Tailored Endovascular Therapy for Deformed VIABAHN VBX Balloon-Expandable Stent Graft by External Force in Aortoiliac Disease

The VIABAHN VBX balloon-expandable stent graft (VSG) is recommended for aortoiliac disease. VSG deformation is rare, and no appropriate therapeutic strategy for deformed VSG has been developed. We report 2 cases in which VSGs deployed using the kissing stent technique in aortoiliac lesions were deformed by external forces owing to acupressure or bent back. In patient 1, balloon angioplasty was sufficient to maintain patency because the external force caused by acupressure was avoided by prohibiting it. In patient 2, as the external force caused by the bent back was unavoidable, the VSG deformations were repeated by balloon angioplasty. Bilateral self-expandable stent implantation successfully improved and prevented the VSG deformation. To our knowledge, this is the first report of long-term patency after managing VSG deformation with appropriate device choices. Tailored endovascular therapy achieved 4-year patency, highlighting the importance of managing external forces causing VSG deformation in aortoiliac disease.