CERAB technique in AIOD lesion

This short video provides step-by-step instructions for the CERAB technique (covered endovascular reconstruction of Aortic bifurcation) for AOID (aorto iliac occlusive diseas)


    Dr. Amer Zanabili
    June 16, 2020

    Thanks Martin for sharing this interesting case. To create a debate around this technique, I would like to ask you some questions.
    1. Which kind of CS have you used and the dimension of them?
    2. In your clinical practice, in which percentage do you usually use more than 3 CS to perform the CERAB technique in complex AIOD? Was it necessary to perform any treatment in the external iliac or common femoral arteries in this case?
    3. And the last one, do you always predilate the lesion before the stenting implantation? I usually avoid to do it to minimize the risk of distal embolization.

    MD Martin Schroeder
    June 17, 2020

    Dear Amer , thank you for your feedback and questions.
    1) we use Bentley covered stents (Begraft Aortic) the reason for this is the large radial force and the corresponding diameter in the area of the aorta. In our case 16mm (11F) post dilation 18mm (BD Atlas Ballon) with easy adjustability.
    2) normally you need 3 covered stents for the CERAB technique – which refers to the infrarenal aorta and the bifurcation of the iliac vessels. however, additional interventions in the iliac vessels are sometimes necessary in complex situations
    (TASC II D lesions with extension of the CS, chimney, coiling, etc.)
    In our case it was a bilateral occlusion of the ICA and IEA. In this case, a stent is particularly helpful in cases of severe calcification and possible dissection during revascularization and protects against an early re-occlusion.
    3) predilatation, I think it makes sense to create a certain space for the sheats which are important to get the covered stents in place. Distal embolization is of course an issue, two comments to avoid: A) if you use a cut down in the area of the groin as access – flush. B) A preoperative CT angiography and the medical history should provide information about the duration of the occlusion. depending on that i would plan my procedure.
    Thank you again for your questions, best regards

    Dr. Amer Zanabili
    June 17, 2020

    Thanks Martin for your useful answers and explanations. In my opinion, the CERAB technique is a useful tool when there is a lesion like stenosis or thrombus at the level of the IMA. However, it has some disadvantages like more collateral need to be sacrificed with uncertain consequences (inferior mesenteric artery, lumbar arteries, accessory renal arteries);
    in up to 45 – 50% of cases it is necessary to use 4 or 5 stents, and it could be less practical when the aortic diameter is larger than 16 mm.

    Best regards and thanks again for your excellent work!!!

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