Covered endovascular reconstruction of aortoiliac bifurcation for complex aortoiliac occlusive disease: experiences and insights_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Yu , QI Yuhan , HUANG Bin , WANG Tiehao , WANG Jiarong , WENG Chengxin , ZHAO Jichun ,  YUAN Ding

Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

YUAN Ding, Email: docyuanding@gmail.com

Keywords：

aortoiliac; endovascular; covered endovascular reconstruction of aortic bifurcation; efficacy; safety

DOI：

10.7507/1007-9424.202512067

Video：

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Objective To evaluate the mid-term clinical outcomes of covered endovascular reconstruction of aortic bifurcation (CERAB) for the treatment of complex aortoiliac occlusive disease and to evaluate the efficacy and safety of this technique. Methods A total of 12 patients with complex aortoiliac occlusive lesions [Trans-Atlantic Inter-Society Consensus (TASC) Ⅱ C and D] who underwent CERAB reconstruction at West China Hospital of Sichuan University, from December 2020 to December 2024 were prospectively enrolled and analyzed. Baseline and procedural data and follow-up data at 1, 6, 12, and 24 month(s) were collected. Technical success and 30-day complications as well as overall survival were evaluated. Patency and freedom from target lesion revascularization rates were analyzed using Kaplan-Meier curve. Results All patients were male, with an age of (66.1±8.3) years; 10 cases were TASC Ⅱ C and 2 were TASC Ⅱ D. Technical success was achieved in all procedures. There were 2 cases of the procedure-related complications: one patient developed acute ischemia of the left lower limb postoperatively and recovered after emergency thrombectomy and endarterectomy; another patient died of a cerebrovascular event on day 3 after surgery. No bleeding, renal failure, pseudoaneurysm, or dissection occurred. The cumulative overall survival rates at 6, 12, and 24 months after surgery calculated by the Kaplan-Meier method were all 91.7%, with the cumulative primary patency rates being 86.7%, 73.4%, and 73.4% respectively, and the cumulative secondary patency rates being 100%, 100%, and 92.9% respectively. No amputations occurred during follow-up. Conclusions The results of this cohort suggest that CERAB induces favorable mid-term efficacy and safety in the treatment of complex aortoiliac occlusive lesions (TASC Ⅱ C and D). However, the further research is required to explore its suitability for the juxtarenal lesions of TASC Ⅱ D.

Citation： YANG Yu, QI Yuhan, HUANG Bin, WANG Tiehao, WANG Jiarong, WENG Chengxin, ZHAO Jichun, YUAN Ding. Covered endovascular reconstruction of aortoiliac bifurcation for complex aortoiliac occlusive disease: experiences and insights. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(1): 47-52. doi: 10.7507/1007-9424.202512067 Copy

