb ischemia and in asymptomatic patients in whom large-bore access is required (eg, mechanical circulatory support or transcatheter aortic valve replacement). The authors review the data supporting endovascular therapy for AIOD, indications and contraindications for AIOD revascularization, as well as the procedural techniques required to safely perform endovascular therapy in this vascular bed. They review prevention and management of the major complications that can occur during these procedures. Finally, they discuss postprocedural management to maintain patency and optimize patient outcomes.
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Affiliation(s)
- Andrew J Klein
- Piedmont Heart Interventional Cardiology, 95 Collier Road, Suite 2065, Atlanta, GA 30309, USA.
| | - Ammar Nasir
- John Cochran VA Medical Center, Section 2B Cardiology, 915 N. Grand Boulevard, St Louis, MO 63106, USA
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Armstrong EJ, Soukas PA, Shammas N, Chamberlain J, Pop A, Adams G, de Freitas D, Valle J, Woo E, Bernardo NL. Intravascular Lithotripsy for Treatment of Calcified, Stenotic Iliac Arteries: A Cohort Analysis From the Disrupt PAD III Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1262-1268. [PMID: 32147133 DOI: 10.1016/j.carrev.2020.02.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The presence of calcification in the iliac arteries is associated with decreased procedural success and increased complication risk during endovascular intervention. The objective of this study was to evaluate the safety and efficacy of peripheral intravascular lithotripsy (IVL) during endovascular treatment of iliac arterial peripheral artery disease (PAD). METHODS The Disrupt PAD III Observational Study is a prospective, non-randomized, multi-center single-arm study to assess the 'real-world' safety and effectiveness of the Shockwave Peripheral IVL System for the treatment of de novo calcified lesions in the peripheral arteries, with a goal of treating 1500 patients. This is an analysis of consecutive patients enrolled for treatment of an iliac artery, a specified sub-group, with at least moderate calcification and a minimum length of 20 mm. RESULTS Between December 2017 and July 2019, 118 patients with a total of 200 lesions were enrolled across 20 sites. 101 patients were treated primarily for claudication or critical limb ischemia, while 17 patients were treated to optimize the iliac vasculature for large-bore access. All 118 patients had successful IVL catheter delivery. The average reference vessel diameter was 7.3 mm ± 1.9 mm, with an average diameter stenosis of 83.1% ± 13.4% and an average lesion length of 58.3 mm ± 57.6 mm. Severe calcification was present in 82.0% of overall cases. Stent placement was performed in 72.9% of the overall cases. As expected, the access group received less adjunctive therapies including stents (41.2%, p < 0.001). Angiographic complications were minimal with no flow-limiting dissections and a final mean residual stenosis of 12.0% ± 12.1% with no differences between the groups. CONCLUSIONS Acute results with IVL in calcified iliac lesions suggest that it is a safe and effective option for calcified, stenotic iliac disease. IVL can be used successfully both for treatment of PAD symptoms and to optimize access for large-bore procedures.
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Affiliation(s)
- Ehrin J Armstrong
- University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Peter A Soukas
- The Miriam Hospital/Brown Medical School, Providence, RI, United States of America.
| | - Nicolas Shammas
- Midwest Cardiovascular Research Foundation, Davenport, IA, United States of America
| | - Jack Chamberlain
- Alexian Brothers Medical Center, Elk Grove Village, IL, United States of America
| | - Andrei Pop
- Alexian Brothers Medical Center, Elk Grove Village, IL, United States of America.
| | - George Adams
- UNC Rex Healthcare, Raliegh, NC, United States of America.
| | - Dorian de Freitas
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado School of Medicine, Auorora, CO, United States of America.
| | - Javier Valle
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado School of Medicine, Auorora, CO, United States of America.
| | - Edward Woo
- Medstar Washington Hospital Center, Washington, DC, United States of America.
| | - Nelson L Bernardo
- Medstar Washington Hospital Center, Washington, DC, United States of America
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Robaldo A, Apostolou D, Peano E, Novali C. Giant saccular aneurysm of the innominate artery. Interact Cardiovasc Thorac Surg 2020; 30:321-323. [PMID: 31603210 DOI: 10.1093/icvts/ivz244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 11/14/2022] Open
Abstract
We report a rare case of a saccular aneurysm of innominate artery without any apparent causative history. Although the treatment choice remains debatable, due to the poor condition of the patient, the lesion was excluded by using a balloon-expandable covered stent with a satisfactory early-term outcome.
