Viabahn Stent Research Articles

Hypogastric preservation with Viabahn stent graft during endovascular aneurysm repair

The presence of bilateral iliac aneurysms extending to the iliac bifurcations, in conjunction with an abdominal aortic aneurysm, complicates endovascular repair because of the difficulty of preserving one or both hypogastric arteries. Several open techniques have been suggested for hypogastric preservation, but they usually involve some type of anatomic or extra-anatomic bypass. Endovascular techniques for hypogastric preservation include branch iliac grafts, chimney grafts, and bellbottom limbs. We report the use of a Viabahn stent graft (W. L. Gore and Associates, Flagstaff, Ariz) within the iliac limb of a Powerlink device (Endologix, Inc, Irvine, Calif) to preserve a hypogastric artery.

Endovascular Reconstruction of Giant Gastroduodenal Artery Aneurysm With Stent Graft: Case Report

Gastroduodenal artery (GDA) aneurysms are rare and mainly asymptomatic vascular diseases. Endovascular intervention can provide an alternative method of treatment for GDA aneurysms. We present a case of endovascular repair of giant GDA aneurysm, with stent graft. A 56-year-old man, smoker, presented with nausea, acute worsening of chronic abdominal pain, and a large, tender, pulsating mass in his right upper abdomen with no previous medical history. Computed tomographic (CT) angiography was performed, and there was GDA aneurysm. Through the left brachial approach, we did the endovascular repair of GDA with Viabahn stent graft. Endovascular gastroduodenal aneurysm artery reconstruction with stent graft is a reasonable alternative to open surgical repair and it is safety option in carefully selected patients.

Endovascular Treatment of a Pseudoaneurysm After an Iatrogenic Axillary Artery Injury

The efficacy of covered stents for treatment of upper extremity pseudoaneurysms (PSA) has not been well documented. We report a case of an 82-year-old woman who presented with a hematoma in the left infraclavicular region as a result of previous permanent pacemaker placement. Subsequent ultrasound and chest computed tomography confirmed an axillary artery PSA. An endovascular approach enabled successful coil embolization and Viabahn stent (W. L. Gore & Associates, Flagstaff, AZ) placement, which excluded the axillary artery PSA. To our knowledge, there is only one other case of this nature reported in the literature.

True lumen re-entry after extravascular recanalization of a superficial femoral artery chronic total occlusion

A 66-year-old man was treated for disabling right leg calf claudication with angioplasty and stenting of a chronically occluded superficial femoral artery. During attempted subintimal passage, the guidewire tracked extralumenally, which was not recognized, but it was successfully redirected into the true lumen distal to the occlusion with the use of the Outback (Cordis Endovascular, Miami Lakes, Fla) re-entry device. A bare metal nitinol stent was initially deployed extralumenally in the perivascular soft tissue. The patient returned for reintervention 9 days later complaining of pain and discoloration of the popliteal space. Duplex evaluation of the superficial femoral artery revealed a pseudoaneurysm, and Viabahn stent grafts (W. L. Gore & Assoc, Flagstaff, Ariz) were successfully deployed to produce an endovascular percutaneous prosthetic bypass.

Use of a Viabahn Stent for Repair of a Common Carotid Artery Pseudoaneurysm and Dissection

Carotid procedures in the previously operated neck are both technically demanding and subject to increased rates of complications. Adding radiation to the operated field only increases these risks. The incidence of cranial nerve injury in the reoperative neck has increased. Similarly, patients with a history of radiation are at increased risk for stroke, cranial nerve injury, and wound complications. Before the endovascular era, the only option for repair of an extracranial carotid aneurysm was open operation. Recently, more experience has been gained using endovascular techniques to repair these aneurysms. We present a patient with a history of radiation and radical neck dissection who developed a pseudoaneurysm of the common carotid artery. This pseudoaneurysm was repaired successfully using a Viabhan covered stent graft.

