10 Years' Experience of Endovascular Reconstruction of Aortoiliac Occlusive Lesions: HERAB Technique

Hybrid endovascular reconstruction of the aortic bifurcation (HERAB) is an alternative technique to covered endovascular reconstruction of aortic bifurcation (CERAB) developed in our tertiary center for complex (TransAtlantic Inter-Society Consensus C-D) aortoiliac occlusive disease (AIOD). The purpose of this study was to report our results at 10 years and try to identify factors influencing patency.

From 2012 to 2023, all consecutive cases requiring endovascular aortic bifurcation reconstruction with HERAB technique for AIOD were collected at our tertiary center. Baseline data, procedural data, their 30-days complications, and overall survival were recorded. Patency and freedom from target lesion revascularisation were analyzed. Univariate analysis was performed to identify predictors of patency loss.

A total of 92 patients were included in the study. The AIOD was classified as TASC II D in 97% of cases, and indication for revascularisation was intermittent claudication in 63 cases (68.5%). Technical success rate was 93.5% and the 30-day mortality rate was 1.1%. Respective 5-year primary, primary assisted, and secondary patency rates were 68.8%, 80.7%, and 89.5%, with freedom from target lesion revascularisation rate of 83.7%. The collateral network patent before the surgery was preserved in 97% of cases. Only the use of a LifeStream stent for iliac kissing stent was associated with the loss of patency. In the case of patency loss, clinical presentation was the same as the onset event in 52% of cases. Overall, the limb salvage rate was 98%.

HERAB represents a safe and effective long-term alternative to CERAB. This procedure offers an advantage of preserving the collateral network, allowing the use of low-profile devices, and less expensive procedure.