Abstract：
BACKGROUND: Covered endovascular reconstruction of aortic bifurcation (CERAB) is increasingly used as a first line-treatment in patients with aortoiliac occlusive disease (AIOD). We sought to compare the outcomes of patients who underwent CERAB compared with the gold standard of aortobifemoral bypass (ABF).
METHODS: The Vascular Quality Initiative was queried for patients who underwent ABF or CERAB from 2009 to 2021. Propensity scores were generated using demographics, comorbidities, Rutherford class, and urgency. The two groups were matched using 5-to-1 nearest-neighbor match. Our primary outcomes were 1-year estimates of primary patency, major adverse limb events (MALEs), MALE-free survival, reintervention-free survival, and amputation-free survival. Standard statistical methods were used.
RESULTS: A total of 3944 ABF and 281 CERAB cases were identified. Of all patients with AIOD, the proportion of CERAB increased from 0% to 17.9% between 2009 and 2021. Compared with ABF, patients who underwent CERAB were more likely to be older (64.7 vs 60.2; P < .001) and more often had diabetes (40.9% vs 24.1%; P < .001) and end-stage renal disease (1.1% vs 0.3%; P = .03). In the matched analysis (229 CERAB vs 929 ABF), ABF patients had improved MALE-free survival (93.2% [±0.9%] vs 83.2% [±3%]; P < .001) and lower rates of MALE (5.2% [±0.9%] vs 14.1% [±3%]; P < .001), with comparable primary patency rates (98.3% [±0.3%] vs 96.6% [±1%]; P = .6) and amputation-free survival (99.3% [±0.3%] vs 99.4% [±0.6%]; P = .9). Patients in the CERAB group had significantly lower reintervention-free survival (62.5% [±6%] vs 92.9% [±0.9%]; P < .001). Matched analysis also revealed shorter length of stay (1 vs 7 days; P < .001), as well as lower pulmonary (1.2% vs 6.6%; P = .01), renal (1.8% vs 10%; P < .001), and cardiac (1.8% vs 12.8%; P < .001) complications among CERAB patients.
CONCLUSIONS: CERAB had lower perioperative morbidity compared with ABF with a similar primary patency 1-year estimates. However, patients who underwent CERAB experienced more major adverse limb events and reinterventions. Although CERAB is an effective treatment for patients with AIOD, further studies are needed to determine the long-term outcomes of CERAB compared with the established durability of ABF and further define the role of CEARB in the treatment of AIOD.
METHODS: The Vascular Quality Initiative was queried for patients who underwent ABF or CERAB from 2009 to 2021. Propensity scores were generated using demographics, comorbidities, Rutherford class, and urgency. The two groups were matched using 5-to-1 nearest-neighbor match. Our primary outcomes were 1-year estimates of primary patency, major adverse limb events (MALEs), MALE-free survival, reintervention-free survival, and amputation-free survival. Standard statistical methods were used.
RESULTS: A total of 3944 ABF and 281 CERAB cases were identified. Of all patients with AIOD, the proportion of CERAB increased from 0% to 17.9% between 2009 and 2021. Compared with ABF, patients who underwent CERAB were more likely to be older (64.7 vs 60.2; P < .001) and more often had diabetes (40.9% vs 24.1%; P < .001) and end-stage renal disease (1.1% vs 0.3%; P = .03). In the matched analysis (229 CERAB vs 929 ABF), ABF patients had improved MALE-free survival (93.2% [±0.9%] vs 83.2% [±3%]; P < .001) and lower rates of MALE (5.2% [±0.9%] vs 14.1% [±3%]; P < .001), with comparable primary patency rates (98.3% [±0.3%] vs 96.6% [±1%]; P = .6) and amputation-free survival (99.3% [±0.3%] vs 99.4% [±0.6%]; P = .9). Patients in the CERAB group had significantly lower reintervention-free survival (62.5% [±6%] vs 92.9% [±0.9%]; P < .001). Matched analysis also revealed shorter length of stay (1 vs 7 days; P < .001), as well as lower pulmonary (1.2% vs 6.6%; P = .01), renal (1.8% vs 10%; P < .001), and cardiac (1.8% vs 12.8%; P < .001) complications among CERAB patients.
CONCLUSIONS: CERAB had lower perioperative morbidity compared with ABF with a similar primary patency 1-year estimates. However, patients who underwent CERAB experienced more major adverse limb events and reinterventions. Although CERAB is an effective treatment for patients with AIOD, further studies are needed to determine the long-term outcomes of CERAB compared with the established durability of ABF and further define the role of CEARB in the treatment of AIOD.
