Restoring flow in a patient with severe claudication and focal iliac calcification

Case submitted by Chris Metzger, M.D.
Kingsport, Tennessee

View video of Case submitted by Chris Metzger, M.D.

Challenge:

  • A 57-year-old male with severe intermittent claudication (Rutherford 3).
  • TASC II B lesion in the right common iliac artery (CIA) and focal iliac calcification.
  • Relevant patient history:
    • Current smoker with hypertension, hyperlipidemia and previous diagnosis of peripheral artery disease in the right limb that was treated with medication.
    • Baseline ankle-brachial index (ABI) = 0.76.

Focal calcification in the right CIA

Focal calcification in the right CIA

Procedure:

  • Started with bilateral access, identified focal lesion in the distal right CIA that was ~80% stenosed.
  • Angiography showed robust multi-vessel distal runoff down to the foot.
  • Pre-dilated with a 5 × 20 mm ABBOTT® ARMADA PTA balloon, observed presence of calcification nodule that prevented full dilatation of the percutaneous transluminal angioplasty (PTA) balloon.
  • Delivered and deployed an 8 mm × 39 mm GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis (VBX Stent Graft).
  • Slight residual stenosis observed following VBX Stent Graft deployment.
  • Post-dilatation performed using a 7 × 20 mm ABBOTT® ARMADA PTA balloon inflated to 14 atm (near rated burst pressure).
  • Final angiogram showed complete restoration of patency in the right CIA with good distal outflow.
Left Coronary
Abdomen

GORE® VIABAHN® VBX Balloon Expandable Endoprostheiss deployment and post dilatation

Result:

At discharge, the patient’s ABI was 1.0. At three-year follow-up, ABI was measured at 0.99 and patient was Rutherford 0 with no report of pain/discomfort or problems with mobility.

Complete restoration of patency

Complete restoration of patency

Case takeaways:

Calcified lesions present challenges in endovascular treatment of aortoiliac occlusive disease, including an increased risk of rupture. The VBX Stent Graft provides a barrier that mitigates concerns about neointimal hyperplasia and provides high radial strength to restore patency in even the most calcified lesions.1

Images courtesy of Chris Metzger, M.D. Used with permission.

  1. Bismuth J, Gray BH, Holden A, Metzger C, Panneton J; VBX FLEX Study Investigators. Pivotal study of a next-generation balloon-expandable stent-graft for treatment of iliac occlusive disease. Journal of Endovascular Therapy 2017;24(5):629-637.

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