[MO-74] Presentation Awards
A case of Viabahn® VBX subacute occlusion implanted for in-stent occlusion of Leriche syndrome with severe calcification.
Case was 83-year-old female presented with right claudication.
She had history of EVT for Leriche syndrome with severe calcification and implanted BNSs 30 months ago.
Angiography revealed that in-stent occlusion of stent implanted from aorta to right CIA and in-stent restenosis of stent at left side. The lumen of the stent was occupied by a mass of calcification and we successfully crossed the 0.014 inch Astato 9-40 wire at the center of calcification. After dilation by non-compliant balloon, we implanted two Viabahn VBX, newly introduced balloon-expandable stent graft, from aorta to both CIA. IVUS after implantation showed good expansion.
Her symptom disappeared after EVT, right leg claudication recurred 28 days after EVT. Angiography showed bilateral Viabahn VBX occlusion at aorta. Wire easily passed the lesion. IVUS showed severe narrowing of Viabahn VBX and extension of thrombus to proximal aorta. The suspected mechanism of occlusion is the compression of sever calcification. Different from self-expandable Viabahn, Viabahn VBX has strong radial force. To obtain superior radial force, we decided to implant 2 types of stents inside Viabahn VBX. Firstly, we implanted 2 long BNS from aorta to both CIA to cover thrombus. And then implanted 2 balloon expandable stents at the culprit sight of re-occlusion inside the BNS. IVUS showed greater expansion compared with previous procedure.
High patency rate of Viabahn VBX has been reported. The indication of Viabahn VBX is the complex aortoilliac lesions. However, we experienced the subacute occlusion and this was the first case of Viabahn VBX occlusion in Japan.This is the Japan’s first case of VIABAHAN VBX occlusion. VIABAHAN VBX is useful device in calcified stenosis involving the risk of perforation, however, in very severe calcification like this case, radial force of VIABAHN VBX might be not enough.
She had history of EVT for Leriche syndrome with severe calcification and implanted BNSs 30 months ago.
Angiography revealed that in-stent occlusion of stent implanted from aorta to right CIA and in-stent restenosis of stent at left side. The lumen of the stent was occupied by a mass of calcification and we successfully crossed the 0.014 inch Astato 9-40 wire at the center of calcification. After dilation by non-compliant balloon, we implanted two Viabahn VBX, newly introduced balloon-expandable stent graft, from aorta to both CIA. IVUS after implantation showed good expansion.
Her symptom disappeared after EVT, right leg claudication recurred 28 days after EVT. Angiography showed bilateral Viabahn VBX occlusion at aorta. Wire easily passed the lesion. IVUS showed severe narrowing of Viabahn VBX and extension of thrombus to proximal aorta. The suspected mechanism of occlusion is the compression of sever calcification. Different from self-expandable Viabahn, Viabahn VBX has strong radial force. To obtain superior radial force, we decided to implant 2 types of stents inside Viabahn VBX. Firstly, we implanted 2 long BNS from aorta to both CIA to cover thrombus. And then implanted 2 balloon expandable stents at the culprit sight of re-occlusion inside the BNS. IVUS showed greater expansion compared with previous procedure.
High patency rate of Viabahn VBX has been reported. The indication of Viabahn VBX is the complex aortoilliac lesions. However, we experienced the subacute occlusion and this was the first case of Viabahn VBX occlusion in Japan.This is the Japan’s first case of VIABAHAN VBX occlusion. VIABAHAN VBX is useful device in calcified stenosis involving the risk of perforation, however, in very severe calcification like this case, radial force of VIABAHN VBX might be not enough.