摘要：
背景：主动脉分叉（CERAB）的覆盖血管内重建越来越多地用作主动脉-髂动脉闭塞性疾病（AIOD）患者的一线治疗。我们试图将接受CERAB的患者的预后与主动脉双口经桥（ABF）的金标准进行比较。
方法：对2009-2021年接受ABF或CERAB的患者进行了血管质量调查。倾向评分是使用人口统计生成的，合并症,卢瑟福班,和紧迫性。两组使用5对1最近邻匹配进行匹配。我们的主要结果是1年估计的原发性通畅性，主要不良肢体事件（男性），无男性生存,无再干预生存，和无截肢生存。使用标准统计方法。
结果：共发现3,944例ABF和281例CERAB。所有AIOD患者中,2009-2021年，CERAB的比例从0%上升至17.9%。与ABF相比,接受CERAB的患者年龄较大（64.7vs.60.2；p<.001），更常见于糖尿病（40.9%vs.24.1%；p<.001）和终末期肾病（1.1%vs.0.3%；P=0.03）。在匹配分析中(229CERABvs.929ABF)，ABF患者无男性生存率提高（93.2%[±0.9%]vs.83.2%[±3%]；p<.001）和较低的男性比率（5.2%[±0.9%]与14.1%[±3%]；p<.001)，具有可比的主要通畅率（98.3％[±0.3％]与96.6%[±1%]；p=.6）和无截肢生存率（99.3%[±0.3%]vs.99.4%[±0.6%]；p=.9）。CERAB组患者的无再干预生存率明显较低（62.5%±[6%]vs.92.9%±[0.9%]；p<.001）。匹配分析还显示LOS较短（1与7天；p<.001)，以及肺下部(1.2%与6.6%；p=0.01)，肾（1.8%vs.10%；p<.001)，和心脏（1.8%与12.8%；p<.001)CERAB患者并发症。
结论：与ABF相比，CERAB的围手术期发病率较低，1年的原发性通畅率相似。然而,接受CERAB治疗的患者经历了更多的主要肢体不良事件和重新干预.尽管CERAB是AIOD患者的有效治疗方法，需要进一步的研究来确定CERAB与已确定的ABF耐久性相比的长期结局,并进一步确定CEARB在AIOD治疗中的作用.
方法：对2009-2021年接受ABF或CERAB的患者进行了血管质量调查。倾向评分是使用人口统计生成的，合并症,卢瑟福班,和紧迫性。两组使用5对1最近邻匹配进行匹配。我们的主要结果是1年估计的原发性通畅性，主要不良肢体事件（男性），无男性生存,无再干预生存，和无截肢生存。使用标准统计方法。
结果：共发现3,944例ABF和281例CERAB。所有AIOD患者中,2009-2021年，CERAB的比例从0%上升至17.9%。与ABF相比,接受CERAB的患者年龄较大（64.7vs.60.2；p<.001），更常见于糖尿病（40.9%vs.24.1%；p<.001）和终末期肾病（1.1%vs.0.3%；P=0.03）。在匹配分析中(229CERABvs.929ABF)，ABF患者无男性生存率提高（93.2%[±0.9%]vs.83.2%[±3%]；p<.001）和较低的男性比率（5.2%[±0.9%]与14.1%[±3%]；p<.001)，具有可比的主要通畅率（98.3％[±0.3％]与96.6%[±1%]；p=.6）和无截肢生存率（99.3%[±0.3%]vs.99.4%[±0.6%]；p=.9）。CERAB组患者的无再干预生存率明显较低（62.5%±[6%]vs.92.9%±[0.9%]；p<.001）。匹配分析还显示LOS较短（1与7天；p<.001)，以及肺下部(1.2%与6.6%；p=0.01)，肾（1.8%vs.10%；p<.001)，和心脏（1.8%与12.8%；p<.001)CERAB患者并发症。
结论：与ABF相比，CERAB的围手术期发病率较低，1年的原发性通畅率相似。然而,接受CERAB治疗的患者经历了更多的主要肢体不良事件和重新干预.尽管CERAB是AIOD患者的有效治疗方法，需要进一步的研究来确定CERAB与已确定的ABF耐久性相比的长期结局,并进一步确定CEARB在AIOD治疗中的作用.
