Two-year Outcomes of the Covered Endovascular Reconstruction of the Aortic Bifurcation in Patients with Aortoiliac Occlusive Disease

Introduction: Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) has been demonstrated as a valuable endovascular technique creating a neo-aortic bifurcation with a better flow profile to mimic the natural geometry and optimize the endovascular outcomes. Methods: All patients treated with CERAB with and without chimney stent grafts for chronic aortoiliac disease in a high-volume, tertiary referral university hospital were identified and analyzed retrospectively. Demographic and procedural data were scored, and follow-up was collected at 6 weeks, 6, 12 and 24 months. Technical success and morbidity rates were evaluated, as well as overall survival. Patency rates were analyzed using Kaplan–Meier curves. The risk factors for patency loss were evaluated using univariate and multivariate Cox regression analyses. Results: Twenty-five patients were included (17 male and 8 female) with a mean age of 66.67 years ± 8.4 between January 2018 and March 2020; 56% of them presented with IC (Rutherford 3), and 44% presented with critical limb-threatening ischemia (Rutherford 4–6). Most lesions (92%) were classified as Transatlantic Inter-society Consensus (TASC) C/D. Technical success was achieved in all patients. Clinical improvement and limb salvage at 2 years were obtained in 100% of patients with no 30-day mortality rate. The overall 30-day complication rate was 36%, including three major complications (12%). Kaplan–Meier 2-year primary patency, assisted primary patency, and secondary patency were 80%, 92%, and 100%, respectively. Clinically driven target lesion revascularization was 20% at 2-year follow-up. No statistically significant independent predictors for primary patency loss of this CERAB technique at 2-year follow-up were detected by multivariate analysis. Conclusion: This study indicates that endovascular revascularization using a CERAB configuration for TASC C/D aortoiliac lesions is a safe and feasible with excellent short- and mid-term patency outcomes.