First Results of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique for Aortoiliac Occlusive Disease

Abstract

Objective: Recent studies with asymptomatic carotid patients on best medical management have shown that the annual risk of stroke has decreased to approximately 1%. There is no evidence that a similar decrease in mortality has occurred. In addition, the intensity of statin therapy for these patients has not yet been determined. The aims of this review were to determine (a) the reported long-term all-cause and cardiac-related mortality in patients with asymptomatic carotid stenosis (ACS) >50%, (b) whether there has been a decrease in mortality in recent years, (c) the available methods of mortality risk stratification, and (d) whether the latest ACC/AHA guidelines on the treatment of serum lipids can be applied to this group of patients.Methods: Systematic review of PubMed, EuroPubMed, and Cochrane Library and meta-analysis using random effects for pooled proportions were performed regarding long-term all-cause and cardiac-related mortality and the associated risk factors in ACS patients. The last day for literature search was October 30, 2014.Results: Seventeen studies were retrieved reporting 5-year all-cause mortality in 11,391 patients with ACS >50%. The 5-year cumulative allcause mortality across all 17 studies was 23.6% (95% CI 20.50-26.80). Twelve additional studies, reporting both all-cause and cardiac mortality with a minimum of 2 year follow-up and involving 4072 patients were identified. Of the 930 deaths reported, 589 (62.9%; 95% CI 58.81-66.89) were cardiac-related. This translates into an average cardiac-related mortality of 2.9% per year.Conclusions: All-cause and cardiac mortality in ACS patients are very high. Although risk stratification is possible, most patients are classified as high risk. In view of this high risk, aggressive statin therapy is indicated if the new ACC/AHA guidelines on serum lipids are to be adhered to.

Outcome After Open and Laparoscopic Aortic Surgery in Matched Cohorts Using Propensity Score Matching

“…The composite primary end point grouped together the following adverse events (AEs): (1) all death < 30 days and late deaths related to aortic surgery; (2) post-operative hemorrhage necessitating re-operation; (3) myocardial infarction 30 days; (4) any stroke 30 days; (5) postoperative respiratory failure necessitating > 4 days of (24) .37 Female 19 (13) 11 (13) .97 6 (12) 7 (14) .76 BMI ! 30 (Kg/m 2 ) 21 (14) 11 (13) .75 6 (12) 8 (16) .56 COPD 45 (31) 24 (28) .…”

Endovascular treatment of aortoiliac occlusive disease involving the aortic bifurcation: Case Report

“…But the long term patency rates of endovascular therapies are uncertain for type C and D lesions. (2)(3)(4) In some recent reports authors revealed good results that approximating those of open surgery for type B or C lesions. Saher S Sabri at al.…”

Aortic Stenting in Symptomatic Infrarenal Aortic Stenosis and Subtotal Aortic Occlusion

“…17 The advantages of the use of covered stents is that it might prevent or immediately treat procedural complications such as rupture and distal embolization, but covered stents are more expensive than bare metal stents, and therefore, the cost-effectiveness of the Covered Endovascular Reconstruction of the Aortic Bifurcation procedure is unclear and long-term data are required. 18…”