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Gecoverte endovaskuläre Rekonstruktion der Aortenbifurkation (CERAB)

Covered endovascular reconstruction of aortic bifurcation (CERAB)

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Zusammenfassung

Hintergrund

Die aortoiliakalen Stenosen sind eine häufige Ursache für die periphere arterielle Verschlusskrankheit (PAVK), welche insbesondere im höheren Alter (> 60 Jahre) mit einer Prävalenz von 20 % gehäuft auftritt. In frühen Stadien (TASC [Trans-Atlantic Inter-Society Consensus] II A/B) lassen sich diese Stenosen mittels endovaskulärer Therapieverfahren erfolgreich behandeln. Bei den komplexeren aortoiliaklen Stenosen (TASC II C/D) wurden in der Vergangenheit vornehmlich die offen-chirurgischen Therapieverfahren durchgeführt.

Klinisches Problem

Aufgrund des hohen Alters und den multiplen Komorbiditäten der PAVK-Patienten mit komplexen aortoiliaklen Stenosen stellt die offen-chirurgische Therapie meist ein hohes Risiko dar, weshalb die endovaskulären Verfahren trotz ihres schlechteren Outcomes eine Alternative darstellen. Durch die Methode der gecoverten endovaskulären Rekonstruktion der Aortenbifurkation (CERAB) soll die primäre Offenheitsrate gegenüber der üblichen endovaskulären Implantation von Kissing-Stents verbessert werden.

Datenlage

Hinsichtlich der primären Offenheitsrate ist die offen-chirurgische Therapie den beiden endovaskulären Verfahren weiterhin überlegen, allerdings zeigt die CERAB-Technik ein besseres 5‑Jahres-Outcome als die Kissing-Stent-Technik. Bei der sekundären Offenheitsrate finden sich bei keinem der 3 Verfahren Unterschiede. Die Morbidität und Mortalität der CERAB- und Kissing-Stent-Technik sind vergleichbar niedrig, beide Verfahren sind der offen-chirurgischen Therapie überlegen.

Schlussfolgerung

Aufgrund des besseren Langzeit-Outcomes der CERAB- gegenüber der Kissing-Stent-Technik sollte diese bei Patienten mit komplexen aortoiliakalen Stenosen mit einem erhöhten Komplikationsrisiko bei der offenen chirurgischen Versorgung angewandt werden.

Abstract

Background

Aortoiliac stenosis is common cause of peripheral arterial disease (PAD), which is particularly prevalent in older age (> 60 years) with a prevalence of 20%. In early stages (TASC [Trans-Atlantic Inter-Society Consensus] II A/B), these stenoses can be successfully treated by endovascular procedures. For more complex aortoiliac stenoses (TASC II C/D), open surgical treatment was the primary treatment in the past.

Clinical issue

Because of the advanced age and multiple comorbidities of PAD patients with complex aortoiliac stenoses, open surgical treatment is usually associated with high risk, and therefore endovascular procedures are an alternative despite their poorer outcome. Covered endovascular reconstruction of the aortic bifurcation (CERAB) aims to improve the primary patency rate compared with the usual endovascular implantation of kissing stents.

Data

With regard to the primary patency rate, open surgical treatment remains superior to both endovascular procedures; however, the CERAB technique shows a better 5‑year outcome than the kissing stent technique. No differences are found in the secondary patency rate for any of the three procedures. The morbidity and mortality of the CERAB and kissing stent techniques are comparably low, and both procedures are superior to open surgical treatment.

Conclusion

Because of the better long-term outcome of the CERAB versus the kissing stent technique, it should be used in patients with complex aortoiliac stenoses with increased risk of complications expected with open surgical treatment.

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Authors and Affiliations

  1. Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl-Gustav-Carus, TU Dresden, Fetscherstr. 74, Haus 27, 01307, Dresden, Deutschland

    Christoph G. Radosa, H. Nebelung, F. Schön & R. T. Hoffmann

  2. Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl-Gustav-Carus, TU Dresden, Dresden, Deutschland

    C. Reeps

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  1. Christoph G. Radosa
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Correspondence to Christoph G. Radosa.

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Interessenkonflikt

C.G. Radosa, C. Reeps, H. Nebelung, F. Schön und R.T. Hoffmann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Radosa, C.G., Reeps, C., Nebelung, H. et al. Gecoverte endovaskuläre Rekonstruktion der Aortenbifurkation (CERAB). Radiologie 62, 601–606 (2022). https://doi.org/10.1007/s00117-022-00989-6

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  • DOI: https://doi.org/10.1007/s00117-022-00989-6

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