Remodeling of the Aortic Neck with a Balloon-Expandable Stent Graft in Patients with Complicated Neck Morphology

Graft migration and other device-related problems are more frequent in abdominal aortic aneurysm (AAA) patients with a complicated neck. We wanted to evaluate the performance of a balloon-expandable stent graft in these cases. Complicated aortic neck morphology was defined as a combination of short (<15 mm) and angulated (>45 degrees) necks with or without circumferential thrombus. Severe aortic angulation was defined as less than 120 degrees. During a 24-month period, 18 consecutive patients with complicated neck anatomy were treated with the Vascular Innovations (VI)-Datascope balloon-expandable endograft. In two patients, a balloon-expandable cuff was implanted to remodel the neck prior to insertion of a bifurcated endograft (Excluder, W.L. Gore & Associates, Flagstaff, AZ). Demographic, procedural, and outcome data were collected prospectively and retrospectively analyzed. All patients had preoperative computed tomographic (CT) angiography to determine aortic neck angulation and were followed with duplex ultrasonography and CT every 3 and 6 months postoperatively to assess aortic neck and sac dilatation, as well as device migration. The VI-Datascope graft consists of an aortounifemoral polytetrafluoroethylene (PTFE) graft sutured to a proximal balloon-expandable stent. The length of the graft is 40 cm; thus, the distal end of the graft always protrudes through the ipsilateral arteriotomy and can be cut to an appropriate length for each patient. The covered portion of the graft was deployed just below the level of the lowest renal artery. The proximal bare metal stent was deployed in the suprarenal area. An endoluminal hand-sewn anastomosis was performed between the aortounifemoral limb and the distal external iliac or the common femoral arteries. An occluder device was placed in the contralateral common iliac artery to prevent retrograde perfusion of the aneurysm. A femorofemoral 8 mm Dacron graft bypass was then performed to establish flow to the contralateral extremity and pelvis. Using this approach, remodeling and straightening of angulated aortic neck morphology were achieved in all cases, including in 44% of patients with severe aortic neck angulation. The average follow-up period was 11.5 months (4-21 months). There was one early occlusion (<30 days after implantation) of the PTFE limb requiring thrombectomy and one late occlusion (6 months after implantation) requiring thrombectomy and implantation of a Viabahn stent graft (W.L. Gore & Associates). Scheduled CT scans did not show any graft migration or proximal neck dilatation. Neither neck dilatation nor endograft migration was observed with the balloon-expandable stent graft. In patients with complicated aortic neck morphology, balloon-expandable stent grafts such as the VI-Datascope graft provide more secure fixation and better long-term outcomes compared with the more commonly used self-expanding endografts.

Tratamento endovascular de aneurisma de artéria poplítea

CONTEXTO: Dos aneurismas periféricos, o da artéria poplítea é o mais freqüente, correspondendo a 70 a 80% dos casos. O tratamento cirúrgico convencional consta de exclusão do aneurisma e interposição de enxerto em ponte ou de ressecção parcial ou total do aneurisma e reconstrução arterial com enxerto em continuidade. O tratamento endovascular surgiu como uma alternativa ao reparo convencional. OBJETIVO: Avaliar o uso de endoprótese para o tratamento endovascular do aneurisma de artéria poplítea. METODOLOGIA: Num total de 17 pacientes, todos do sexo masculino, 11 foram tratados por técnica endovascular, utilizando-se próteses Hemobahn e Viabahn. RESULTADOS: Um paciente apresentou pseudo-aneurisma no pós-operatório imediato. Dentre as complicações tardias, um paciente apresentou endoleak distal da prótese após 7 meses, e houve oclusão da endoprótese em outro. Os nove pacientes restantes apresentaram controle de eco-Doppler satisfatório aos 20 meses, resultando em uma perviedade primária de 90% em um período médio de 27 meses de seguimento. CONCLUSÃO: O tratamento endovascular para aneurisma de artéria poplítea é factível e apresenta algumas vantagens em relação ao tratamento aberto, como menor tempo de internação e de recuperação.

Endovascular repair of an iatrogenic superior vena caval injury: A case report

We present the case of a patient with an iatrogenic injury to the superior vena cava during a central venous catheter placement. The vena cava was perforated when a left subclavian dialysis catheter was placed. The perforation in the right side of the vena cava occurred at the confluence of the innominate veins. This perforation was successfully repaired using a 10 mm Viabahn stent graft (W. L. Gore, Flagstaff, Ariz) delivered through a femoral approach. The stent graft was deployed as the dialysis catheter was removed. This case demonstrates the utility of stent graft repair of the superior vena cava in emergency situations.

