Who is using the GORE Viabahn Endoprosthesis? What are your experiences?
I use the Viabahn for both occlusive disease and certainly aneurysmal disease in this segment, and run the Gore Advanced Femoropopliteal Viabahn Workshop in the UK. Very versatile device but use appropriately for the right indication. Surveillance is a must both types of disease and also dual anti-platelet therapy.
How long do you implement post-interventional dual antiplatelet regime? For six months and then a mono- therapy?
In our Institute - Heart Institute of Sao Paolo - BR, for peripheral Endovascular procedures, we use Clopidogrel + AAS during the first 3 months and then mono-therapy with AAS, forever!
The issue really is why do we even consider stopping DAP and switching to MAP? As a covered stent, this will NEVER be endothelised for starters- even with drug- eluting stents in the coronaries (agree, different circulatory bed, different device) the AHA recommended 12 months of DAP which was published in 2007 in Circulation. Stoppage of DAP has been cited as an independent risk factor for graft thrombosis. Is it worth doing a study? Difficult to say. I use DAP for life!!
Do you make any difference in use of antiplatelet therapy after bare metal stent / drug eluting stent / drug eluting balloon / covered stents? What is your regime like?
This is where there may be room for flexibility. We don't use BMS for SFA/popliteal disease and go straight for DES is a stent is required. This will of course endothelise (or be covered up in new atheroma!) so there is a case for initial DAP followed by MAP. GIven that the drug-eluting aspects are deployed to modify endothelial activity, perhaps aggressive statin usage and tight lipid control is also an aspect that is not fully appreciated/ investigated especially at the primary care level.
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