Presenter: Michele Piazza, MD

Affiliation: University of Padua, Italy

Abstract

Multicenter data (n=204 limbs) proves: IVUS-guided CERAB technique with VBX stent achieves 100% 24-month primary patency vs 88% for kissing stents, revolutionizing complex aortoiliac occlusive disease management.

Introduction

Aortoiliac bifurcation reconstruction demands anatomical precision. While kissing stent (KS) techniques face patency limitations, the CERAB (Covered Endovascular Reconstruction of Aortic Bifurcation) technique with Gore's VBX balloon-expandable stent offers a breakthrough, enhanced by IVUS guidance.

Key Evidence (JVS 2023)

1.Technical Superiority

CERAB vs KS: 100% vs 88% 24-month patency

IVUS Revision Rate: 25% cases required intraoperative adjustments

2.VBX Dominance

3.IVUS Critical Findings

"D-Shape" Apposition: Physiological aortic cross-section post-stent (Ø5.4mm)

Defect Detection: 15-20% cases showed:

Inadequate wall apposition (14%)

Distal edge dissection (6%)

Residual stenosis/kinking (11%)

High-Risk Predictors

Narrow Bifurcation (<12mm): OR=2.34 (p=0.032)

External Iliac CTO: OR=1.85 (p=0.044)

Severe Calcification + Stenosis: OR=3.00 (p=0.021)

VBX Stent Advantages

1.Structural Innovation

Independent Stainless Steel Rings: Balances flexibility and radial strength

CBAS® Heparin Coating: Reduces thrombogenicity

2.CERAB-Specific Benefits

Low-Profile Delivery: 7Fr system minimizes access injury

Hemodynamic Conformity: IVUS-confirmed D-shape apposition

3.Complex Case Validation

Calcified Aorta: Successful deployment in heavy calcification

Extended Coverage: 6.9cm mean iliac coverage (CERAB group)

Conclusions

1.IVUS Mandatory: Recommended for all CERAB procedures, especially for:

Aortic bifurcation <12mm

External iliac CTO

2.Heavily calcified lesions

VBX First-Choice: 91% utilization in CERAB with 100% midterm patency

Paradigm Shift: Balloon-expandable stents (VBX/BeGraft) superseding self-expanding options