IYSC10 - 5-YEAR RESULTS FOLLOWING ENDOVASCULAR TREATMENT OF AORTIC OBSTRUCTION WITH COVERED KISSING STENT AND CERAB TECHNIQUE. A SINGLE-CENTER EXPERIENCE.

Objectives: Endovascular treatment of peripheral arterial disease involving the infrarenal aorta and the aortic bifurcation still remains a challenge scenario especially for long highly calcified lesions. To date, an endovascular approach for obstructive aorto-iliac lesions is considered feasible if done by experienced team in selected cases. Aim of the study was to evaluate the long-term performances of covered kissing stent (cKS) and CERAB in the endovascular/hybrid treatment of aortic obstructive disease.

Methods: A retrospective review was conducted on all the patients treat at our institution between January 2015 and October 2024. Cases affected by total obstruction and significative arterial stenosis involving the infrarenal aorta and/or the aortic bifurcation treated with cKS or CERAB were selected. Early results were analyzed in terms of 30-day thrombosis, amputation and death. Follow-up results were analyzed by life-table analyses (Kaplan-Meier curves) in terms of primary and secondary graft patency, freedom from reintervention, amputation free survival and overall survival. Groups were compared with log-rank test and P< 0.05 was considered significant.

Results: A total of 42 patients were selected and divided in the two groups (cKS – 21 pts / CERAB – 21 pts). Mean age was 65±10.8 years (p=.228). The majority of cases were affected by Rutherford 3 category (57.8%) and TASC II – D lesions (90.5%). Aortic involvement was observed in all the cases (infrarenal 33.3%, bifurcation 66.7%) and total obstructive lesions were prevalent (69%, p=.739). Antegrade recanalization through brachial or contralateral femoral access (when feasible) was performed in all the cases. cKS and CERAB was performed with covered stent and the choice of balloon-expandable or self-expandable stent was left to surgeons’ judgement. No ruptures or conversions to OSR were recorded and technical success was obtained in all the cases. At 30-day, two thrombosis (p=.244) and one death (p=.311) was recorded for cKS group and one major amputation (p=.311) in the CERAB group. Mean follow-up was 48.8±28.2 months. Estimated 5-year overall survival was 74.1% (p=.693) and primary patency was 90% (cKS 86.9% - CERAB 91.7%, p=.407). Estimated 5-year secondary patency was 100% and freedom from reintervention was 93.8% (p=.394). Amputation free-survival at 5-year was 94.2% and events were recorded in the CERAB group (5-yr Af-s 89.6%).

Conclusions: CERAB technique represents the rational evolution of cKS in the endovascular treatment of infrarenal aorta and aortic bifurcation. In the presented experience, no significative differences were observed between the techniques at long-term follow-up with promising profiles of safety and effectiveness.