Our purpose is to compare the clinical outcomes of the covered endovascular reconstruction of the aortic bifurcation (CERAB) and the kissing stent technique in the treatment of aortoiliac occlusive disease (AIOD). We conducted a retrospective review of consecutive patients with AIOD who underwent either CERAB or kissing stent procedures at a tertiary referral center in China between December 2015 and January 2025. Baseline characteristics, procedural details, ankle-brachial index (ABI), early complications, and patency rates were compared. Kaplan–Meier analysis assessed primary/secondary patency and freedom from reintervention. Multivariate Cox regression analysis was performed to identify the independent predictors of primary patency. A total of 75 AIOD patients were included, including 57 patients (76.0%) in the Kissing stent group and 18 patients (24.0%) in the CERAB group. Technical success (100% vs. 98.2%, P = 1.000) and 30-day mortality (0% vs. 3.5%, P = 1.000) did not differ significantly between the groups. Both groups showed significant ABI improvement. The 5-year primary patency was lower with CERAB (57.2% vs. 74.4%, P = 0.012), but the difference was nonsignificant after multivariate adjustment ( P = 0.100). Secondary patency (88.5% vs. 89.8%, P = 0.180) and freedom from reintervention (61.4% vs. 78.9%, P = 0.170) were comparable. Multivariate analysis identified access route, femoral artery stenosis, and stent diameter as independent predictors of primary patency. Both techniques are safe and effective. Anatomic factors and procedural details exert a greater influence on clinical outcomes than the choice of technique itself. Therefore, preprocedural planning should emphasize individualized anatomical assessment and meticulous surgical execution.
Zhou et al. (2026) studied this question.