Acute Compartment Syndrome Related to Stent-Graft Exclusion of a Popliteal Arterial Aneurysm

The purpose of this morbidity and mortality case report is to discuss a characteristic of the Viabahn (W.L. Gore, Newark, DE) stent-graft deployment as well as a complication related to wire trauma during endovascular exclusion of a popliteal artery aneurysm. We encountered a phenomenon not described in the literature during deployment of a Viabahn stent graft. This necessitated further wire purchase, which resulted in perforation of a branch vessel within the calf. The rapid recognition of the clinical findings and prompt diagnosis of compartment syndrome was essential to early intervention, which prevented further complication and permanent sequelae.

Successful Covered Stent-Graft Exclusion of Carotid Artery Pseudo-aneurysm: Two Case Reports and Review of Literature

Postendarterectomy carotid artery pseudo-aneurysm (CPA) is a relatively infrequent complication with an estimated incidence of 0.3%-0.6%. A report from a single center experience on open-surgical repair of CPA has shown the associated high morbidity and mortality. Endovascular therapy is emerging as a safer alternative to open-surgical therapy. We describe two cases of CPA treated with commercially available Viabahn stent graft system (Gore AL, Flagstaff, AZ).

Randomized comparison of percutaneous Viabahn stent grafts vs prosthetic femoral-popliteal bypass in the treatment of superficial femoral arterial occlusive disease

This randomized prospective study was designed to compare the effectiveness of treating superficial femoral artery occlusive disease percutaneously with expanded polytetrafluoroethylene (ePTFE)/nitinol self-expanding stent grafts vs surgical femoral-to-above knee (AK) popliteal artery bypass with synthetic graft material. From March 2004 to May 2005, 100 limbs in 86 patients with femoral-popliteal arterial occlusive disease were identified. Patients had symptoms ranging from claudication to rest pain, with or without tissue loss, and were prospectively randomized for treatment into one of two groups. The limbs were treated percutaneously with angioplasty and one or more self-expanding stent grafts (n = 50) or surgically with femoral-to-AK popliteal artery bypass using synthetic Dacron or ePTFE grafts (n = 50). The mean +/- SD total length of artery stented was 25.6 +/- 15 cm. Follow-up evaluation with ankle-brachial indices and color flow duplex sonography imaging were performed at 3, 6, 9, and 12 months after treatment. Patients were monitored for a median of 18 months. No statistical difference was found in the primary patency (P = .895) or secondary patency (P = .861) between the two treatment groups. Primary patency at 3, 6, 9, and 12 months of follow-up was 84%, 82%, 75.6%, and 73.5% for the stent graft group and 90%, 81.8%, 79.7%, and 74.2% for the femoral-popliteal surgical group. Thirteen patients in the stent graft group had 14 reinterventions, and 12 reinterventions occurred in the surgical group. This resulted in secondary patency rates of 83.9% for the stent graft group and 83.7% for the surgical group at the 12-month follow-up. Management of femoral-popliteal arterial occlusive disease using percutaneous treatment with a stent graft is comparable with surgical revascularization with conventional femoral-to-AK popliteal artery bypass using synthetic material up to 12 months. Longer-term follow-up would be helpful in determining ongoing efficacy.

Endovascular Treatment Of Popliteal Artery Aneurysms

Popliteal artery aneurysms are relatively uncommon but potentially limb-threatening lesions that can thrombose or cause distal embolization. Identification of these aneurysms, especially in patients with abdominal aortic aneurysms, is imperative, and prophylactic treatment with either surgical exclusion and bypass or endoluminal stent grafting is critical to prevent these poor outcomes. Endovascular approaches currently using the Viabahn stent graft offer several advantages, including a minimally invasive approach, fewer perioperative complications, and a faster recovery. This must be balanced with a potentially higher failure rate or requirement for reintervention, although contemporary series report comparable short-term outcomes. We present our approach to the evaluation and diagnosis of popliteal aneurysms, the technical aspects of endovascular popliteal aneurysm repair, and a representative case study.

Endovascular repair of an infected carotid artery pseudoaneurysm

Pseudoaneurysm formation after carotid endarterectomy is a rare but potentially lethal complication. The risks for embolization and continued expansion necessitate repair. Traditional surgical repair of carotid pseudoaneurysms is often technically demanding, and is associated with relatively high morbidity and mortality. Endovascular stent grafts have been used to treat both posttraumatic and postoperative carotid pseudoaneurysms. An endovascular approach to these pseudoaneurysms limits the risks for operative damage to surrounding structures and the potential for substantial blood loss. We present the case of an infected carotid pseudoaneurysm that was successfully treated with a covered stent graft.