The GORE® VIAFORT Vascular Stent IVC Study

Preoperative Inclusion Criteria:

• Patient is at least 18 years of age.

• Patient is willing and able to comply with all follow-up evaluations as well as anyrequired medication or compression regimen.

• Patient is able to provide informed consent.

• One of the following: Clinical severity class of CEAP 'C' classification ≥3 or rVCSSpain score ≥2.

• Intention to treat the target areas with only the GORE® VIAFORT Vascular Stent.

• Estimated life expectancy ≥1 year.

• Patient is ambulatory (use of assistive walking device such as a cane or walker isacceptable).

• Patient has adequate inflow to the target lesion(s), perinvestigator/sub-investigator discretion, involving at least a patent femoral ordeep femoral vein.

Preoperative Exclusion Criteria:

• Patient is a pregnant or breastfeeding woman, a woman planning to become pregnantthrough the 12-month visit, or a woman who is unwilling to practice an acceptablemethod of preventing pregnancy through the 12-month visit.

• Patient has clinically significant (e.g., symptoms of chest pain, hemoptysis,dyspnea, hypoxia, etc.) pulmonary embolism (confirmed via Computed TomographyAngiography) at the time of enrollment.

• Patient has a known uncorrectable bleeding diathesis or active coagulopathy meetingthe following definitions: uncorrected INR>2 (not as a result of warfarin or DOACtherapy), OR platelet count <50,000 or >1,000,000 cells/mm3, OR white blood cellcount <3,000 or >12,500 cells/mm3.

• Patient has impaired renal function (eGFR <30 mL/min/1.73m2) or is currently ondialysis.

• Patient has uncorrected hemoglobin of <9 g/dL.

• Patient has known history of antiphospholipid syndrome (APS) or patients withhypercoagulable states that are unwilling to take anticoagulant medications on along-term basis.

• Patient has known homozygous inherited coagulation defect or Protein C/S deficiency.

• Patient has a planned surgical intervention (other than pre-stenting procedures suchas thrombolysis or thrombectomy) within 30 days prior to or within 30 days after theplanned study procedure.

• Patient is currently participating in another investigational drug or device studythat has not completed the primary endpoint or that clinically interferes with theendpoints of this treatment, in the opinion of the investigator/sub-investigator.Observational studies are permitted.

• Patient has had a previous major (i.e., above the ankle) amputation of the targetlower limb.

• Patient has known sensitivity to device materials or contraindication toantiplatelets, thrombolytics, anticoagulants (including patients with known priorinstances of Heparin Induced Thrombocytopenia type 2 (HIT-2)), or iodinatedcontrast.

• Patient has had prior stenting or grafts in the target vessels.

• Patient has a known or suspected active systemic infection at the time of the indexprocedure. Patients with a chronic infection (e.g., HIV, hepatitis C) that is wellcontrolled under their current treatment regimen may be eligible.

• Patient has known history of intravenous drug abuse within one year of treatment.

• Patient has significant peripheral arterial disease (chronic Rutherford Type 2 orgreater, acute Rutherford Type IIa or greater).

• Patient has a BMI >40.

• Patient is actively undergoing or plans to begin cancer treatment.

Intraoperative Inclusion Criteria:

• Presence of non-malignant obstruction of the inferior vena cava defined as occlusionor at least 50% reduction in target vessel lumen as measured by procedural IVUS andvenogram, with or without non-malignant obstruction of the common femoral vein,external iliac vein, and/or common iliac vein.

• Patient can accommodate an appropriately sized GORE® VIAFORT Vascular Stent as perreference vessel diameter (see IFU), as determined by intraoperative IVUS postpre-dilation.

• Patient must have appropriate access vessels to accommodate the delivery sheath forthe selected device size.

• Patient has adequate landing zones free from significant disease requiring treatmentwithin the native vessels beyond the proximal and distal margins of the lesion.

• Patient has adequate inflow to the target lesion(s), perinvestigator/sub-investigator discretion, involving at least a patent femoral ordeep femoral vein.

• Lesion can be traversed with a guidewire.

• Disease involves the inferior vena cava and may include iliofemoral segments withintent to stent all affected iliofemoral and caval segments.

• Patient does not have significant (i.e., >20% residual thrombosis) acute thrombuswithin the target stent area at the time of investigational device placement.Patients with acute thrombus within the target stent area must have thrombussuccessfully treated prior to investigational device placement. Successful thrombustreatment is defined as reestablishment of antegrade flow with ≤20% residualthrombosis as confirmed by IVUS and venogram, AND freedom from bleeding, vascularinjury, or hemodynamically significant pulmonary embolism. After successful thrombustreatment, investigational device placement can occur within the same procedure.

• Patient does not have an inferior vena cava filter present within the target stentarea at the time of investigational device placement. Patients with an inferior venacava filter present within the target stent area must have the filter successfullyremoved prior to investigational device placement. Successful removal is defined asremoval of the main body of the filter and intra-luminal fragments such that thereis minimal risk to luminal integrity per investigator/sub-investigator discretionAND freedom from bleeding, vascular injury, or hemodynamically significant pulmonaryembolism. After successful filter removal, investigational device placement canoccur within the same procedure.