[MP-3] Endovascular treatment with Next-Generation Balloon-Expandable Endoprosthesis (Viabahn® VBX) for Aorto-Iliac Occlusive Disease (Leriche syndrome):Case Report.
A-59-year-old man with severe claudication in both legs admitted to our hospital. Ankle-Brachial Index (ABI) was 0.64/0.61. CT angiography showed stenosis from bifurcation of left renal artery to lumbar artery and occlusion from bifurcation of lumber artery to bilateral common iliac artery (CIA). We performed Endovascular therapy (EVT) with general anesthesia and 2-operators. 4.5Fr Guiding sheath placed from right radial artery and two 7Fr semi-long sheath placed from both common femoral arteries. We started antegrade approach with 4Fr angiographic catheter and 0.014-inch taper guidewire, simultaneously retrograde approach with IVUS and 0.014-inch intermediate guidewire. Antegrade guidewire went through the all true limen with IVUS guidance from retrograde subintimal lumen and passed into the guiding catheter from right iliac artery. After balloon angioplasty from aorta to right CIA, retrograde 0.014-inch guidewire easily passed from left CIA to aorta. At first, we implanted 14 x 40mm self-expandable standard nitinol stent just below the left renal artery in order to avoid lumbar artery occlusion and spinal cord infarction. After that, connected two Viabahn@VBX Stent (8.0 x 59mm, 8.0 x 59mm) And implanted with simultaneously kissing stent technique from aorta to bilateral CIA. Finally, Added 2 Standard nitinol stents from bilateral CIA to external iliac artery (EIA). Final angiogram showed good antegrade flow at both legs and finished procedure without any complication. Procedure time was about 140 minutes. After procedure, claudication disappeared and ABI was improved 0.80/0.72.