RESULTS OF VIABAHN IN AORTO ILIAC OCCLUSION
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1 RESULTS OF VIABAHN IN AORTO ILIAC OCCLUSION JORGE FERNÁNDEZ NOYA ANGIOLOGY AND VASCULAR SURGERY DEPARTMENT UNIVERSITY CLINICAL HOSPITAL SANTIAGO DE COMPOSTELA
2 ALTERNATIVAS ENDOVASCULAR TERAPÉUTICAS TREATMENT DE LAS FOR LESIONES SFA ALTERNATIVAS OCLUSIVAS EN OBSTRUCTIVE TERAPÉUTICAS LA ARTERIA FEMORAL DISEASE SUPERFICIAL DE LA AFS ILIAC SECTOR TASC C Bilateral EIA stenoses 3-10 cm long not extending into the CFA Unilateral EIA stenosis extending into the CFA Unilateral EIA occlusion that involves the origins of internal iliac and/or CFA TASC D Diffuse disease involving the aorta and both iliac arteries Diffuse multiple stenoses involving the unilateral CIA, EIA and CFA Unilateral occlusions of both CIA and EIA Bilateral occlusions of EIA
3
4 COVERED-STENTS
5 COVERED-STENTS
6 ALTERNATIVAS ENDOVASCULAR TERAPÉUTICAS TREATMENT DE LAS FOR LESIONES SFA ALTERNATIVAS OCLUSIVAS EN OBSTRUCTIVE TERAPÉUTICAS LA ARTERIA FEMORAL DISEASE SUPERFICIAL DE LA AFS COVERED-STENTS Clinical benefit with balloonexpandable stent-grafts in complex TASC II C & D lesions 5 yr. follow up PP 74.7% CS vs 62.5 % BM SP 96% CS vs 74% BM
7 ALTERNATIVAS ENDOVASCULAR TERAPÉUTICAS TREATMENT DE LAS FOR LESIONES SFA ALTERNATIVAS OCLUSIVAS EN OBSTRUCTIVE TERAPÉUTICAS LA ARTERIA FEMORAL DISEASE SUPERFICIAL DE LA AFS COVERED-STENTS - INDEPENDENT OF THE LESION LENGTH WHY FOR COMPLEX LESIONS??? - AVOID DIFUSE RE-STENOSIS - PREVENT BLEEDING - HIGH PRESSURE BALLOONS CAN BE USED
8 ALTERNATIVAS ENDOVASCULAR TERAPÉUTICAS TREATMENT DE LAS FOR LESIONES SFA ALTERNATIVAS OCLUSIVAS EN OBSTRUCTIVE TERAPÉUTICAS LA ARTERIA FEMORAL DISEASE SUPERFICIAL DE LA AFS COVERED-STENTS Creating a physical barrier Prevents Ingrowth of proliferating SMCs
9 COVERED-STENTS Try to obtain the PATENCY of open surgery Endovascular advantage: Lower morbimortality Shorter hospital stay PATIENT CONFORT
10 COVERED-STENTS V12CERAB 6m 12m Prim patency 97.0% 89.55% 88.07% 85.07% 86.6% Sec Patency Freedom fromtlr 100% 95.5% 93.5% 93.5% 92.5% 98.5% 91.5% 89.55% 86.5% 85.0% P. Goverde. CERAB 3 years LINC17
11 ALTERNATIVAS TERAPÉUTICAS DE LAS LESIONES ALTERNATIVAS OCLUSIVAS EN TERAPÉUTICAS LA ARTERIA FEMORAL SUPERFICIAL DE LA AFS COVERED-STENTS CONFORMABILITY MATTERS!!!
