Hybrid covered endovascular reconstruction of the aortic bifurcation (CERAB) procedure is preferable to aortobifemoral bypass for limb-threatening aortoiliac occlusive disease during the COVID-19 crisis

McElligott, Helen; Toale, Conor; Kavanagh, Eamon G.; Moloney, Michael A.

doi:10.1016/j.jvscit.2020.08.019

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…Additionally, a recent report by McElligott et al has also underlined the value of this endovascular therapy in reducing the impact of vascular surgery on intensive care capacity during the current critical period of COVID-19 pandemic. 9 Either way, when compared with other endovascular techniques, CERAB better mimics the aortic bifurcation's anatomy and physiology possibly improving the overall patency. 6,7 In CERAB, the occlusion of the revascularization at the long-term seems to be linked to stent collapse or kinking and it is probably the results of the progressive evolution of the inflow or outflow obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…has also underlined the value of this endovascular therapy in reducing the impact of vascular surgery on intensive care capacity during the current critical period of COVID-19 pandemic. 9…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, two aspects of this approach should not be underestimated during current COVID-19 pandemic: CERAB may be performed without need for critical care bed and guarantees shorter length of hospital stay. 8,9 In the present study, we report the results achieved with the CERAB technique in the treatment of TASC II C-D AIOD in term of technical success, limb salvage, target lesion revascularization, primary and secondary patency rate at the mid-term follow-up at our Institution.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Two-year single centre results with covered endovascular reconstruction of aortic bifurcation (CERAB) in the treatment of extensive aorto-iliac occlusive disease

et al. 2021

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Objective To report the results of a single-centre in the treatment of extensive aorto-iliac occlusive disease (AIOD) by the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. Methods A retrospective analysis was conducted on data obtained from the review of medical charts of all consecutive patients treated with CERAB technique for AIOD between January 2016 and December 2019 in San Giovanni-Addolorata Hospital (Rome, Italy). Clinical examination, duplex ultrasound with ankle-brachial index measurement and contrast-enhanced computed tomography angiography were performed preoperatively. A clinical and ultrasound follow-up was carried out at one month and then half yearly after the intervention to evaluate patients’ clinical status, limb salvage, target lesion revascularization rate, primary and secondary patency rate. Results During the study period, 24 patients (14 men, 58.3%; 10 women, 41.7%; median age 59 years, range 37–79 years) underwent CERAB for AIOD (TASC II C 29.2%, TASC II D 70.8%). Indications for treatment were: intermittent claudication in 18 patients (75%) and critical limb ischemia in 6 (25%). Technical success was achieved in all cases. Perioperative minor complications occurred in three cases (12.5%). One patient reported an intraoperative iliac rupture requiring adjunctive covered stenting. Median hospital length of stay was two days (range 1–9). No patient died perioperatively nor at the last follow-up. At a median follow-up of 18 months (range 6–48 months), mean ankle-brachial index increased significantly (from 0.62 ± 0.15 before the procedure to 0.84 ± 0.18) ( P < 0.001) and target lesion revascularization rate was 12.5%. At two years, the limb salvage rate was 100%, and primary and secondary patency rates were 87.5% and 100%, respectively. Conclusion CERAB technique demonstrated to be effective at the mid-term follow-up with low rate of complications and short length of stay. Long-term results and more robust data are needed to affirm this technique as the first-line treatment for extensive AIOD. However, it could become the preferred option especially in fragile patients and during contemporary COVID-19 pandemic due to the current limitations in vascular and critical care bed capacity.

