Abstract

GONZALEZ-FAJARDO, José A. CERAB (covered endovascular reconstruction of aortic bifurcation). Angiología [online]. 2022, vol.74, n.4, pp.195-197.  Epub Oct 24, 2022. ISSN 1695-2987.  https://dx.doi.org/10.20960/angiologia.00395.

According to the Trans-Atlantic Inter-Society Consensus (TASC II) bypass grafting is the treatment of choice for extensive aortoiliac occlusive disease (AIOD) due to the good long-term patency rates. However, surgical reconstruction is associated with perioperative morbidity and mortality.

Kissing stent technique was introduced as an endovascular treatment alternative for bilateral aortoiliac occlusive disease in 1991. Reported technical success rates varied with the use of bare metal stents in extensive AOID.

The COBEST trial showed that covered balloon expandable stents (CBES) have a superior primary patency rate and clinical improvement outcome at 24 months when compared with bare metal stents. CBES may immediately reduce the risk of procedural complications such as dissection, perforation, in-stent stenosis, and embolization.

In 2013 the Covered Endovascular Reconstruction of Aortic Bifurcation (CERAB) technique was introduced to improve endovascular treatment results by a more anatomical and physiological reconstruction, with a subsequent better clinical outcome.

The CERAB technique was developed to overcome the anatomical and physiological disadvantages of kissing stents such as flow disturbances leading to turbulence and stasis of blood, which may cause thrombus formation and intimal neohyperplasia. The advantages of this technique are:

It is a minimally invasive procedure compared to open surgery.

Applicable for almost all patients with aortoiliac pathology.

Lower risk of complications when using covered stents.

Short hospital stays, given rapid postoperative recovery.

The early results of the CERAB configuration are promising at 1-year follow-up in a group of 130 patients with AOID and the 30-day major complication rate was 7.7 %. Long-term follow-up results are still unknown.

CERAB may change the treatment algorithm of AIOD and juxtarenal occlusive disease. It appears to be a safe and feasible alternative with promising results, which makes it a valid alternative for surgery.

Keywords : Pelvic varices; Embolization; Pelvic pain.

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