Covered Endovascular Reconstruction of the Iliac Artery Bifurcation (CERIB)

Abstract

Purpose:

The aim of this study was to present the covered endovascular reconstruction of the iliac artery bifurcation (CERIB) technique as a revascularization option for aorto-iliac occlusive disease (AIOD) involving the iliac artery bifurcation.

Methods:

This was a retrospective single-center study including all patients undergoing a CERIB procedure from January 2021 until December 2022. Covered endovascular reconstruction of the iliac artery bifurcation procedures were performed percutaneously with bilateral femoral access, excepting cases where simultaneous open femoral artery reconstruction was required due to the extension of peripheral arterial occlusive disease. Standard patient, procedural, and follow-up (FU) data including survival and arterial reinterventions were gathered and analyzed.

Results:

A total of 13 patients were included (11/13 male, median age=70 [60-76] years). Additional open and/or endovascular procedures included endarterectomy of the femoral bifurcation (n=6), rotational atherectomy (n=2), and 1 axillary artery cutdown for upper limb access (n=1). Median operating time was 2.9 hours (1.5-4.9 hours); median radiation duration and dose were 28.4 (14.3-63.3 minutes) and 4090.6 (384.4-9430.1 cGray/cm²), respectively. The stent grafts used for CERIB were BeGraft peripheral n=31, BeGraft Aortic n=4 and BeGraft peripheral plus n=1 (Bentley InnoMed GmbH, Hechingen, Germany). In 2 patients with prior stenting of the common iliac artery (CIA), only the internal and external iliac arteries (IIA and EIA) were treated in this study, and in 2 cases, additional uncovered stents were required for relining. Technical success was 100%. During a midterm FU (median 18 [4-31] months), 2 patients died from cardiovascular reasons and 1 patient with prior iliac stenting required reinterventions for recurring occlusion.

Conclusion:

Covered endovascular reconstruction of the iliac artery bifurcation is a straightforward option for treating AIOD involving the iliac artery bifurcation that allows preservation of internal iliac artery perfusion and shows good early and midterm results. Prior iliac artery stenting may be a risk factor for early occlusion after CERIB.

Clinical impact

Aorto-iliac occlusive disease with involvement of the internal iliac artery is encountered regularly in vascular surgical practice, but the internal iliac artery is often not included in the revascularization strategy. The present article will increase the awareness for the relevance of including the internal iliac artery in revascularization strategies and presents CERIB as another method to be added to the armamentarium of (endo-)vascular surgeons and interventionalists.

Keywords

peripheral artery disease arterial occlusive disease endovascular treatment/therapies stent stent graft

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References

Aboyans

Ricco

Bartelink

MEL

, et al Editor’s choice: 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(3):305–368. doi:10.1016/j.ejvs.2017.07.018.

Mahé

Kaladji

Le Faucheur

, et al Internal iliac artery stenosis: diagnosis and how to manage it in 2015. Front Cardiovasc Med. 2015;2:33. doi:10.3389/fcvm.2015.00033.

Kouvelos

Katsargyris

Antoniou

, et al Outcome after interruption or preservation of internal iliac artery flow during endovascular repair of abdominal aorto-iliac aneurysms. Eur J Vasc Endovasc Surg. 2016;52(5):621–634. doi:10.1016/j.ejvs.2016.07.081.

Donas

Schwindt

Pitoulias

, et al Endovascular treatment of internal iliac artery obstructive disease. J Vasc Surg. 2009;49(6):1447–1451. doi:10.1016/j.jvs.2009.02.207.

Reijnen

MM.

Update on covered endovascular reconstruction of the aortic bifurcation. Vascular. 2020;28(3):225–232. doi:10.1177/1708538119896197.

Rouwenhorst

Abdelbaqy

OMA

van der Veen

, et al Long-term outcomes of the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique in patients with aorto-iliac occlusive disease [published online ahead of print April 28, 2023]. J Endovasc Ther. doi:10.1177/15266028231166539.

Steffel

Eikelboom

Anand

, et al The COMPASS trial: net clinical benefit of low-dose rivaroxaban plus aspirin as compared with aspirin in patients with chronic vascular disease [Erratum in: Circulation. 2020;142(1):e23]. Circulation. 2020;142(1):40–48. doi:10.1161/CIRCULATIONAHA.120.046048.

Wanhainen

Verzini

Van Herzeele

, et al Editor’s choice: European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms [Erratum in: Eur J Vasc Endovasc Surg. 2020;59(3):494]. Eur J Vasc Endovasc Surg. 2019;57(1):8–93. doi:10.1016/j.ejvs.2018.09.020.

Mwipatayi

Sharma

Daneshmand

, et al Durability of the balloon-expandable covered versus bare-metal stents in the covered versus balloon expandable stent trial (COBEST) for the treatment of aortoiliac occlusive disease. J Vasc Surg. 2016;64(1):83–94. doi:10.1016/j.jvs.2016.02.064.

10.

Fox

KAA

Anand

Aboyans

, et al Xarelto plus acetylsalicylic acid: treatment patterns and outcomes in patients with atherosclerosis (XATOA): rationale and design of a prospective registry study to assess rivaroxaban 2.5 mg twice daily plus aspirin for prevention of atherothrombotic events in coronary artery disease, peripheral artery disease, or both. Am Heart J. 2020;222:166–173. doi:10.1016/j.ahj.2020.01.015.