Mid-term outcome of CERAB for aorto-iliac occlusive disease. Michel Reijnen Rijnstate Arnhem The Netherlands
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1 Mid-term outcome of CERAB for aorto-iliac occlusive disease Michel Reijnen Rijnstate Arnhem The Netherlands
2 Disclosure Speaker name: Michel Reijnen I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s); Research funding I do not have any potential conflict of interest
3 Lesions of the aortic bifurcation and Kissing Stents Wide range in patency results of kissing stents, usually inferior compared to isolated stents in iliac artery or the aorta Patency affected by geometry: Radial mismatch; aortic lumen dead space around the protruding segment of the stents Differences in stent conformation The overlap of the free proximal stent ends Re-circulation, turbulence and stasis Mesenchymal tissue, thrombus and intimal hyperplasia Greiner A, et al. J Endovasc Ther 2005; 12: Sharafuddin MJ, et al. Ann Vasc Surg 2008;22: Hughes M, et al. Cardiovasc Intervent Radiol 2006; 29:
4 Covered Endovascular Reconstruction of the Aortic Bifurcation - CERAB
5 CERAB related to: Lowest radial mismatch High conformation ratio ( double-d configuration) CERAB Stent geometry Groot Jebbink E, et al. J Vasc Surg May;61(5):
6 CERAB Laser Particle Image Velocimetry CERAB and BM kissing stents; Mostly laminar flow throughout the cardiac cycle BM Kissing stents; turbulence and recirculation at phases B and C Groot Jebbink E, et al. J Vasc Surg Jul;66(1):
7 Clinical results of CERAB Midterm outcome February 2009 July elective patients, two centers Age 61 (36-81) years, 69 male Chimney procedures excluded Previous aorto-iliac intervention in 41 % Rutherford classification: TASC -II classification: 1 (n=1) 0.8% B 2 (n=0) 0.0% C 3 (n=84) 66.1% D n=7 n=7 n=116 (5.4%) (5.4%) (89.2%) 4 (n=22) 17.3% 5 (n=18) 14.2% 6 (n=2) 1.6% Taeymans K et al. J Vasc Surg 2017 Nov 20. [Epub ahead of print]
8 Clinical results of CERAB Midterm outcome Taeymans K et al. J Vasc Surg 2017 Nov 20. [Epub ahead of print]
9 Clinical results of CERAB complications Taeymans K et al. J Vasc Surg 2017 Nov 20. [Epub ahead of print]
10 Clinical results of CERAB Midterm outcome Median follow-up 24 months Total primary patency 12 months 91% 24 months 89% 36 months 87% Secondary patency 12 months 97% 24 months 97% 36 months 97% Clinical improvement at 36 months 96% Limb salvage rate at 36 months 97% Taeymans K et al. J Vasc Surg 2017 Nov 20. [Epub ahead of print]
11 Clinical results of CERAB Previous treatment Previous treatment of AIOD Surgical reconstruction of the aortoiliac segment (n=7); Five aorto-bi-iliac, one ileo-femoral and one femoro-femoral crossover bypass Endovascular intervention (N=46, 35%) 46% PTA of the common iliac artery (in 17% kissing balloons) 37% were PTA with stenting of the common iliac artery (31% KS) Taeymans K et al. J Vasc Surg 2017 Nov 20. [Epub ahead of print]
12 Balloon expandable covered stents Issues with availability of large diameter Advanta V12 Alternative BE covered stents Atrium Maquet V12 Bard Lifestream Bentley BeGraft Gore Viabahn BX Stent material 316L Stainless steel 316L Stainless steel CoCr (L605) Stainless steel Graft material eptfe eptfe eptfe eptfe with Heparin surface Porosity µm µm 102±25 µm N/A Graft design Completely encapsulated 2 Layers, sandwich Single stent, external cover Internal cover Stent diameters (mm) RX: 5, 6, 7 OTW: 5, 6, 7, 8, 9, 10 LD: 12, 14, 16 Stent lengths (mm) RX: 16, 21, 24 OTW: 16, 22, 38, 59 Strut Dimensions (Strut Width x Strut thickness) 5, 6, 7, 8, 9, 10, 12 SV: 5, 6 MV: 7, 8 LV: 9, Ø: 16, 26, 37, Ø: 38, 58 SV: 18, 22, 28, 38, 58 MV: 18, 23, 27, 37, 57 LV: 27, 37, 57 LD: 29, 41, 61 N/A N/A x mm (SV) x mm (MV) x mm (LV) 5, 6, 7, 8, 9, Ø: 15, 19, 39, Ø: 39, 59 Catheter length (cm) 80 and and and and 135 N/A
13 CERAB with different aortic stents AdvantaV12 Lifestream CP Stent BeGraft
14 Conclusions Endovascular treatment of AIOD is an established treatment modality, also for complex disease The CERAB configuration is related to good outcomes up to three years, but issues with availability of the LD Atrium V12 stent Alternatives are available and the choice will mainly depend on availability, personal preference and costs Further studies are indicated to assess the outcome of alternative balloon-expandable covered stents
15 Mid-term outcome of CERAB for aorto-iliac occlusive disease Michel Reijnen Rijnstate Arnhem The Netherlands
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