The Use of Begraft® Balloon-Expandable Covered Stents as Cerab Technique for the Treatment of Aorto-Iliac Aortic Disease

Abstract

Introduction - Peripheral arterial disease (PAD) affects more than 20% of the population above 70 years old. Nowadays, the treatment of occlusive aorto-iliac disease has moved to an endovascular-first approach in many centers, even for complex TASC C and D lesions. In this situation, balloon-expandable covered stents have demonstrated superior results. However, few options exist when dealing with aortic lesions requiring large diameter covered stents. Methods - To report a case of the use of large diameter BeGraftÒ balloon-expandable covered stents with the CERAB technique in the treatment of aorto-iliac occlusive disease. Results - A 77-year-old man was referred to our Department for pelvis and thigh claudication and impotence worsening over the last 2 years. He underwent an angio-CT scan, which demonstrated a significant tight stenosis of the infra-renal aorta extending to the iliac bifurcation. Flows were monophasic at the femoral level on both sides. The patient was offered percutaneous endovascular treatment using the CERAB technique. Firstly an aortic balloon-expandable covered stent BeGraft (Bentley, Hechingen, Germany) 18x48 mm was placed and dilated to 20mm proximally and then two iliac 10x38mm BeGraft were successfully implanted partially in the first aortic stent. Completion angiography demonstrated a patent aorta, no residual stenosis and a rapid flow down to the limbs. Patient was discharged on the following day. At 1 month follow up, the patient was free from pain during exercise and described normal sexual function. Vascular examination revealed palpable pedal pulses. An angio CT-scan confirmed a patent CERAB, without any complications. Conclusion - To our knowledge, this is the first report of the implantation of a large diameter BeGraft covered stent at the level of the abdominal aorta to treat occlusive disease using the CERAB technique. Aortic lesions are often highly calcified, partially thrombosed and thus difficult to cross. Due to the risk of flow limiting dissection, perforation or embolization, the use of covered stent allows to immediately treat these complications. The CERAB technique has been shown to offer better hemodynamics conditions as compared to kissing stents, reducing the risk of restenosis. BeGraft stent appears to be a safe and valid in the treatment of aorto-iliac stenosis. Further cases and studies are required to confirm this preliminary excellent result.