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A systematic review of covered balloon-expandable stents for treating aortoiliac occlusive disease
B Patrice Mwipatayi1, Kenneth Ouriel2, Tahmina Anwari3
1School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia; Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia.
Insights
Covered balloon-expandable (CBE) stents show high technical success and 12-month patency for complex aortoiliac disease. Long-term data for the iCast/Advanta V12 stent demonstrate favorable 5-year outcomes.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Aortoiliac occlusive disease presents complex challenges for endovascular treatment.
- Covered balloon-expandable (CBE) stents offer a potential solution for these challenging lesions.
Purpose of the Study:
- To evaluate and compare the outcomes of covered balloon-expandable (CBE) stents in treating aortoiliac occlusive disease.
- To analyze technical success, patency rates, and long-term efficacy of various CBE stent devices.
Main Methods:
- Systematic literature search of studies published between 2000 and 2019.
- Inclusion of prospective and retrospective studies on CBE stent use for aortoiliac disease.
- Extraction and analysis of demographic, procedural, and outcome data from 15 articles representing 14 studies.
Main Results:
- Fifteen articles covering five CBE stent types (iCast/Advanta V12, Viabahn VBX, BeGraft, LifeStream, JOSTENT) were reviewed.
- Studies reported high technical success and 12-month patency rates across all evaluated CBE stents.
- Real-world studies indicated higher lesion complexity (TASC II class D, occlusions) compared to prospective trials.
Conclusions:
- Covered balloon-expandable (CBE) stents are a viable treatment for complex aortoiliac lesions, demonstrating high technical success and 12-month patency.
- Long-term efficacy data is limited, with only the iCast/Advanta V12 showing favorable 5-year primary patency (74.7%).
- Further research is needed to establish long-term outcomes for other CBE stent devices.
Objective:
To evaluate and compare studies reporting the outcomes of the use of covered balloon-expandable (CBE) stents for the treatment of aortoiliac occlusive disease.
Methods:
A systematic literature search was conducted to identify studies that investigated the use of CBE stents for the treatment of aortoiliac occlusive disease and were published between 2000 and 2019. Baseline demographic data, procedural variables, and long-term outcomes were extracted from publications for analysis.
Results:
A total of 15 published articles about 14 studies were included in the review. Of these, eight studies were prospective clinical trials and six studies were retrospective real-world studies. The articles included data regarding five different CBE stents, namely, the iCast/Advanta V12, Viabahn VBX, BeGraft, LifeStream, and JOSTENT. Lesion severity was higher in real-world studies, with more TransAtlantic Inter-Society Consensus Classification class D lesions and a higher percentage of occlusions. All studies showed high rates of technical success and patency over the course of 12 months. Long-term data were only available for the iCast/Advanta V12 device, which had a primary patency rate of 74.7% at 5 years.
Conclusions:
CBE stents are a viable treatment option for patients with complex aortoiliac lesions because of their high rates of technical success and favorable patency across all devices at 12 months. However, long-term data are only available for a single device, the iCast/Advanta V12. The results of using this device were favorable over the course of 5 years.
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