1.	Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg, 2019, 69(6S): 3S-125S. e40. doi: 10.1016/j.jvs.2019.02.016.
2.	Aboyans V, Ricco JB, 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.
3.	Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg, 2024, 67(2): 192-331.
4.	袁丁. 下肢外周動脈疾病腔內治療演變—2024 ESVS《無癥狀下肢外周動脈疾病和間歇性跛行管理臨床實踐指南》解讀: 基于指南與循證醫學證據剖析. 中國普外基礎與臨床雜志, 2025, 32(4): 433-440.
5.	Goverde PC, Grimme FA, Verbruggen PJ, et al. Covered endovascular reconstruction of aortic bifurcation (CERAB) technique: a new approach in treating extensive aortoiliac occlusive disease. J Cardiovasc Surg (Torino), 2013, 54(3): 383-387.
6.	Groot Jebbink E, Grimme FA, Goverde PC, et al. Geometrical consequences of kissing stents and the covered endovascular reconstruction of the aortic bifurcation configuration in an in vitro model for endovascular reconstruction of aortic bifurcation. J Vasc Surg, 2015, 61(5): 1306-1311.
7.	袁丁, 祁渝涵, 翁誠馨, 等. 主髂動脈分叉部覆膜支架重建術治療主髂動脈閉塞癥的療效評估. 中華血管外科雜志, 2023, 8(1): 22-25.
8.	祁渝涵, 翁誠馨, 黃斌, 等. 主髂動脈分叉部覆膜支架重建(CERAB)技術治療主髂分叉病變的要點與解析. 中國普外基礎與臨床雜志, 2022, 29(7): 852-856.
9.	Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the management of peripheral arterial disease (TASC Ⅱ). J Vasc Surg, 2007, 45 Suppl S: S5-S67. doi: 10.1016/j.jvs.2006.12.037.
10.	Bontinis V, Bontinis A, Giannopoulos A, et al. Editor’s choice—Covered stents versus bare metal stents in the treatment of aorto-iliac disease: a systematic review and individual participant data meta-analysis. Eur J Vasc Endovasc Surg, 2024, 68(3): 348-358.
11.	Bontinis V, Bontinis A, Giannopoulos A, et al. Covered endovascular reconstruction of the aortic bifurcation: a systematic review aggregated data and individual participant data meta-analysis. J Vasc Surg, 2024, 79(6): 1525-1535.
12.	Grimme FA, Goverde PC, Verbruggen PJ, et al. Editor’s choice—First results of the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique for aortoiliac occlusive disease. Eur J Vasc Endovasc Surg, 2015, 50(5): 638-647.
13.	Dijkstra ML, Goverde PC, Holden A, et al. Initial experience with covered endovascular reconstruction of the aortic bifurcation in conjunction with chimney grafts. J Endovasc Ther, 2017, 24(1): 19-24.
14.	Taeymans K, Groot Jebbink E, Holewijn S, et al. Three-year outcome of the covered endovascular reconstruction of the aortic bifurcation technique for aortoiliac occlusive disease. J Vasc Surg, 2018, 67(5): 1438-1447.
15.	Saratzis A, Salem M, Sabbagh C, et al. Treatment of aortoiliac occlusive disease with the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique: results of a UK multicenter study. J Endovasc Ther, 2021, 28(5): 737-745.
16.	de Cort BA, Salemans PB, Fritschy WM, et al. Long-term outcome for covered endovascular reconstruction of aortic bifurcation for aortoiliac disease: a single-center experience. J Endovasc Ther, 2021, 28(6): 906-913.
17.	Borghese O, Ferrer C, Coscarella C, et al. Two-year single centre results with covered endovascular reconstruction of aortic bifurcation (CERAB) in the treatment of extensive aorto-iliac occlusive disease. Vascular, 2022, 30(3): 500-508.
18.	Piffaretti G, Fargion AT, Dorigo W, et al. Endovascular reconstruction for total aorto-iliac occlusion. J Endovasc Ther, 2022, 29(4): 565-575.
19.	Zacà S, Desantis C, Di Stefano L, et al. Outcomes of endovascular reconstructive techniques in Trans-Atlantic Inter-Society Consensus Ⅱ C-D aortoiliac lesions. Ann Vasc Surg, 2023, 90: 172-180.
20.	Kruszyna ?, Strauss E, Tomczak J, et al. Outcomes of covered endovascular reconstruction of the aortic bifurcation (CERAB) procedure for the treatment of extensive aortoiliac occlusive disease using the begraft balloon-expandable covered stent: a multicenter observational study. J Endovasc Ther, 2025, 32(3): 688-697.
21.	Dikmen N, Ozcinar E, Ak?a F, et al. The long-term results of covered endovascular aortic bifurcation repair in complex aortoiliac disease: a two-year follow-up. J Clin Med, 2024, 13(19): 5684. doi: 10.3390/jcm13195684.
22.	Semaan DB, Habib SG, Abdul-Malak OM, et al. Aortobifemoral bypass vs covered endovascular reconstruction of aortic bifurcation. J Vasc Surg, 2024, 80(2): 459-465.
23.	Rouwenhorst KB, Abdelbaqy OMA, van der Veen D, et al. Long-term outcomes of the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique in patients with aorto-iliac occlusive disease. J Endovasc Ther, 2025, 32(1): 110-120.
24.	Zarrintan S, Jagadeesh V, Patel RJ, et al. Midterm outcomes of aortobifemoral bypass, axillobifemoral bypass and covered endovascular reconstruction of aortic bifurcation. J Vasc Surg, 2025, 81(6): 1456-1466.
25.	Misuraca L, Buonpane A, Trimarchi G, et al. Covered endovascular reconstruction of aortic bifurcation facilitated by intravascular lithotripsy with shockwave balloon: a case report. Cureus, 2024, 16(8): e66874. doi: 10.7759/cureus.66874.
26.	Li HL, Cui DZ, Chan YC, et al. Combination of covered endovascular reconstruction of aortic bifurcation technique and on-table fenestration to preserve inferior mesenteric artery in the treatment of subacute infrarenal aortoiliac occlusion. J Vasc Surg Cases Innov Tech, 2024, 10(6): 101634. doi: 10.1016/j.jvscit.2024.101634.
27.	Torrealba JI, Blessing E, Rohlffs F, et al. Single access covered endovascular reconstruction of the aortic bifurcation. J Vasc Surg Cases Innov Tech, 2023, 9(4): 101343. doi: 10.1016/j.jvscit.2023.101343.

1. Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg, 2019, 69(6S): 3S-125S. e40. doi: 10.1016/j.jvs.2019.02.016.
2. Aboyans V, Ricco JB, 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.
3. Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg, 2024, 67(2): 192-331.
4. 袁丁. 下肢外周動脈疾病腔內治療演變—2024 ESVS《無癥狀下肢外周動脈疾病和間歇性跛行管理臨床實踐指南》解讀: 基于指南與循證醫學證據剖析. 中國普外基礎與臨床雜志, 2025, 32(4): 433-440.
5. Goverde PC, Grimme FA, Verbruggen PJ, et al. Covered endovascular reconstruction of aortic bifurcation (CERAB) technique: a new approach in treating extensive aortoiliac occlusive disease. J Cardiovasc Surg (Torino), 2013, 54(3): 383-387.
6. Groot Jebbink E, Grimme FA, Goverde PC, et al. Geometrical consequences of kissing stents and the covered endovascular reconstruction of the aortic bifurcation configuration in an in vitro model for endovascular reconstruction of aortic bifurcation. J Vasc Surg, 2015, 61(5): 1306-1311.
7. 袁丁, 祁渝涵, 翁誠馨, 等. 主髂動脈分叉部覆膜支架重建術治療主髂動脈閉塞癥的療效評估. 中華血管外科雜志, 2023, 8(1): 22-25.
8. 祁渝涵, 翁誠馨, 黃斌, 等. 主髂動脈分叉部覆膜支架重建(CERAB)技術治療主髂分叉病變的要點與解析. 中國普外基礎與臨床雜志, 2022, 29(7): 852-856.
9. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the management of peripheral arterial disease (TASC Ⅱ). J Vasc Surg, 2007, 45 Suppl S: S5-S67. doi: 10.1016/j.jvs.2006.12.037.
10. Bontinis V, Bontinis A, Giannopoulos A, et al. Editor’s choice—Covered stents versus bare metal stents in the treatment of aorto-iliac disease: a systematic review and individual participant data meta-analysis. Eur J Vasc Endovasc Surg, 2024, 68(3): 348-358.
11. Bontinis V, Bontinis A, Giannopoulos A, et al. Covered endovascular reconstruction of the aortic bifurcation: a systematic review aggregated data and individual participant data meta-analysis. J Vasc Surg, 2024, 79(6): 1525-1535.
12. Grimme FA, Goverde PC, Verbruggen PJ, et al. Editor’s choice—First results of the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique for aortoiliac occlusive disease. Eur J Vasc Endovasc Surg, 2015, 50(5): 638-647.
13. Dijkstra ML, Goverde PC, Holden A, et al. Initial experience with covered endovascular reconstruction of the aortic bifurcation in conjunction with chimney grafts. J Endovasc Ther, 2017, 24(1): 19-24.
14. Taeymans K, Groot Jebbink E, Holewijn S, et al. Three-year outcome of the covered endovascular reconstruction of the aortic bifurcation technique for aortoiliac occlusive disease. J Vasc Surg, 2018, 67(5): 1438-1447.
15. Saratzis A, Salem M, Sabbagh C, et al. Treatment of aortoiliac occlusive disease with the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique: results of a UK multicenter study. J Endovasc Ther, 2021, 28(5): 737-745.
16. de Cort BA, Salemans PB, Fritschy WM, et al. Long-term outcome for covered endovascular reconstruction of aortic bifurcation for aortoiliac disease: a single-center experience. J Endovasc Ther, 2021, 28(6): 906-913.
