Factors Associated With Primary Patency Loss After Covered Endovascular Reconstruction of the Aortic Bifurcation for Aortoiliac Occlusive Disease: An Individual Patient Data Meta-analysis

BACKGROUND: Covered endovascular reconstruction of the aortic bifurcation (CERAB) has emerged as an endovascular treatment option for complex aortoiliac occlusive disease (AIOD). However, factors associated with loss of patency remain insufficiently defined. This individual patient data (IPD) meta-analysis evaluated outcomes after CERAB and identified factors associated with loss of primary patency. METHODS: Six retrospective CERAB datasets including 412 patients treated for symptomatic AIOD between 2009 and 2021 were identified through systematic literature review, harmonized, and merged. The primary outcome was loss of primary patency. Secondary outcomes included primary-assisted patency, secondary patency, freedom from target lesion revascularization, morbidity, mortality, and functional outcomes. Kaplan-Meier analysis estimated patency and survival, while Cox proportional hazards regression identified factors independently associated with primary patency loss. Freedom from target lesion revascularization was 91.8% at 1 year and 80.1% at 5 years. Perioperative complications occurred in 10.4% of patients, and 30-day mortality was 1.0%. Ankle-brachial index and Rutherford classification improved significantly within 30 days, although long-term functional follow-up was limited by incomplete data. CONCLUSIONS: Covered endovascular reconstruction of the aortic bifurcation was associated with favorable mid-term patency, low perioperative morbidity, and meaningful early clinical improvement in patients with complex AIOD. Younger age, advanced Rutherford category, and prior target-area revascularization were independently associated with loss of primary patency.Clinical ImpactThis individual participant data meta-analysis moves beyond descriptive outcome reporting by identifying clinically relevant factors associated with patency loss after covered endovascular reconstruction of the aortic bifurcation for aortoiliac occlusive disease. It identifies younger age, advanced Rutherford stage, and previous target-area revascularization as factors associated with loss of primary patency. These findings add granularity to the existing CERAB literature and may help refine patient selection, inform counseling, and support more individualized follow-up strategies.