Naoki Fujimura
Nationality
Japan
Current Position
Vascular Surgeon / Chief physician
Organization
Department of Vascular Surgery, Saiseikai Central Hospital
Peripheral Artery Session

Topic: Application of balloon expandable endoprosthesis in iliac artery pathologies

Abstract

Evidences have shown that balloon-expandable endoprosthesis (BEE) are effective in complex aorto-iliac pathologies like Trans Atlantic Inter-Society Consensus (TASC) C and D lesions. It will not only decrease the chances of restenosis in a long diffuse lesions, but also fatal perforations in severely calcified lesions and distal embolisms in plaque rich lesions. Two types of BEEs are available in Japan, Viabahn VBX from W.L Gore and Associates and Life Stream from BD. Both BEEs have shown satisfactory results in clinical trials and share similar characteristics like using expanded polytetrafluoroethylene (ePTFE) for the graft material, and ability to post dilate using bigger sized balloon catheter after the initial dilation. However, they also have distinct characteristics different from each other, which will be useful during the actual intervention. In this presentation, characteristics of Viabahn VBX and Life Stream will be compared, and will show how I differentiate these two BEEs during the endovascular intervention of complex aorto-iliac lesions.

 


Abdominal Aorta & Aortic iliac Session

Topic: Multicenter Japanese registry for comparison of Endurant vs Excluder; ULTIMATE 2 study

Abstract

Objective: To compare the long-term outcomes of the Endurant and Excluder stent grafts using Japanese multicenter registry.
Methods: A retrospective analysis of endovascular aneurysm repairs (EVAR) for abdominal aortic and iliac artery aneurysms using either the Endurant or Excluder stent grafts from January 2012 to July 2019 at 10 Japanese hospitals was performed.
Results: A total of 332 and 378 EVARs using the Endurant and Excluder stent grafts, respectively, were analyzed. Although the patients’ characteristics were generally similar in the two groups, the Endurant group exhibited significantly shorter, larger, and more reversed tapered proximal necks. The incidence of instructions for use (IFU) violations was similar between the two groups (Endurant: 59.0%, Excluder: 54.5%; P = 0.223). However, the Endurant group had significantly more proximal neck-related IFU violations, more access-related IFU violations, and fewer bilateral hypogastric artery embolizations compared to the Excluder group. The incidence of intraoperative and perioperative complications was equivalent in the two groups. However, there was a significantly higher incidence of postoperative type II endoleaks and less aneurysm sac regression in the Excluder group. On the other hand, the Endurant group had significantly higher incidence of type V endoleaks and more sac increase. Kaplan-Meier curve and log rank analyses revealed no statistical differences in late complications and overall survival.
Conclusions: There were no statistically significant differences between the Endurant and Excluder stent grafts in terms of intraoperative, perioperative, and late complication rates; however, the anatomical characteristics of the patients were significantly different and appropriate device selection seems to be important.