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Affiliation(s)
| | | | - Enrico Peano
- Department of Radiology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Claudio Novali
- Vascular Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
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Gallitto E, Faggioli G, Pini R, Mascoli C, Sonetto A, Abualhin M, Logiacco A, Ricco JB, Gargiulo M. First/Preliminary Experience of Gore Viabahn Balloon-Expandable Endoprosthesis as Bridging Stent in Fenestrated and Branched Endovascular Aortic Repair. Ann Vasc Surg 2019; 61:299-309. [DOI: 10.1016/j.avsg.2019.04.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Faraj J, Choudhary A, Ritter JC. Covered Stenting as Bail-Out Technique for Central Venous Catheter Malposition Within the Brachiocephalic Trunk. Vasc Endovascular Surg 2019; 54:65-68. [DOI: 10.1177/1538574419873175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Central venous catheter (CVC) insertion with ultrasound guidance is routine clinical practice in the critically ill patient. Arterial malposition is serious and may lead to severe complications such as hemorrhage, stroke, or death. We describe a bail-out technique for removal of right-sided CVC that was mispositioned into the brachiocephalic trunk (BCT) at the origin of the right common carotid artery (CCA). Covered stenting of the BCT extending into the CCA in combination with plug embolization of the right subclavian artery was utilized.
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Affiliation(s)
- Joseph Faraj
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Anwar Choudhary
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jens C. Ritter
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Medicine, Curtin University, Perth, Western Australia, Australia
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Banafsche R, Jerkku T, Tsilimparis N. Commentary: What ILIACS Can Tell Us - Future Perspectives of Endovascular AIOD Treatment. J Endovasc Ther 2019; 26:633-636. [PMID: 31466494 DOI: 10.1177/1526602819871867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ramin Banafsche
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Germany
| | - Thomas Jerkku
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Germany
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Taneva GT, Donas KP, Torsello GB, Seifarth H, de Azevedo FM, Austermann M, Torsello GF. In Vitro Evaluation of Balloon-Expandable Chimney Grafts in the Renal Arteries Combined With the Endurant Endograft. J Endovasc Ther 2019; 26:865-870. [DOI: 10.1177/1526602819872498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To compare balloon-expandable covered stents (BECS) available for use as renal chimney grafts to the Advanta V12 approved for use with the Endurant endograft. Materials and Methods: A silicone model was manufactured based on preoperative computed tomography angiography (CTA) scans of a patient with a 7-cm juxtarenal aneurysm treated with an Endurant bifurcated endograft and an Advanta V12 covered stent for the 6-mm-diameter right renal artery. The model was placed in a flow box filled with a 37°C blood-mimicking solution equipped with a pulsatile pumping system (140/60 mm Hg). The tested BECS were the Advanta V12, the VBX, and the BeGraft+. A 36-mm-diameter Endurant II endograft with a 16-mm-diameter contralateral limb and a 6×59-mm BECS chimney graft were used in 9 consecutive tests (3 for each combination). After each implantation, the model was placed in the CT scanner, and 2 radiologists blinded to the test device independently measured the gutter areas and the patent chimney graft lumen at the level of the Endurant’s suprarenal stent, at the level of the chimney’s maximum curvature, and 10 mm inside the renal artery. The intraclass correlation coefficients (ICC) were calculated to assess interreader reliability. Results: The mean gutter areas were 19.3±7, 20.2±8, and 22.3±8 mm2 for the Advanta, VBX, and BeGraft+, respectively (all p>0.05). At the level of the aortic endograft’s suprarenal stent struts, the mean diameter of the Advanta V12, VBX, and BeGraft+ were 4.46±0.3, 4.12±0.4, and 4.12±0.3 mm, respectively (all p>0.05). At the level of the maximum chimney graft angulation, the mean diameters were 3.77±0.3, 4.16±0.1, and 3.74±0.3 mm, respectively (all p>0.05). In the right renal artery, the mean diameters were 3.91±0.2, 4.05±0.9, and 4.3±0.4 mm, respectively (all p>0.05). The ICCs varied between 0.7 and 0.9, indicating good agreement between readers. Conclusion: These in vitro findings showed comparable results between the Advanta V12 and the available BECS used in conjunction with the Endurant endograft according to the instructions for use. Further clinical evaluation is needed to confirm these results.
