Viabahn stent graft for arterial injury management: safety, technical success, and long-term outcome

Abstract

Background: The Viabahn stent graft has emerged as an integral tool for managing vascular diseases, but there is limited long-term data on its performance in emergency endovascular treatment. This study aimed to assess safety, technical success, and long-term efficacy of the Viabahn stent graft in emergency treatment of arterial injury.

Methods: We conducted a retrospective single tertiary centre analysis of patients who underwent Viabahn emergency arterial injury treatment between 2015 and 2020. Indication, intraoperative complications, technical and clinical success, and major adverse events at 30 days were evaluated. Secondary efficacy endpoints were the primary and secondary patency rates assessed by Kaplan-Meier analysis.

Results: Forty patients (71 ± 13 years, 19 women) were analyzed. Indications for Viabahn emergency treatment were extravasation (65.0%), arterio-venous fistula (22.5%), pseudoaneurysm (10.0%), and arterio-ureteral fistula (2.5%). No intraoperative adverse events occurred, technical and clinical success rates were 100%. One acute stent graft occlusion occurred in the popliteal artery on day 9, resulting in a 30-day device-related major-adverse-event rate of 2.5%. Median follow-up was 402 days [IQR, 43-1093]. Primary patency rate was 97% (95% CI: 94-100) in year 1, and 92% (95% CI: 86-98) from years 2 to 6. One stent graft occlusion occurred in the external iliac artery at 18 months; successful revascularization resulted in secondary patency rates of 97% (95% CI: 94-100) from years 1 to 6.

Conclusion: Using Viabahn stent graft in emergency arterial injury treatment had 100% technical and clinical success rates, a low 30-day major-adverse-event rate of 2.5%, and excellent long-term patency rates.

Keywords: Bleeding; Endoprosthesis; Graft; Heparin; Injury; Stent; Viabahn.

Fig. 1

Long-term patency rates for Viabahn stent graft treating vessel injury. Curves show patency rates (%) over 6 years in patients treated with Viabahn stent graft for vessel injury: A primary patency (green curve), and (B) secondary patency (blue curve). CI = confidence interval

Fig. 2

Viabahn stent graft for endovascular treatment of extravasation. A 79-year-old female with (A) fulminant bleeding (green arrows) from the common femoral artery after transcatheter aortic valve replacement procedure. B Implantation of a Viabahn stent graft after crossover maneuver. C Final target site angiography demonstrated successful hemostasis

Fig. 3

Viabahn stent graft for endovascular rupture treatment. A 52-year-old male reported experiencing leg pain following a work-related accident at a construction site. A Angiogram revealed traumatic rupture of the popliteal artery (blue arrows). B A Viabahn stent graft was deployed. C Final target site angiography demonstrated restored blood flow

Fig. 4

Viabahn stent graft for endovascular treatment of uretero-iliacal fistula. In an 80-year-old male patient with a complex medical history, including extensive prior surgery and chemotherapy for colon carcinoma, multiple prior surgeries for urolithiasis, and ureteric stent implantation, the removal of the ureteric stent led to massive hematuria. A Subsequent ureterorenoscopy revealed the presence of a fistulous connection between the left ureter and the adjacent left internal iliac artery (red arrows), B which was first addressed through coiling. C Due to residual perfusion (orange arrows), D a Viabahn stent graft was deployed. E Ureterography showed no remaining perfusion of the fistula. F Final target site angiography demonstrated preserved left iliac blood flow