17. Borghese O, Ferrer C, Coscarella C, et al. Two-year single centre results with covered endovascular reconstruction of aortic bifurcation (CERAB) in the treatment of extensive aorto-iliac occlusive disease. Vascular, 2022, 30(3): 500-508.
18. Piffaretti G, Fargion AT, Dorigo W, et al. Endovascular reconstruction for total aorto-iliac occlusion. J Endovasc Ther, 2022, 29(4): 565-575.
19. Zacà S, Desantis C, Di Stefano L, et al. Outcomes of endovascular reconstructive techniques in Trans-Atlantic Inter-Society Consensus Ⅱ C-D aortoiliac lesions. Ann Vasc Surg, 2023, 90: 172-180.
20. Kruszyna ?, Strauss E, Tomczak J, et al. Outcomes of covered endovascular reconstruction of the aortic bifurcation (CERAB) procedure for the treatment of extensive aortoiliac occlusive disease using the begraft balloon-expandable covered stent: a multicenter observational study. J Endovasc Ther, 2025, 32(3): 688-697.
21. Dikmen N, Ozcinar E, Ak?a F, et al. The long-term results of covered endovascular aortic bifurcation repair in complex aortoiliac disease: a two-year follow-up. J Clin Med, 2024, 13(19): 5684. doi: 10.3390/jcm13195684.
22. Semaan DB, Habib SG, Abdul-Malak OM, et al. Aortobifemoral bypass vs covered endovascular reconstruction of aortic bifurcation. J Vasc Surg, 2024, 80(2): 459-465.
23. Rouwenhorst KB, Abdelbaqy OMA, van der Veen D, et al. Long-term outcomes of the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique in patients with aorto-iliac occlusive disease. J Endovasc Ther, 2025, 32(1): 110-120.
24. Zarrintan S, Jagadeesh V, Patel RJ, et al. Midterm outcomes of aortobifemoral bypass, axillobifemoral bypass and covered endovascular reconstruction of aortic bifurcation. J Vasc Surg, 2025, 81(6): 1456-1466.
25. Misuraca L, Buonpane A, Trimarchi G, et al. Covered endovascular reconstruction of aortic bifurcation facilitated by intravascular lithotripsy with shockwave balloon: a case report. Cureus, 2024, 16(8): e66874. doi: 10.7759/cureus.66874.
26. Li HL, Cui DZ, Chan YC, et al. Combination of covered endovascular reconstruction of aortic bifurcation technique and on-table fenestration to preserve inferior mesenteric artery in the treatment of subacute infrarenal aortoiliac occlusion. J Vasc Surg Cases Innov Tech, 2024, 10(6): 101634. doi: 10.1016/j.jvscit.2024.101634.
27. Torrealba JI, Blessing E, Rohlffs F, et al. Single access covered endovascular reconstruction of the aortic bifurcation. J Vasc Surg Cases Innov Tech, 2023, 9(4): 101343. doi: 10.1016/j.jvscit.2023.101343.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Covered endovascular reconstruction of aortoiliac bifurcation for complex aortoiliac occlusive disease: experiences and insights

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