A systematic review of covered balloon-expandable stents for treating aortoiliac occlusive disease

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.

Clinical outcomes of endovascular procedure using VIABAHN® VBX covered stent in complex aortoiliac artery disease: Result from AVOCADO study

“…This stent consists of discrete stainless steel rings fully encapsulated in fluoropolymer and are coated with heparin. [7][8][9][10][11][12][13][14][15] In clinical settings, the combinatorial therapy with the different type of stents is often selected to compensate for the disadvantages of individual stents. According to the data presented in this study, 60% of EVT procedures were done using VBX alone; the remaining 40% of the procedures were done using combinatorial therapy including covered stent, as well as the SES for multiregion disease, covered stent for an aortic and common iliac lesion, and a bare stent for external iliac lesion.…”

“…The application of covered stent demonstrated patency benefit over the traditional bare‐metal stent (BMS)‐based interventions in complex cardiovascular diseases 11 . A previous report has systematically reviewed the clinical feasibility of the covered balloon‐expandable stent‐based medical intervention 12 …”

“…The VBX Stent Graft is a balloon‐expandable covered stent, which was approved in 2018 for de novo treatment of restenotic aortoiliac lesions, including aortoiliac bifurcations. This stent consists of discrete stainless steel rings fully encapsulated in fluoropolymer and are coated with heparin 7–15 . In clinical settings, the combinatorial therapy with the different type of stents is often selected to compensate for the disadvantages of individual stents.…”

Successfully stented aortoiliac occlusive disease that has multi-level crossing channels in occluded terminal aorta

“…Many aortoiliac occlusive disease cases are nowadays safely treated by endovascular treatment [2]. A technically important point is how to dilate the channels that show this special configuration of horizontal and vertical directions.With careful procedures, it was a safe and effective strategy to dilatesuchhorizontally running small channels with the preparation ofthe use of covered balloon-expandable stents [3].…”

Descending thoracic aorta to bilateral femoral artery bypass and thoracic endovascular aortic repair in the management of atypical aortoiliac occlusive disease

“…Percutaneous treatment is now routinely applied to long-segment occlusions such as TASC II D (Trans-Atlantic Inter-Society Consensus class D) lesions. 3 , 4 Nevertheless, open bypass remains a critical part of management when extensive disease or complex anatomy impedes suitable endovascular approaches. 3 , 5 , 6 , 7 Additionally, the challenges associated with suprarenal clamping on the mid-visceral atherosclerotic aorta, the presence of a hostile abdomen, or the simultaneous need to correct inflow and outflow have made isolated endovascular and open aortobifemoral bypass methods less attractive.…”