VBX as primary choice for complex aorto-iliac reconstructions.

Complex aorto-iliac occlusive disease involves extensive narrowing or blockage of the aorta and iliac arteries, often including the aortic bifurcation. It typically causes severe bilateral leg claudication, buttock claudication, and in men may cause impotence. Treatment options include open aorto-bifemoral bypass or endovascular reconstruction such as CERAB.

The Gore VBX balloon-expandable covered stent is used in CERAB and complex iliac reconstructions where precise deployment and high radial force are required. Its covered design prevents tissue ingrowth and allows treatment of the aortic bifurcation with excellent technical precision.

Diagnosis is based on clinical assessment, ankle brachial index measurement, and CT or MR angiography to define the extent and distribution of disease. Aortography may be performed at the time of the endovascular procedure. Duplex ultrasound can also assess the iliac arteries non-invasively.

Modern endovascular techniques for aorto-iliac disease, including CERAB, have demonstrated good technical success rates and durable patency in published series. Results are best in patients with favourable anatomy and effective cardiovascular risk factor management following the procedure.

Endovascular aorto-iliac reconstruction is performed through small groin punctures and typically requires only an overnight hospital stay. Recovery is significantly faster than open aorto-bifemoral bypass surgery. Most patients return to normal activities within one to two weeks, with ongoing follow-up imaging arranged.