Long-term Follow-up after Covered Endovascular and Hybrid Reconstructions of Aorto-iliac and Aorto-iliac-femoral Occlusive Disease

Abstract Covered endovascular repair of the aortic bifurcation (CERAB) is an attractive alternative option to open surgery for aorto-iliac occlusive disease. In combination with additional surgical reconstruction of the femoral vessels, hybrid CERAB (HCERAB) may expand the applicability of this technique. The aim of this study was to provide long-term results after HCERAB and isolated CERAB procedures. All patients treated with CERAB and HCERAB at our department between April 2012 and June 2021 were enrolled in this retrospective single-center study. Primary patency rate during follow-up served as the primary endpoint. Clinical outcome including perioperative complications, reinterventions, and limb salvage rates were defined as secondary endpoints. A total of 70 patients (36 males and 34 females) underwent either CERAB (n = 45) or HCERAB (n = 25). Mean age was 62.1 years. Average follow-up was 29.68 (0–108) months. Indications for CERAB included claudication (67.1%), ischemic rest pain (11.4%), tissue loss (12.9%), and acute limb ischemia (8.6%). Technical success was 95.7%, with primary and secondary patency rates of 77.2 and 85.7%, respectively. Stent graft occlusions occurred in 17 (24.3%) cases, with no significant differences between treatment groups. Three perioperative occlusions were detected, all occurring within the CERAB subgroup. The 30-day mortality rate was 1.4%. Reinterventions were required in 14.3% of cases, predominantly in the CERAB group. Limb salvage rate was 95.7% at 1 year. CERAB is a safe and feasible treatment option even in patients with aorto-iliac occlusive disease. HCERAB procedures optimize outflow and increase applicability and feasibility.