Viabahn balloon expandable outcomes as bridging covered stent in fenestrated and branched endovascular aortic repair

BACKGROUND: Target vessel outcomes affect fenestrated and branched endovascular aortic repair (f/bEVAR) durability. This systematic review and meta-analysis aimed to assess Viabahn balloon expandable (VBX) covered stent outcomes for bridging in f/bEVAR.METHODS: This systematic review was conducted according to PRISMA (PROSPERO: CRD420251034221). Database search was performed in PubMed, Cochrane Library and Embase. Studies between 2017-2025 reporting on f/bEVAR patients managed with bEVAR using the VBX for target vessel bridging were included. The risk of bias was assessed with ROBINS-I and the quality of evidence with GRADE. Target vessel technical success, instability (TVI), occlusion/stenosis, endoleak and reintervention rate were assessed as primary outcomes.RESULTS: Among 1728 studies, 16 were included (2214 patients, 5440 target vessels; 4406 branches, 993 fenestrations; 2918 bridged using VBX). Eight studies were at serious and eight at moderate risk of bias (ROBINS-I). Quality of evidence was ‘very low’ for all primary outcomes (GRADE). The median follow-up was 12.1 months (95% CI 9.1-15.1). Target vessel technical success was 98.9% (95% CI 97.3-99.5%; I2=0%), while TVI was 5.4% (95% CI 3.7-7.6%; I2=62%), occlusion/stenosis 3% (95% CI 1.8-4.9%; I2=62%), endoleak Ic/IIIc 2.9% (95% CI 2.2-3.7%; I2=0) and reintervention rate 3.1% (95% CI 1.6-6.1%; I2=54%). Analysis per vessel type revealed higher TVI for renal arteries. Subgroup analysis per incorporation type revealed higher technical success, but worse TVI, occlusion/stenosis and reintervention rate for branches.CONCLUSIONS: The VBX demonstrated high technical success and low complication rate. Target vessel incorporation with branches carried higher rates of complications compared to fenestrations.