How the GORE® VIABAHN® Endoprosthesis with PROPATEN Bioactive Surface* changed the natural history of a rapidly failing arteriovenous (AV) access circuit

Challenge

  • Severe stenosis across the elbow of a 78-year-old patient
  • A rapidly failing forearm loop graft that thrombosed three times over a 40-day period
  • The graft worked well for nearly two years before the first of the three thrombosis events
angiogram

First intervention — Declot percutaneous transluminal angioplasty (PTA) was chosen to treat the thrombosed graft.

Declot PTA procedure:
  • The thrombosed graft was secondary to a severe venous anastomotic stenosis.
  • The circuit had been working well for nearly two years.
Treatment rationale:
  • Give the lesion an opportunity to “declare its natural history”
  • KDOQI 6.7 – treatment of thrombosis and associated stenosis
    • 6.7.5 stenoses should be corrected by using angioplasty or surgical revision
Result:
  • Nice angiographic result initially with restored flow however, the patient returned 12 days later with a clotted graft.

Images courtesy of Minneapolis Vascular Physicians. Used with permission.

angiogram

Second intervention — Declot PTA was chosen again to treat the thrombosed graft.

Declot PTA procedure
  • Only 12 days passed after the first intervention.
  • Patient again presented with thrombosed graft secondary to severe venous anastomotic stenosis.
Treatment rationale:
  • Continue to allow the lesion an opportunity to “declare its natural history”
  • KDOQI 6.6 – If angioplasty of the same lesion is required more than two times within a three-month period, the patient should be considered for surgical revision if the patient is still a good surgical candidate
    • Still has not exceeded the KDOQI recommendation
Result:
  • Again, nice angiographic result achieved initially with restored flow however, the patient returned 28 days later with a clotted graft

Images courtesy of Minneapolis Vascular Physicians. Used with permission.

angiogram

Third intervention — GORE® VIABAHN® Device placed across the elbow to treat recurrent severe venous anastomotic stenosis.

The GORE® VIABAHN® Device procedure
  • Placed the GORE® VIABAHN® Device across the elbow instead of abandoning circuit.
Treatment rationale:
  • Exceeded KDOQI 6.6 recommendation – If angioplasty of the same lesion is required more than two times within a three-month period, the patient should be considered for surgical revision if the patient is still a good surgical candidate.
  • Accurate deployment of the GORE® VIABAHN® Device allows for treatment of stenosis across elbow while saving upper arm real estate.
Results:
  • Nice angiographic result. Flow was restored.
  • Accurate deployment left open the possibility of upper arm fistula.
  • Long term, the GORE® VIABAHN® Device broke the clotting cycle of this graft.
  • The patient returned for three interventions (two PTA of stenosis and one declot) from May 2012 to January 2016, with an average of 414 days between interventions.

Images courtesy of Minneapolis Vascular Physicians. Used with permission.

Case Takeaways

before and after data
  • Placing the GORE® VIABAHN® Device across the elbow extended the life of the graft without sacrificing the opportunity for an upper arm access

The outcomes and observations reported are based on individual case experience and the patients treated. The steps described here may not be complete, and are not intended to be a replacement for the Instructions for Use or the education, training and professional judgment of Healthcare Providers. Healthcare Providers remain solely responsible for making decisions about patient care and the use of medical technologies.

Visit our clinical uses page

*As used by Gore, PROPATEN Bioactive Surface refers to Gore’s proprietary CBAS® Heparin Surface.

eIFU Symbol

Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. RXOnly

231311950-EN

Residents of some states have the right to opt-out of the “sharing” or “selling” of their personal information. Gore does not "sell" the personal information of website users. Gore may "share" the personal information of website users, as standard advertising practice meant to offer you a more personalized service.

If you want to opt-out from Gore “sharing” your personal information, click on Opt-Out of Sharing to turn off the targeting cookies that we share with our advertising partners in order to provide you with personalized information. Disabling sharing will stop the use of cookies to targeted advertising but you may still see generic Gore ads.

Please note that your exercising of the rights outlined will have no adverse effect on the price and quality of our goods or services.

Opt-Out of Sharing

You Have Successfully Opted Out of the Sharing of Your Personal Information

Please note that if you clear your cookies and then use another device or browser, etc. your opt-out status is not transferred to the new device or browser.