12 RESULTS ENDOVASCULAR OF VIABAHN TREATMENT FOR IN SFA AORTO ILIAC OBSTRUCTIVE OCCLUSION DISEASE VIABAHN - Nitinol Stent - Inner layer of eptfe -Superb flexibility -Low fractures reported -Heparin-bonded luminal surface for thrombo-resistance - Actually up to 25 cm lenght GORE VIABAHN Endoprosthesis with Heparin Bioactive Surface Control Endoprosthesis
13 VIABAHN RESULTS OF VIABAHN IN AORTO.Restoring and improving the patency of the iliac arteries BeGraft aortic Stent Graft System
14 VIABAHN.Restoring and improving the patency of the iliac arteries
15 VIABAHN RESULTS OF VIABAHN IN AORTO.Restoring and improving the patency of the iliac arteries BeGraft aortic Stent Graft System
16 VIABAHN RESULTS OF VIABAHN IN AORTO.Restoring and improving the patency of the iliac arteries BeGraft aortic Stent Graft System
17 VIABAHN RESULTS OF VIABAHN IN AORTO.Restoring and improving the patency of the iliac arteries BeGraft aortic Stent Graft System
18 VIABAHN.Restoring and improving the patency of the iliac arteries 24% 53% patients 4 CFA LESIONS HYBRID TECHNIQUE Objective Healthy distal landing zone Improve the outflow Patency is not affected 4 Go across inguinal ligament 4 Piazza M. J Vasc Surg 2011; 54:402-11
19 VIABAHN
20 24% 53% patients 4 CFA LESIONS HYBRID TECHNIQUE Objective Healthy distal landing zone Improve the outflow Patency is not affected 4 Go across inguinal ligament 4 Piazza M. J Vasc Surg 2011; 54:402-11
21 VIABAHN Retrospective study. Jan Dec patients. 22 EVR, 21 OSR. Primary patency at 2 years 94% EVR vs 97% OSR Secondary patency 97% EVR vs 100% OSR Complications rate 4% EVR vs 18% OSR. (p.32) Femoral thromboendarterectomy 36% EVR 100% VIABAHN
22 VIABAHN 6 Juxtarenal occlusion 5 Distal aortic occlusion 11 total iliac occlusion TORINO EXPERIENCE : 22 cases Rutherford Class III 13 IV 7 V and VI 2 M. LINC2017
23 VIABAHN Technical success 100% Renal/Visceral embolization 0% Days hospital stay 3.9+/-2.2 TORINO EXPERIENCE : 22 cases Follow up (12 ± 9.1 m) Primary patency 90.9% Secondary patency 96.5% M. LINC2017
24 VIABAHN Retrospective study. Jan Jun iliac /125 patients. TASC C (51%) y D (49%). 82 CS (49%) 85 BMS (51%) Primary patency for 2 years 93% CS vs 80% BMS (p=0.14) 56.1 % VIABAHN Permeability TASC D 88% CS vs 61% BMS (p=0.07) Permeability TASC D (CIA + EIA) 88% CS vs 57% BMS (p=0.03)
25 VIABAHN 60% Viabahn - TOTAL LESSION LENGTH > 6 cm - OCCLUSION LENGTH > 3.5 cm - CALCIFICATION INVOLVING > 75%
26 HOSPITAL UNIVERSITARIO CENTRAL DE ASTURIAS EXPERIENCE ENERO DIC 2016 Rutherford 3/4-5 ASA III/IV TASC C/TASC D Aorto-iliac obstruction Covered stents - Viabahn (7-8 mm) - Advanta 138 ptes (178 iliacas) 69.2%/30.2% 50.8% 45.5%/40.3% 11.1% 364 (2.64) 78.7% 21.3% Tech. Succes 98.3% (174/178) Bare metal Stents 44 Courtesy Dr. Zanabili/ Dr. Camblor
27 HOSPITAL UNIVERSITARIO CENTRAL DE ASTURIAS EXPERIENCE Patency Primary Secondary Follow -up 3-24 months 96.6% (172/178) 100% TLR (100% EIA envolvement) 6 re-stenosis (distal edge Viabahn) 6 thrombosis (3 percutaneus access) TEA / Femoral Patch EIA Occlusion 6.74% (12) 3 overlap/3 TEA / 6 thrombolysis/4 TEA 57% 74% Infrainguinal revascularization 7% (9) Extra-anatomic by-pass 1 FEM-FEM 0 AXILO-FEMORAL Courtesy Dr. Zanabili/ Dr. Camblor
