O20 – Wouter IJgosse – ZGV

Outcomes of Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) for Juxtarenal and Pararenal Aorto-Iliac Occlusive Disease

Objective: To evaluate early safety and long-term durability of Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) for juxtarenal and pararenal aorto-iliac occlusive disease (AIOD).

Methods: Retrospective, two-centre cohort study of consecutive patients treated with CERAB (2013–2025) for ≥50% stenosis/occlusion requiring reconstruction ≤10 mm from the most caudal renal artery (juxtarenal) or involving a renal ostium (pararenal). The primary endpoint was 30-day safety (mortality and Clavien–Dindo complications). Secondary endpoints included technical success, procedural parameters, renal protection strategies, renal function (eGFR), and Kaplan–Meier estimates of primary, assisted-primary, and secondary patency.

Results: Thirty-eight patients (mean age 62.8 years; 42.1% women) underwent CERAB with 100% technical success; upper-extremity access was used in 20/38 (52.6%). Mean procedure duration was 170.5 minutes (SD 87.9; n=24). Median hospital stay was 3 days (IQR 2–8.3) and 13/38 (34.2%) required intensive care (median 9 days; IQR 5–27). Renal protection was applied selectively (balloon 10/38 [26.3%]; renal chimney 9/38 [23.7%]). Within 30 days, 19 complications occurred in 14/38 (36.8%) patients (Clavien–Dindo grades I/II/III/IV/V: 6/4/5/4/2), including four reinterventions under general anaesthesia; 30-day mortality was 2/38 (5.3%), both procedure-related. One planned major amputation occurred (2.6%). Mean eGFR declined transiently at 24–48 h in balloon- and chimney-protected patients with recovery towards baseline by discharge/30 days, while unprotected patients remained stable. A total of 111 stents were implanted, predominantly balloon-expandable covered devices; no drug-coated balloons or drug-eluting stents were used. With maximum follow-up of 2872 days, Kaplan–Meier primary patency was 100%, 82.5% and 82.5% at 1, 3 and 5 years; assisted-primary patency was 100%, 93.8% and 93.8%; secondary patency remained 100%.

Conclusion: CERAB for juxtarenal/pararenal AIOD achieved excellent technical success and durable patency, with acceptable 30-day morbidity and mortality in experienced centres.