Keschenau Paula Rosalie, Stark Mirja, Weiss Benjamin, Palacios Daniel, Kalder Johannes
Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany.
J Endovasc Ther. 2024 Jun 16:15266028241258659. doi: 10.1177/15266028241258659.
The aim of this study was to present the covered endovascular reconstruction of the iliac artery bifurcation (CERIB) technique as a revascularization option for aorto-iliac occlusive disease (AIOD) involving the iliac artery bifurcation.
This was a retrospective single-center study including all patients undergoing a CERIB procedure from January 2021 until December 2022. Covered endovascular reconstruction of the iliac artery bifurcation procedures were performed percutaneously with bilateral femoral access, excepting cases where simultaneous open femoral artery reconstruction was required due to the extension of peripheral arterial occlusive disease. Standard patient, procedural, and follow-up (FU) data including survival and arterial reinterventions were gathered and analyzed.
A total of 13 patients were included (11/13 male, median age=70 [60-76] years). Additional open and/or endovascular procedures included endarterectomy of the femoral bifurcation (n=6), rotational atherectomy (n=2), and 1 axillary artery cutdown for upper limb access (n=1). Median operating time was 2.9 hours (1.5-4.9 hours); median radiation duration and dose were 28.4 (14.3-63.3 minutes) and 4090.6 (384.4-9430.1 cGray/cm), respectively. The stent grafts used for CERIB were BeGraft peripheral n=31, BeGraft Aortic n=4 and BeGraft peripheral plus n=1 (Bentley InnoMed GmbH, Hechingen, Germany). In 2 patients with prior stenting of the common iliac artery (CIA), only the internal and external iliac arteries (IIA and EIA) were treated in this study, and in 2 cases, additional uncovered stents were required for relining. Technical success was 100%. During a midterm FU (median 18 [4-31] months), 2 patients died from cardiovascular reasons and 1 patient with prior iliac stenting required reinterventions for recurring occlusion.
Covered endovascular reconstruction of the iliac artery bifurcation is a straightforward option for treating AIOD involving the iliac artery bifurcation that allows preservation of internal iliac artery perfusion and shows good early and midterm results. Prior iliac artery stenting may be a risk factor for early occlusion after CERIB.
Aorto-iliac occlusive disease with involvement of the internal iliac artery is encountered regularly in vascular surgical practice, but the internal iliac artery is often not included in the revascularization strategy. The present article will increase the awareness for the relevance of including the internal iliac artery in revascularization strategies and presents CERIB as another method to be added to the armamentarium of (endo-)vascular surgeons and interventionalists.
本研究旨在介绍髂动脉分叉部覆膜血管腔内重建术（CERIB）技术，作为治疗累及髂动脉分叉的主-髂动脉闭塞性疾病（AIOD）的一种血管重建选择。
这是一项回顾性单中心研究，纳入了2021年1月至2022年12月期间接受CERIB手术的所有患者。除因外周动脉闭塞性疾病扩展而需要同时进行开放性股动脉重建的病例外，髂动脉分叉部覆膜血管腔内重建术均通过双侧股动脉入路经皮进行。收集并分析了包括生存情况和动脉再次干预在内的标准患者、手术及随访（FU）数据。
共纳入13例患者（11/13为男性，中位年龄=70[60-76]岁）。额外的开放性和/或血管腔内手术包括股动脉分叉部内膜切除术（n=6）、旋磨术（n=2）以及1例为建立上肢入路而进行的腋动脉切开术（n=1）。中位手术时间为2.9小时（1.5-4.9小时）；中位辐射时间和剂量分别为28.4（14.3-63.3分钟）和4090.6（384.4-9430.1厘戈瑞/厘米）。用于CERIB的覆膜支架有BeGraft外周型n=31、BeGraft主动脉型n=4以及BeGraft外周加强型n=1（德国黑兴根的本特利创新医疗有限公司）。在2例先前已对髂总动脉（CIA）进行支架置入的患者中，本研究仅处理了髂内动脉和髂外动脉（IIA和EIA），且有2例患者需要额外置入裸支架进行内衬。技术成功率为100%。在中期随访（中位时间18[4-31]个月）期间，2例患者死于心血管原因，1例先前有髂动脉支架置入的患者因复发性闭塞需要再次干预。
髂动脉分叉部覆膜血管腔内重建术是治疗累及髂动脉分叉的AIOD的一种直接选择，可保留髂内动脉灌注，且早期和中期效果良好。先前的髂动脉支架置入可能是CERIB术后早期闭塞的一个危险因素。
在血管外科实践中，经常会遇到累及髂内动脉的主-髂动脉闭塞性疾病，但髂内动脉通常不被纳入血管重建策略。本文将提高对在血管重建策略中纳入髂内动脉相关性的认识，并将CERIB作为另一种方法补充到（血管）外科医生和介入医生的技术库中。
