Viabahn and Viabahn VBX demonstrate favorable outcomes for the treatment of percutaneous access related complications
Michael J. Wilderman, MD1, Ahkar Phyo, MD1, Sophia Simonian, MD1, Courtney Micallef, MD1, David J. O'Connor, MD1, Anjali Ratnathicam, DO1, Kristen Cook, MD1, Joseph DeGregorio, MD2, Massimo Napolitano, MD1.
1Hackensack University Medical Center, Hackensack, NJ, USA, 2Englewood Hospital and Medical Center, Englewood, NJ, USA.
OBJECTIVES: With increasing numbers of percutaneous procedures being performed, there are increases in access related complications, including bleeding, pseudoaneurysms, dissections, and thrombosis. Traditionally, these ileo-femoral artery complications were treated with direct open repair, as they are considered “no stent zones”. Moreover, many are being performed in catheterization laboratories rather than hybrid operating rooms. Transferring a patient to an OR takes time and poses other risks, which increases the rate of complications. Both balloon expandable and self-expanding covered stent grafts can be deployed percutaneously to treat these complications providing short term stabilization and potentially offer a long-term solution.
METHODS: Over 36 months, we placed 48 Viabahn or Viabahn VBX (WL Gore) stent grafts across the inguinal ligament in emergent settings to treat percutaneous access related complications including bleeding and hemorrhagic shock, pseudoaneurysms, arterial dissections, and iatrogenic AV fistulas. We retrospectively reviewed our technical success, defined by complete arterial repair, along with in-hospital and 30-day mortalites. In addition, we examined the incidence of blood transfusions and wound complications and compared this to historic controls from open vascular repair. We followed the patients for stent patency, freedom from intervention, kinking, and clinical symptoms.
RESULTS: 24 Viabahn and 24 VBX stents were placed in the distal external Iliac artery and into the proximal common femoral artery in 25 Men and 23 Women. Indications were bleeding in 29 patients (60%), flow limiting dissection in 16 patients (34%), and symptomatic AVF in 3 patients (6%). All patients were discharged with patent stents. None required open conversion or evacuation of hematomas. The overall transfusion requirement and hospital stay was shortened when compared to historic controls. At 30-day follow up, stent patency was 100%, and there were no stent fractures or kinks. Limited 1 year follow up (18/48 patients) showed 100% patency with no evidence of stent fracture, stenosis, or kinking.
CONCLUSIONS: Viabahn and VBX stents can be placed safely and effectively in the distal external iliac and common femoral arteries with little or no vascular complications. Moreover, these stents clearly reduce the need for open surgery, blood transfusions, and other morbidities related to access complications. In short-term and early mid-term follow up, these stent grafts performed well. There was no kinking, thrombosis, or open revision. Longer term follow-up is needed.
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