Three year outcome of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) technique for aortoiliac occlusive disease

TL;DR

This study demonstrates that the CERAB technique for treating extensive aortoiliac occlusive disease yields high patency rates and clinical improvement over a three-year follow-up period, with low limb loss and reintervention rates.

Contribution

This is the first large-scale, multi-center study providing three-year outcome data on the CERAB technique for extensive aortoiliac occlusive disease.

Findings

High technical success rate of 97%

Limb salvage rate of 97% at three years

Patency rates exceeding 82% at three years

Abstract

Objective:The objective of the current study was to demonstrate the three year outcome of the CERAB technique for the treatment of extensive aortoiliac occlusive disease (AIOD). Methods:Between February 2009 and July 2016, all patients treated with the CERAB technique for AIOD were identified in the local databases of two centers and analyzed. Demographics and lesion characteristics were scored. Follow-up (FU) consisted of clinical assessment, duplex ultrasound and ankle brachial indices (ABI). Patency rates and clinically driven target lesion revascularization (CD-TLR) were calculated by Kaplan-Meier analysis. Results: 130 patients (69 male and 61 female) were treated of which 68% patients were diagnosed with intermittent claudication and 32% suffered from critical limb ischemia. The vast majority (89%) were TASC-II D lesions and the remaining were TASC-II B and C (both 5%). Median follow-up was 24 months (range 0-67 months). The technical success rate was 97% and 67% of cases were performed completely percutaneously. The ABI improved significantly from 0.65 plusminus 0.22 preoperatively to 0.88 plusminus 0.15 after the procedure. The 30-day minor and major complication rate was 33% and 7%. The median hospital stay was 2 days (range 1-76 days). At 1 and 3-years FU 94% and 96% of the patients clinically improved at least 1 Rutherford category (2% and 0% unchanged, 4% and 4% worsened). Limb salvage rate at 1-year was 98% and 97% at three year follow-up. Primary, primary-assisted and secondary patency was 86%/91%/97% at 1-year, 84%/89%/97% at 2-year and 82%/87%/97% at 3-year FU. Freedom from CD-TLR was 87% at 1-year and 86% at both 2 and 3-year FU. Conclusions:The CERAB technique is a safe and feasible technique for the treatment of extensive aortoiliac occlusive disease with good three year results regarding patency and clinical improvement.