Midterm outcomes of the covered endovascular reconstruction of the aortic bifurcation for aortoiliac occlusive disease in a latinoamerican population

Objective This UK multicenter study aims to report early- and medium-term results following covered endovascular reconstruction of aortic bifurcation (CERAB) for the treatment of aortoiliac occlusive disease (AIOD) in patients with chronic limb threatening ischemia (CLTI) or intermittent claudication (IC). Materials and Methods Retrospective case analysis was performed of patients who underwent CERAB between November 1, 2012 and March 31, 2020 in 6 centers across the United Kingdom. Anatomical data, including degree of plaque calcification, were assessed using preoperative imaging. Outcome measures included mortality, perioperative complications, target lesion reintervention (TLR), and major limb amputation. Primary, assisted primary, and secondary patencies were calculated at set intervals. Results A total of 116 patients underwent CERAB over the study period for the following reasons [48% presenting with CLTI (Rutherford 4–6) and 52% with IC (Rutherford 1–3)]; 82% presented had Trans-Atlantic Inter-Society Consensus (TASC) D AIOD disease. Median age was 65 years (range 42–90 years); 76% of the cohort were male. Severely calcified aortic and iliac lesions were noted in 90% and 80% of patients, respectively. Over a median follow-up of 18 months (range 1–91 months), 2 (1.7%) patients were lost to follow up. In total 5, (4.3%) patients died and 2 (1.7%) had a major amputation. Endovascular TLR was required in 14 (12.1%) patients at last follow up. Surgical TLR was performed in 4 (3.4%) patients at last follow-up. Seven (6%) patients developed an aortic/iliac stent occlusion at last follow-up. The Kaplan-Meier (KM) freedom from TLR at 1 year was 94% and KM 1-year primary patency, assisted primary patency, and secondary patency were 88%, 94%, and 98% respectively. Subanalysis found the following features were associated with need for TLR; TASC D disease (OR = 2.45, 95% CI 1.44 to 3.71), severe aortic calcification (OR = 2.01, 95% CI 1.03 to 2.20), and presence of tissue loss at baseline (OR = 1.43, 95% CI 1.01 to 4.63). Conclusion Perioperative (<30 days) and medium-term morbidity, mortality, and patency rates in this pragmatic cohort of patients with severe AIOD lesions show that CERAB is a valid revascularization option. A direct comparison with surgical treatments for AIOD in a randomized controlled trial is justified.

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FT15. Endovascular vs Open Treatment of Severe Aortoiliac Occlusive Disease: Outcomes of Kissing Self-Expanding Covered Stent for Reconstruction of the Aortic Bifurcation

Journal of Vascular Surgery ◽

10.1016/j.jvs.2017.03.041 ◽

2017 ◽

Vol 65 (6) ◽

pp. 21S

Author(s):

Sandro Lepidi ◽

Francesco Squizzato ◽

Riccardo Bozza ◽

Laura Ventura ◽

Marco Zavatta ◽

...

Keyword(s):

Covered Stent ◽

Occlusive Disease ◽

Aortic Bifurcation ◽

Aortoiliac Occlusive Disease ◽

Disease Outcomes ◽

Open Treatment

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Editor's Choice – First Results of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique for Aortoiliac Occlusive Disease

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2015.06.112 ◽

2015 ◽

Vol 50 (5) ◽

pp. 638-647 ◽

Cited By ~ 36

Author(s):

F.A.B. Grimme ◽

P.C.J.M. Goverde ◽

P.J.E.M. Verbruggen ◽

C.J. Zeebregts ◽

M.M.P.J. Reijnen

Keyword(s):

Occlusive Disease ◽

Aortic Bifurcation ◽

Aortoiliac Occlusive Disease ◽

First Results

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First Results of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique for Aortoiliac Occlusive Disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2015.09.040 ◽

2015 ◽

Vol 62 (5) ◽

pp. 1371-1372

Author(s):

F.A.B. Grimme ◽

P.C.J.M. Goverde ◽

P.J.E.M. Verbruggen ◽

C.J. Zeebregts ◽

M.M.P.J. Reijnen

Keyword(s):

Occlusive Disease ◽

Aortic Bifurcation ◽

Aortoiliac Occlusive Disease ◽

First Results

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Initial Experience With Covered Endovascular Reconstruction of the Aortic Bifurcation in Conjunction With Chimney Grafts

Journal of Endovascular Therapy ◽

10.1177/1526602816673824 ◽

2016 ◽

Vol 24 (1) ◽

pp. 19-24 ◽

Cited By ~ 8

Author(s):

Martijn L. Dijkstra ◽

Peter C. J. M. Goverde ◽

Andrew Holden ◽

Clark J. Zeebregts ◽

Michel M. P. J. Reijnen

Keyword(s):

Renal Artery ◽

Limb Ischemia ◽

Occlusive Disease ◽

Left Renal Artery ◽

Aortic Bifurcation ◽

Aortoiliac Occlusive Disease ◽

The One ◽

The Right ◽

Chimney Graft

Purpose: To show feasibility of the covered endovascular repair of the aortic bifurcation (CERAB) technique in conjunction with chimney grafts in aortic side branches for complex aortoiliac occlusive disease. Methods: Two European centers and one facility located in New Zealand participated in a retrospective observational study that enrolled 14 consecutive patients (mean age 61.2±8.9 years; 11 men) treated with CERAB in conjunction with chimney graft(s) between December 2012 and May 2015. Indications for treatment included disabling claudication in 9 and critical limb ischemia in 5. Lesions were classified as TransAtlantic Inter-Society Consensus II B (n=1), C (n=1), or D (n=12). Results: A total of 15 chimney grafts were used to perfuse the inferior mesenteric artery (n=8), the right renal artery (n=4), and the left renal artery (n=3). Technical success was achieved in all cases. Procedural complications included 5 unintended dissections and 1 vessel thrombosis, all of which were successfully treated intraoperatively. Five patients developed access-site hematoma/ecchymosis (3 at the brachial access). Mean follow-up was 12 months (range 6–24) without death or loss to follow-up. One patient suffered occlusion of a CERAB limb and an IMA chimney graft; the former was recanalized, but the IMA graft was not; there were no signs of bowel ischemia. Ankle-brachial indices significantly increased from 0.54 (range 0.47–0.60) preoperatively to 0.97 (range 0.90–1.00) in 11 patients examined at 12 months, and all patients had an improvement in the Rutherford category. All CERAB limbs, including the one recanalized, were patent at the most recent follow-up, as were 14 of 15 chimney grafts. Conclusion: Chimney-CERAB is technically feasible and may offer an alternative to open surgery for complex aortoiliac occlusive disease. Further prospective studies are needed to confirm these findings.

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