Utilization of VBX Expandable Covered Stents in Severe Calcified Aortoiliac Disease to Perform a Mini-EVAR

Subash Swarna, Seena Firouzbakht, Vivie Tran, Amber Hernandez, Hoang Ho, Leigh A. Jenkins, MD, Mohammad M. Ansari, MD 

PAD Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX, USA 

Introduction

Aortoiliac disease poses a significant challenge in medical management. While conventional approaches include medications, various interventions, and surgical procedures, some patients are high risk for surgery and percutaneous endovascular intervention. In cases of severe aortoiliac disease leading to CLI, the need for a more advanced solution becomes paramount. EVAR can be an option, however, a mini-EVAR by utilizing VBX expandable covered stents can widen narrowed arteries and maintain their patency. Beyond addressing the severe stenosis, they also serve as a safeguard against potential reclosure. This not only treats the immediate issues associated with aortoiliac disease but also can enhance long-term outcomes and prevent future complications.

Case Presentation

Male, age 64 with a PMH of PAD, CAD, femoral-femoral bypass graft, CABG, HTN, HLD, and vertebral occlusion presented to the ER with severe bilateral leg claudication. Peripheral angiogram revealed severe CTO in the bilateral common iliac arteries. After crossing the stenotic and occluded vessels, a covered stent was successfully advanced through the bilateral common iliac arteries in a coordinated, unison direction towards the aorta. The stents were successfully deployed under high pressure covering the speculated calcium, showing excellent results with no signs of dissection, perforation, or distal embolization. Hence, severe CTO of the bilateral iliac arteries was successfully treated with excellent results. The patient was discharged from hospital for clinic follow-up.

Conclusion

Our case illuminates the impact of utilizing VBX expandable covered stents in severe aortoiliac disease. Beyond addressing immediate symptoms, this intervention has shown better long-term outcomes and proactively prevents future complications. This demonstrates that high-risk patients now have an option of a mini-EVAR, which can be safe and effective in treating severe calcified aortoiliac disease. In situations where conventional, simpler approaches falter, the implementation of these stents enhance our ability to manage the disease most effectively.