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Section: Discussionmentioning

confidence: 99%

“…has also underlined the value of this endovascular therapy in reducing the impact of vascular surgery on intensive care capacity during the current critical period of COVID-19 pandemic. 9…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Two-year single centre results with covered endovascular reconstruction of aortic bifurcation (CERAB) in the treatment of extensive aorto-iliac occlusive disease

et al. 2021

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“…This mechanical phenomenon develops neointimal hyperplasia induced by low oscillating wall shear stress and stagnant blood flow [2] , [3] . The recent evidence shows a technical success rate for CERAB above 90% with a primary patency at one year of 87% for TASC-C and 90% for TASC-D lesions, respectively with a shorter hospital stay compared to aorto-bi-femoral graft or endarterectomy [9] , [10] , [11] , [12] . The aim of this study was to evaluate the 2-year outcomes of the first Colombian and Latinoamerican series of CERAB.…”

Section: Introductionmentioning

confidence: 99%

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

García

Gómez-Rodríguez

Cabrera‐Vargas

et al. 2021

International Journal of Surgery Case Reports

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Outcomes of Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Procedure for the Treatment of Extensive Aortoiliac Occlusive Disease Using the BeGraft Balloon-Expandable Covered Stent: A Multicenter Observational Study

et al. 2023

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Purpose: The covered endovascular reconstruction of the aortic bifurcation (CERAB) technique offers an alternative for Trans-Atlantic Inter-Society Consensus (TASC) C/D lesions involving the aortic bifurcation. The study aims to evaluate the outcomes of the CERAB technique for extensive aortoiliac occlusive disease (AIOD) using the BeGraft balloon-expandable covered stent (BECS). Materials and Methods: This is a physician-initiated, multicenter, retrospective, observational study. Between June 2017 and June 2021, all consecutive patients who underwent the CERAB procedure using the BeGraft stent (Bentley InnoMed, Hechingen, Germany) in 3 clinics were enrolled. Patients’ demographics, lesion characteristics, and procedural results were collected and retrospectively analyzed. Follow-up was done at 1, 6, and 12 months and then annually with clinical examination, ankle-brachial index (ABI), and duplex ultrasound. The primary endpoint was the patency at 12 months. Secondary endpoints included procedural-related complications, secondary patency, freedom from target lesion revascularization (TLR), and clinical improvement. Results: In all, 120 patients (64 men) with a median age of 65 years (range: 34–84 years) were analyzed. Most patients had extensive AIOD classified as TASC II C (n=32; 26.7%) or TASC II D (n=81; 67.5%). The median duration of the procedure was 120 minutes (interquartile range [IQR]: 80–180 minutes). All 454 BeGraft stents (137 aortic and 317 peripheral) were successfully delivered and deployed. The overall procedural complication rate was 14 (11.7%). The median hospital length of stay was 5 days (IQR: 3–6 days). All patients improved clinically, and the ABI increased significantly (p<0.05). The median follow-up was 19 months (range: 6–56 months). The primary patency rate, secondary patency rate, and freedom from TLR at 12 months were 94.5%, 97.3%, and 93.5%, respectively. Conclusions: The CERAB procedure with BeGraft BECSs has a high technical success rate, favorable patency outcomes, and low morbidity, even in relatively ill patients with extensive AIOD. Prospective randomized studies on the CERAB technique are definitely recommended. Clinical Impact This study evaluates the outcomes of BeGraft stents used during the covered endovascular reconstruction of the aortic bifurcation (CERAB) procedure. To date, several balloon-expandable covered stents have been used for this technique with satisfactory results. This study showed the safety and excellent patency of the CERAB technique in extensive AIOD using BeGraft balloon-expandable covered stents.

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Hybrid covered endovascular reconstruction of the aortic bifurcation (CERAB) procedure is preferable to aortobifemoral bypass for limb-threatening aortoiliac occlusive disease during the COVID-19 crisis

Abstract: Hybrid-CERAB (Covered Endovascular Reconstruction of the Aortic Bifurcation) Procedure is preferable to Aorto-Bi-Femoral Bypass for Limb-threatening Aortoiliac Occlusive Disease during the COVID-19 Crisis.,

Cited by 3 publications

References 10 publications

Two-year single centre results with covered endovascular reconstruction of aortic bifurcation (CERAB) in the treatment of extensive aorto-iliac occlusive disease

Two-year single centre results with covered endovascular reconstruction of aortic bifurcation (CERAB) in the treatment of extensive aorto-iliac occlusive disease

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

Outcomes of Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Procedure for the Treatment of Extensive Aortoiliac Occlusive Disease Using the BeGraft Balloon-Expandable Covered Stent: A Multicenter Observational Study

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