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New GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis: Case experience in aortic disease M. Austermann Department of Vascular Surgery St. Franziskus Hospital Münster Head: Univ. - Prof. Dr. G. Torsello

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Page 1: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

New GORE® VIABAHN® VBX Balloon

Expandable Endoprosthesis:

Case experience in aortic disease

M. Austermann

Department of Vascular SurgerySt. Franziskus Hospital Münster

Head: Univ.- Prof. Dr. G. Torsello

Page 2: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Disclosures:

Consulting Gore, Medtronic

Proctor Cook™ Company

PD Dr. med. Martin Austermann

Senior consultant and

Leader of section „endovascular aortic

therapy“

Page 3: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

FEVAR BEVAR

T-BRANCH CHEVAR

Page 4: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

Advanta V12TM Getinge FluencyTM

Bard

LifestreamTM Bard

Device Overview

IL0109 Rev.1 1

ViabahnTM

Gore

BeGraft+TM

Bentley

Durability of FEVAR, CHEVAR and BEVAR

is strongly associated with the

performance of the bridging devices

Page 5: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

Durability of FEVAR, CHEVAR and BEVAR

is strongly associated with the

performance of the bridging devices

Failure modes of BSG:

Page 6: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

TAAA-BEVAR:

Relined BE-BSG LRA: Occlusion after 1Y

Kinking behind

the BSG

Shrinking of

aneurysm

Page 7: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

The Ideal Bridging stent attributes

should include the followings:

• Cover the distance between the main body and the target vessel (many

length options)

• Good visibility during implantation

• Respect the angulation of the target vessel (flexibility)

• Durable and flexible after flaring, during the cardiac cicles, the diaphragm

movements and after aortic remodelling

• High radial forces and resistance to compression (calcified ostium,

CHEVAR)

• Stent retention during navigation

• High trackability of the delivery system

• Wide range of sizing and oversizing

Page 8: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

GORE® VIABAHN® VBX Balloon

Expandable Endoprosthesis

Page 9: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Independent stainless steel rings

• Independent rings for flexibility

and conformability

• Minimizes foreshortening

• Provides high radial strength

Highly flexible stent and catheter

• Enables contralateral deployment

• Enables implanted conformability

Ultrathin balloon cover

• Improves stent retention and deliverability

Semi-compliant covered balloon

• Enables diameter customization

CBAS Heparin Surface

Technology:

Page 10: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Page 11: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Configurations:

Page 12: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 1: male, 69Y., CAD, COPD

Aortic aneurysm segm. 4 after OR of abd. aneurysm

Page 13: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 1: male, 69Y.

Placement of

the branched

endograft

and

closure of the

femoral access

(avoids SCI)

Page 14: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 1: male, 69Y. - Bridging SMA

Page 15: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 1: male, 69Y. - bridging RRA

Page 16: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 1: male, 69Y.

Before After

Page 17: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 1: male, 69Y. - CT-reconstruction

SMA RRA CT

Page 18: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 2: male, 67Y., CAD, heart insufficiency,

single kidney left side, hostile abdomen

Symptomatic 1a EL after EVAR

Page 19: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 2: male, 67Y.

CHEVAR with

VBX LRA

Page 20: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 2: male, 67Y.

CT-reconstruction: VBX as Chimney-stent

Page 21: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 2: male, 67Y.

Before After

Page 22: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 3: male, 72Y., CAD-MI2008, COPD

Thorakoabdominal aneurysm Type Crawford 4

Page 23: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Case 3: male, 72Y., CAD-MI2008, COPD

Page 24: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Before

After

Case 3: male, 72Y., CAD-MI2008, COPD

Page 25: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Flaired VBX in

a fenestration

(Keyence VHX 6000

Digital Microscope)

Page 26: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Radiological

analysis in two

planes for

detecting stent

fractures

Flaired VBX in

a fenestration

Page 27: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

VBX®: Case experience in aortic disease

Durability of FEVAR, CHEVAR and BEVAR is strongly associated with

the performance of the bridging devices.

Until now, a balloon expandable stent graft has not been designed

specifically for these applications. VBX has been designed with complex

EVAR applications in mind (desirable attributes).

Clinical data reporting vbx outcomes in these applications are awaited.

We have very limited experience across these applications but the first

cases have demonstrated favorable procedural results .

Conclusion:

Page 28: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

Thank you and best regards from Münster!

VBX®: Case experience in aortic disease

[email protected]

Page 29: Case experience in aortic disease M. Austermann · VBX®: Case experience in aortic disease Durability of FEVAR, CHEVAR and BEVAR is strongly associated with the performance of the

New GORE® VIABAHN® VBX Balloon

Expandable Endoprosthesis:

Case experience in aortic disease

M. Austermann

Department of Vascular SurgerySt. Franziskus Hospital Münster

Head: Univ.- Prof. Dr. G. Torsello


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