Preliminary experience with the low profile VBX as bridging stent-graft in fenestrated and branched endovascular aortic repair.

BACKGROUND: Fenestrated and branched endovascular repair (F/B-EVAR) for thoracoabdominal (TAAA) and juxta/pararenal (J/P-AAA) aortic aneurysms has shown good mid- and long-term outcomes; however, the bridging stent graft (BSG) choice remains debated. A new low-profile BSG, The GORE® VIABAHN® VBX Balloon Expandable (BX) was introduced in December 2024. The aim was to report the BX preliminary outcomes in F/B-EVAR.

METHODS: Consecutive patients treated with at least 1 BX in F/B-EVAR between January and August 2025 were retrospectively analyzed. Early outcomes (30 days/in-hospital) included technical and clinical success, patency, and target vessel instability (TVI). Six-month outcomes included secondary endoleak, patency, and TVI, according to the Society for Vascular Surgery (SVS) reporting standards.

RESULTS: A total of 180 target vessels (TVs) in 47 patients were analyzed. Procedures included 17 preloaded-FEVAR, 11 off-the-shelf T-branch, 11 custom-made (CM) BEVAR, and 8 CM-F/B-EVAR. Indications included: 20 TAAA, 19 J/P-AAA, and 8 type IA endoleaks in EVAR. Median aneurysm diameter was 60 mm (53-66). Technical success was achieved in 99.4% (179/180 TVs), with 100% assisted technical success. Clinical success was 89.4% (42/47 patients), all BX-unrelated. Thirty-day TVI was 0.5%, with one renal branch occlusion successfully treated, leading to a secondary patency of 100%. At 6-months, 46 patients completed imaging. One renal fenestration type IC endoleak and one additional renal branch occlusion were observed. Overall primary and secondary patency were 98.9% and 99.4%, respectively. TVI was 1.7%.

CONCLUSIONS: The BX stent-graft appears safe and effective in F/B-EVAR, with satisfying preliminary results. Larger studies with longer follow-up are required to confirm BX durability.