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The risk of edge stenosis after Viabahn implantation was higher in patients with poor distal runoff. DCB reinforcement over the distal edge reduced edge stenosis, decreased 1-year TLR, and improved 1-year primary patency.

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Background: Endovascular therapy has become the first-line treatment for most peripheral artery diseases, but re-entry into the true lumen is not always possible, particularly in some cases of chronic total occlusion (CTO). We previously reported a novel hybrid Viabahn-assisted bypass (VAB) technique to facilitate revascularization of the femoro-popliteal CTO. This study assessed the midterm results of VAB technique. Methods and Results:Between January 2013 and April 2017, 440 patients received femoro-popliteal intervention and 17 of them (mean age, 76.2 years; 11 male patients) were treated using the VAB technique. The technical success was 100%. The mean follow-up period was 27.4±14.4 months (range, 6-50 months). Two patients underwent major amputation at 6 and 11 months postoperatively, but they died of acute myocardial infarction and of sepsis, respectively. Another 3 patients received re-intervention because of edge stenosis of the Viabahn stent graft. Another patient had acute Viabahn thrombosis and was treated using open thrombectomy. The primary and secondary patency rates at 12 months were both 88.2%, and at 24 months they were 69.2% and 84.6%, respectively. Conclusions:The VAB technique could be a safe and feasible alternative treatment for long femoro-popliteal CTO when conventional treatments fail. The technical success is high, and the midterm patency rates are acceptable.