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Affiliation(s)
- Gergana T. Taneva
- Department of Vascular Surgery, St Franziskus Hospital, Münster, Germany
| | | | | | - Harald Seifarth
- Clinic for Diagnostic and Interventional Radiology, Klinikum Esslingen, Esslingen, Germany
| | | | - Martin Austermann
- Department of Vascular Surgery, St Franziskus Hospital, Münster, Germany
| | - Giovanni Federico Torsello
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Germany
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Cole JM, Salavitabar A, Armstrong AK, Berman DP. Use of the Gore Viabahn VBX balloon‐expandable endoprosthesis in the congenital heart disease population. Catheter Cardiovasc Interv 2019; 94:416-421. [DOI: 10.1002/ccd.28389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/17/2019] [Accepted: 06/22/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Jason M. Cole
- Pediatric CardiologyNationwide Children's Hospital Columbus Ohio
| | | | | | - Darren P. Berman
- Pediatric CardiologyNationwide Children's Hospital Columbus Ohio
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iCAST Balloon-Expandable Covered Stent for Iliac Artery Lesions: 3-Year Results from the iCARUS Multicenter Study. J Vasc Interv Radiol 2019; 30:822-829.e4. [DOI: 10.1016/j.jvir.2018.12.707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/15/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022] Open
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Laird JR, Zeller T, Holden A, Scheinert D, Moore E, Mendes R, Schmiedel R, Settlage R, Lansky A, Jaff MR, Elmasri F, Robinson W, Beasley R, Mego D, Marica S, Bersin R, Kujath S, Razavi M, Teßarek J, Schulte KL. Balloon-Expandable Vascular Covered Stent in the Treatment of Iliac Artery Occlusive Disease: 9-Month Results from the BOLSTER Multicenter Study. J Vasc Interv Radiol 2019; 30:836-844.e1. [DOI: 10.1016/j.jvir.2018.12.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/25/2022] Open
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Mafeld S, Annamalai G, Lindsay TF, Zhong I, Tarulli E, Mironov O, Tan KT. Initial Experience With Viabahn VBX as the Bridging Stent Graft for Branched and Fenestrated Endovascular Aneurysm Repair. Vasc Endovascular Surg 2019; 53:395-400. [PMID: 31018828 DOI: 10.1177/1538574419840880] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of a novel balloon-expandable, heparin-bonded endoprosthesis (Viabahn VBX, W. L. Gore and Associates) when used as a bridging stent graft (BSG) with fenestrated and branched endovascular aneurysm repair (FB-EVAR). FB-EVAR and BSGs increase repair complexity with the potential for endoleak formation, stenosis, thrombosis, and graft migration. The mechanical construction of the Viabahn VBX and its antithrombogenic properties may provide an advantage for FB-EVAR over existing BSGs. The efficacy, safety, and clinical outcomes were assessed. MATERIALS AND METHODS Research ethics board approved, prospective, single arm cohort, pilot study of patients undergoing FB-EVAR between February 2017 and January 2018. Fenestrated and branched endovascular aneurysm repair was performed per the standard institutional protocol by a team composed of vascular surgeons and interventional radiologists. Viabahn VBX endografts were used for all intended visceral branches as long as appropriately sized devices were available (Under Investigational Testing Authorization from Health Canada). Patient characteristics, procedural details, and technical and clinical outcomes were reviewed and summarized. RESULTS FB-EVAR was performed in 13 patients (9 male and 4 female) mean age of 74 (range: 61-83) with a total of 41 Viabahn VBXs stents implanted. Mean maximum aneurysm size was 6.7 cm (range: 5.5-9.0 cm) and included 5 juxtarenal abdominal aortic aneurysms and 8 thoracoabdominal; 3 type V, 3 type IV, and 2 type III (Crawford Classification). The Viabahn VBX was successfully deployed in 40 (98%) of 41 of cases. At median follow-up of 223 days (range: 2-462), there was a (40/40) 100% Viabahn VBX patency rate. Seven endoleaks were identified intra- or post procedurally in 6 (46%) of 13 cases, including 1 type IB, 3 type II, 2 type III, and 1 unclassified. Nine complications occurred in 6 patients. CONCLUSION The Viabahn VBX stent is a safe and effective BSG for FB-EVAR with no early stent thrombosis. Further evaluation is required to determine longer term stent efficacy.