28 BEYOND THE SFA. THE VERSATILITY OF GORE VIABAHN ENDOPROSTHESIS FROM HEAD TO FOOT LOS PACIENTES CON ISQUEMIA CRÍTICA DEBERÍAN TRATARSE PRIMERO CON TRATAMIENTOS ENDOVASCULARES. ÚLTIMOS RESULTADOS EUROPEOS DE LA ENDOPRÓTESIS GORE VIABAHN CON SUPERFICIE ILIAC BIOACTIVA OCCLUSION PROPATEN VIABAHN - More than 100 iliac treated with viabahn SE CHUS experience - Adjuntive proximal or distal treatment - Combine different devices
29 ALTERNATIVAS ENDOVASCULAR TERAPÉUTICAS TREATMENT DE LAS FOR LESIONES SFA ALTERNATIVAS OCLUSIVAS EN OBSTRUCTIVE TERAPÉUTICAS LA ARTERIA FEMORAL DISEASE SUPERFICIAL DE LA AFS VIABAHN BX Balloon expandable stent developed on SE platform Stainless steel Semi-compliant covered balloon Stent is not continuous : Flexibility Both surfaces covered with Heparin coated PTFE Scalloped edges. Available pre-mounted 5mm-11mm diameter 15mm-79 mm length No foreshortening, except on over dilatation
30 VIABAHN BX 12 month follow-up results 96.6% primary patency (per-subject) 1 patient with edge stenosis at 7 months, managed with angioplasty and stenting Interim 24 month analysis 28 patients ongoing in study at 24 months 1 further edge stenosis > 50% diameter loss detected on 2 year US (day 723) no TLR as yet 0 TLR from 12 to 24 months Primary 2 years 93% Freedom from 2 years 97% A. LINC2017
31 VIABAHN BX Gore VBX FLEX IDE Clinical Study VBX FLEX IDE clinical study (n=134), 32 percent presented with TASC II type C or D lesions, 18 percent required contralateral access to the lesion, and 42 percent involved kissing stents at the aortic bifurcation. 100 percent success rate in device delivery and coverage of target lesions in all study subjects Clinical Trial results 100 percent success rate in reducing the target lesion to less than or equal to 30 percent of the original stenosis Zero change in median length of the device upon deployment 96.9 percent primary patency at nine-months, including a 95.3 percent primary patency rate in those patients with TASC II C or D type lesions. Further, there were no reported incidences of device dislodgement, failures in stent integrity, or device-related serious adverse events through the primary endpoint follow up.
32 BEYOND THE SFA. THE VERSATILITY OF GORE VIABAHN ENDOPROSTHESIS FROM HEAD TO FOOT LOS PACIENTES CON ISQUEMIA CRÍTICA DEBERÍAN TRATARSE PRIMERO CON TRATAMIENTOS ENDOVASCULARES. ÚLTIMOS RESULTADOS EUROPEOS DE LA ENDOPRÓTESIS GORE VIABAHN CON SUPERFICIE ILIAC BIOACTIVA OCCLUSION PROPATEN COMMENTS - MARKS IN THE STENT - DRUG IN THE EDGES - CONICAL STENTS - MORE STENT LENGTHS - WHAT ELSE?
33 SUMMARY Covered stents prevent athero prolapse and future restenosis an occlusion in TASC C and D lesions covered stents perform better than BMS ( ENDOVASCULAR BY- PASS) COMFORMABILITY MATTERS!!!! Good results using Viabahn in TASC C & D (EIA & cross inguinal lig) Too much BIAS in the studies Viabahn Bx is a new tool that combine the best of the Bx and SE Covered Stents
34 THE USE OF STENT GRAFT AS A PRIORITY FOR LESIONS GREATER THAN 25 CM
PATIENTS WITH CLI THE THREE YEARS OUTCOME OF ENDOLUMINAL BYPASS FOR PATIENTS WITH CLI
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