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Outcomes Analysis of 3 Different Device Platforms for the Covered Endovascular Reconstruction of the Aortic
Gabriele Piffaretti1, Sergio Zacà2, Martina Palughi3
1Vascular Surgery, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy.
Objectives:
To analyze the major aortoiliac obstructive disease (AIOD)-related outcomes after covered endovascular reconstruction of aortic bifurcation (CERAB), comparing 3 different endovascular platforms.
Materials And Methods:
It is a physician-initiated, unsupported, multicenter, observational, retrospective, cohort study. We identified all CERABs between March 1, 2016 and September 30, 2024. We compared 3 different endovascular platforms: Viabahn VBX (W.L. Gore, Flagstaff; Arizona), AFX/AFX-2 (Endologix, Irvine, California), and BeGraft (Hechingen, Germany). Inclusion criteria were CERAB procedure for primary or de novo AIOD; exclusion criteria were CERAB using a combination of different platforms, traumatic lesions, and missing preoperative/follow-up data. Specifically, for the purposes of this study, the primary outcomes were overall survival and CERAB-related reintervention.
Results:
We analyzed 220 (96.9%) CERABs: 132 (60.0%) with the VBX, 60 (27.3%) with the AFX/AFX-2, and 28 (12.7%) with the BeGraft. Patients in the VBX group were older [median-25th-75th interquartile: VBX, 71 [IQR, 65.2-77] vs AFX/AFX-2, 64 [IQR, 59-72] vs BeGraft 68 [IQR, 55.7-73.5], P = .002], whereas AFX/AFX-2 group had the lowest rate of critical limb-threatening ischemia as presenting scenario (VBX, 36.4% vs AFX/AFX-2, 18.2% vs BeGraft 35.7%, while AFX/AFX-2 P = .039). Technical success was achieved in 217 (98.6%) procedures: all 3 failures occurred in the VBX group. The median follow-up was 21 months (IQR, 9-30), with a difference among the groups (months: BeGraft 21 [IQR, 10.7-42] vs VBX, 13.5 [IQR, 6-26] vs AFX/AFX-2, 25 [IQR, 17.2-38.7], P = .001]. Estimated survival was 92% ± 0.2 (95% CI, 87.0-94.9) at 12 months, 87% ± 0.3 (95% CI, 81.4-91.6) at 24 months, and 76 ± 0.5 (95% CI, 64.6-84.2) at 60 months. The freedom from CERAB-related reintervention rate was 94% ± 0.2 (95% CI, 89.7-96.5) at 12 months, 93% ± 0.2 (95% CI, 88.3-95.9) at 24 months, and 89 ± 0.3 (95% CI, 81.4-94.1) at 60 months. Survival and freedom from CERAB-related reintervention did not differ among the groups (P = .696 and P = .497, respectively).
Conclusion:
In patients with AIOD, the CERAB technique proved to be safe procedure with acceptable durability at mid- to long-term follow-up independently of the type of endovascular platform.Clinical ImpactWith the current technical expertise and wide availability of a variety of endovascular platforms and geometries of reconstruction, the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) endovascular reconstruction of aorto-iliac obstructive disease proved to be a satisfactory technique based on durable results at mid-term follow-up with independently of the device used.