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Affiliation(s)
- Sebastian Mafeld
- 1 Interventional Radiology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ganesan Annamalai
- 1 Interventional Radiology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Thomas F Lindsay
- 2 Division of Vascular Surgery, Department of Surgery, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Iris Zhong
- 3 Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Emidio Tarulli
- 1 Interventional Radiology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Oleg Mironov
- 4 Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Kong-Teng Tan
- 1 Interventional Radiology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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Weinstock BS, Haim YD. Pulmonary artery stenting in a patient with Takayasu's arteritis using a novel balloon-expandable covered stent. SAGE Open Med Case Rep 2019; 7:2050313X19841955. [PMID: 31007921 PMCID: PMC6457077 DOI: 10.1177/2050313x19841955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/14/2019] [Indexed: 11/16/2022] Open
Abstract
Patients with Takayasu’s arteritis have pulmonary artery involvement more
commonly than previously appreciated. The majority of these lesions are in
segmental or sub-segmental arteries, but there are some patients who have severe
stenosis of the main pulmonary arteries. Interventional treatment of these
patients is technically feasible, but there are only limited case reports
describing such intervention. Balloon angioplasty and stenting in these lesions
often require high pressure inflations to achieve adequate results and thus has
increased risk due to the possibility of pulmonary artery rupture. The recently
approved Viabahn BX balloon-expandable covered stent may be an optimal device
for main pulmonary artery stenosis as it is relatively low profile, can be
over-expanded to large vessel diameter without compromise or disruption of the
polytetrafluoroethylene covering and virtually eliminates the risk of
catastrophic pulmonary artery rupture. We report here the first known use of
this novel stent for treatment of severe pulmonary artery stenosis.
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Affiliation(s)
- Barry S Weinstock
- AdventHealth Orlando, Orlando, FL, USA.,Orlando Heart & Vascular Institute, Altamonte Springs, FL, USA
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Faries P, Jaff M, Peeters P, Khatib Y, Roberts D, Bosiers M, Malik R, Ravin R, Rundback J. Nine-Month Outcomes of the DURABILITY Iliac Study on Self-Expanding Stents for Symptomatic Peripheral Artery Disease. Ann Vasc Surg 2018; 51:37-47. [DOI: 10.1016/j.avsg.2018.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/17/2018] [Accepted: 02/03/2018] [Indexed: 10/17/2022]
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Piazza M, Antonello M. Commentary: The First Balloon-Expandable Stent-Graft Approved for Treatment of Iliac Occlusive Disease. J Endovasc Ther 2017; 24:638-639. [DOI: 10.1177/1526602817725056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michele Piazza
- Clinic of Vascular and Endovascular Surgery, Padova University School of Medicine, Padua, Italy
| | - Michele Antonello
- Clinic of Vascular and Endovascular Surgery, Padova University School of Medicine, Padua, Italy
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