CERAS: covered endovascular reconstruction of the aorta and side branches. Description of the technique of revascularizing more than two visceral branches in patients with a coral reef aorta

Coral reef aorta represents a distinct vascular pathology characterized by large calcified exophytic plaques that grow into the aortic lumen typically at the level of the visceral and renal arteries. In most cases, these arteries are also heavily calcified and stenosed or occluded. Symptoms vary depending on the affected artery and differ from renovascular hypertension, and renal insufficiency to cardiac decompensation and chronic limb threatening ischemia. This report describes two patients with a coral reef aorta and stenosed aortic side branches. Both patients had experienced episodes of pulmonary flash edema, suffered from lower extremity arterial disease and renal insufficiency. The second patient also had complaints of chronic mesenteric ischemia. Open surgery was considered very high risk in both patients and therefore endovascular treatment was performed. Covered endovascular reconstruction of the aorta and side branches (CERAS) was successfully performed in both patients. The first patient underwent simultaneous stenting of the coeliac artery, superior mesenteric artery, both renal arteries and the aorta. In the second patient, the superior mesenteric artery, both renal arteries and the aorta were stented. During follow-up, all stents were patent and symptoms were resolved. CERAS is a novel endovascular technique to treat a coral reef aorta and its affected side branches. CERAS may offer a solution for patients in which endovascular treatment is often considered "not feasible."