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Midterm outcomes of VBX bridging stent grafts in complex branched endovascular aortic repair
Victor A Nunes1, Claudia Theis2, Zemia C Ferreira3
1Division of Vascular Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA - vnunes@email.unc.edu.
Background:
The aim of the study was to evaluate the midterm durability of GORE® VIABAHN VBX balloon-expandable covered stent grafts used as bridging stents during branched endovascular aortic repair (FB-EVAR), focusing on primary patency and target vessel instability (TVI).
Methods:
This retrospective two-center cohort study analyzed prospectively collected data included consecutive patients undergoing B-EVAR with VBX bridging stent grafts from 2017 to 2025 using company-manufactured devices (CMD). Outcomes were assessed at both vessel and patient levels. Primary outcomes were target vessel instability (TVI) and primary patency per reporting standards. Secondary outcomes included secondary intervention, endoleak subtype, and acute kidney injury (AKI; RIFLE). Time-to-event outcomes were analyzed using Kaplan-Meier methods.
Results:
Among 315 patients, 792 target vessels were treated with branch configuration (265 celiac artery (CA), 277 superior mesenteric artery (SMA) with a VBX, and 250 renal arteries (RA) with VBX and Viabahn, while the remainder of the vessels (total of 468), were treated with fenestrations (SMA 20, celiac 25, renals 91) or other stent platforms. Median age was 73 years (interquartile range [IQR] 67-78), and median follow-up was 2.05 years (IQR, 0.79-3.22). Perioperative (30 days) AKI occurred in 2.2% (7/315), with permanent dialysis in 1% (3/315). The cumulative incidence of any secondary intervention per patient was 6.0%, 12.5%, 34.3% at 1, 2, and 3 years. Cumulative incidences of type I, II, and III endoleaks at 3 years were 16.2%, 25.8%, and 8.6%, respectively. Primary patency at 3 years was 96.8% (celiac), 96% (SMA), and 96.8% (renal) (log-rank P=0.47). Vessel-level TVI occurred in 4.4% (35/792), including 2.3% (celiac), 3.6% (SMA), and 7.6% (renal). Patient-level freedom from any TVI was 97.2%, 94.1%, and 85.2% at 1, 2, and 3 years. Freedom from TVI differed by vessel type (3-year: 96.8% celiac, 95.0% SMA, 91.8% renal), with no statistically significant difference across vessel types (log-rank P=0.70).
Conclusions:
VBX balloon-expandable bridging stent grafts demonstrated durable midterm performance during branched endovascular aortic repair (BEVAR), achieving high patency and low target-vessel instability. Outcomes were consistent with contemporary BEVAR series, supporting VBX as a reliable bridging strategy for complex aortic reconstruction.
