ObjectiveTo evaluate the mid-term clinical outcomes of covered endovascular reconstruction of the aortic bifurcation (CERAB) for the treatment of complex aortoiliac occlusive disease and to evaluate the efficacy and safety of this technique. MethodsA total of 12 patients with complex aortoiliac occlusive lesions [Trans-Atlantic Inter-Society Consensus (TASC) Ⅱ class C/D] who underwent CERAB reconstruction at West China Hospital of Sichuan University, from October 2022 to October 2024 were prospectively enrolled and analyzed. Baseline and procedural data and follow-up were collected at 1, 6, 12, and 24 month(s). Technical success and 30-day complications were evaluated, as well as overall survival. Patency and freedom from target lesion revascularization rates were analyzed using Kaplan Meier curves. ResultsAll 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 3 days 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. ConclusionsThe results of this cohort suggest that CERAB induces favorable mid-term efficacy and safety in the treatment of complex aortoiliac occlusive lesions (TASC Ⅱ types C and D). However, the further research is required to explore its suitability for the juxtarenal lesions of TASC Ⅱ D.
