CERAB: A New Frontier for Extensive Aortoiliac Occlusive Disease

E. D. Cyphers, R. Ahuja, K. Madassery

Purpose: To delineate the feasibility and safety of the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique for the treatment of extensive aortoiliac occlusive disease (AIOD) via review of the current literature

Materials and Methods: A literature search was performed using multiple databases (MEDLINE, Cochrane Library, EMBASE), and three recent studies with CERAB were found. Pooled meta-analysis was gathered for number of patients treated, patient Trans-Atlantic Inner-Society Consensus (TASC-II) lesion type, 30-day morbidity and  mortality, and 3-year patency rates.

Results: A total of 247 patients were analyzed across three studies. Lesions included TASC-II D (n = 216‘ 87.4%), TASC-II C (n = 17‘ 6.9%), and TASC-II B (n = 14‘ 5.7%) lesions. The technical success rate was 96.4% (n = 238). Technical failures in 8 patients (3.2%) were caused by failure of lesion recanalization, and the lesion could not be passed in 1 (0.4%) case. Procedural complications included dissection (n = 12), vessel thrombosis (n = 4), rupture or bleeding (n = 4), stent dislocation (n = 3), and stent deformation (n = 1). Postprocedural (30-day) morbidity and mortality rates were 10% (1%–26%) and 0%, respectively (pooled weighted proportion, 95% confidence interval [CI]). Major postprocedural complications included thrombosis (n = 4), pneumonia (n = 3), kidney failure (n = 2), stent dislocation (n = 1), and multiple organ dysfunction (n = 1). Minor postprocedural complications included access site hematoma (n = 31), pseudoaneurysm (n = 5), fever of unknown cause (n = 4), rebleeding (n = 3), and atrial fibrillation (n = 2). Patency rates were available to 3 years (pooled weighted proportion, 95% CI). Primary patency rates were 88% (83%–92%) at 1 year and 82% (75%–85%) at 3 years. Secondary patency rates were 97% (94%–99%) at 1 year and 97% (92%–99%) at 3 years.

Conclusions: This meta-analysis examines recent studies of the CERAB technique for treatment of extensive AIOD. This technique is safe with a high technical success rate. CERAB is especially useful for TASC-II D lesions but can also be used to treat TASC-II C and TASC-B lesions in some cases and may offer an alternative to conventional stent grafting and bypass surgery. Primary and secondary patency rates were favorable at 1 and 3 years; further experience is needed to determine longer term outcomes. CERAB was associated with no 30-day mortality but is not without management challenges of intra- and periprocedural complications.