Case submitted by Masahiko Fujihara, M.D.
Osaka, Japan

Challenge:

Image: Calcified nodule at the aortoiliac bifurcation

• 78-year-old female with severe intermittent claudication (Rutherford Category 3)
• Bilateral common iliac artery stenosis (TASC II D lesions) originating at the aortic bifurcation
• Relevant patient history:
  • Hypertension, hyperlipidemia, prior bilateral carotid artery stenosis

Left Image: GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis deployment
Right Image: Final post-dilation of the GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis

Procedure:

• Gained bilateral access in the common femoral arteries
• Crossed lesions on both the left and right with .014" guidewires
• Dilated with a 2 mm diameter percutaneous transluminal angioplasty (PTA) balloon to allow for intravascular ultrasound examination
• Predilation with 5 mm balloons in kissing balloon technique
• Exchanged to .035" stiff guidewires and 7 Fr long sheaths
• Deployed two 7 mm x 79 mm GORE® VIABAHN® VBX Balloon Expandable Devices (VBX Stent Graft) using kissing stent technique
• Due to significant calcification, post-dilated first with two 8 mm x 40 mm PTA balloons
• Sequential post-dilation of VBX Stent Grafts proximally with a 10 mm x 20 mm PTA balloon followed by final post-dilation with kissing 8 mm x 40 mm PTA balloons
• Confirmed successful result using intravascular ultrasound and angiography

Image: Fully expanded GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis across the calcified segment

Result:

• The patient was discharged with a full ankle-brachial index recovery and no remaining symptoms.

Case Takeaways

The VBX Stent Graft provides durable outcomes in highly calcified lesions. The performance of the VBX Stent Graft allows device customization to the anatomy (6–11 mm for 7 mm x 79 mm device) and provides radial strength to achieve luminal gain while potentially mitigating the risk of rupture and perforation.