Abstract
Covered endovascular repair of the aortic bifurcation (CERAB) is an attractive alternative
option to open surgery for aorto-iliac occlusive disease. In combination with additional
surgical reconstruction of the femoral vessels, hybrid CERAB (HCERAB) may expand the
applicability of this technique. The aim of this study was to provide long-term results
after HCERAB and isolated CERAB procedures. All patients treated with CERAB and HCERAB
at our department between April 2012 and June 2021 were enrolled in this retrospective
single-center study. Primary patency rate during follow-up served as the primary endpoint.
Clinical outcome including perioperative complications, reinterventions, and limb
salvage rates were defined as secondary endpoints. A total of 70 patients (36 males
and 34 females) underwent either CERAB (n = 45) or HCERAB (n = 25). Mean age was 62.1 years. Average follow-up was 29.68 (0–108) months. Indications
for CERAB included claudication (67.1%), ischemic rest pain (11.4%), tissue loss (12.9%),
and acute limb ischemia (8.6%). Technical success was 95.7%, with primary and secondary
patency rates of 77.2 and 85.7%, respectively. Stent graft occlusions occurred in
17 (24.3%) cases, with no significant differences between treatment groups. Three
perioperative occlusions were detected, all occurring within the CERAB subgroup. The
30-day mortality rate was 1.4%. Reinterventions were required in 14.3% of cases, predominantly
in the CERAB group. Limb salvage rate was 95.7% at 1 year. CERAB is a safe and feasible
treatment option even in patients with aorto-iliac occlusive disease. HCERAB procedures
optimize outflow and increase applicability and feasibility.
Keywords
aorto-iliac occlusive disease - covered endovascular reconstruction of the aortic
bifurcation - CERAB - HCERAB - AIOD - TASC II C - TASC II D
