Endovascular reconstruction is a procedure used to repair a damaged or blocked part of one of your blood vessels.

During endovascular reconstruction, your doctor will insert a thin tube into a major blood vessel, usually in your thigh, to perform a repair.

A particular type of endovascular reconstruction called covered endovascular reconstruction of the aortic bifurcation (CERAB) is used to treat problems with the largest blood vessel in your body, called your aorta, and the main branches that supply your legs.

In this article, we’ll specifically look at why you may need CERAB and what you can expect during the procedure.

Is endovascular reconstruction a major surgery?

CERAB is a minimally invasive but intensive procedure that doctors use to relieve a blockage in your aortic bifurcation. Your aortic bifurcation is where your aorta splits into the two arteries that supply your legs called the common iliac arteries.

Most CERAB procedures are performed under general anesthesia, meaning you’ll be asleep during the surgery.

Sometimes CERAB is used to treat a blocked or damaged section of your lower aorta causing blood flow problems. Problems with this part of your aorta can limit circulation to your lower body and may cause problems such as a condition called intermittent claudication.

Intermittent claudication is aching pain in your legs that primarily occurs when you walk or exercise. It causes pain that ranges from mild to severe as well as:

In a small 2022 study, 6 of 9 people who received CERAB had intermittent claudication that didn’t respond to conservative treatments.

Most blockages are caused by atherosclerosis, the buildup of plaque along your arteries. Left untreated, atherosclerosis of your aorta is associated with complications like heart attack or stroke.

Medical treatment directed at aortic atherosclerosis is the same as the medical treatment used to lower the risk of heart attack and stroke.

In a 2023 study, CERAB was used to treat a 10-year-old girl with injuries sustained in a car collision.

Another type of endovascular reconstruction of the aorta is called endovascular aneurysm repair (EVAR), which is used to treat aortic aneurysms in the location around the aortic bifurcation.

Endovascular reconstruction may also be performed on other major blood vessels like the carotid artery. In a 2023 study, researchers reported endovascular reconstruction being used to treat aortic aneurysms and tears.

Endovascular surgery like CERAB is associated with lower complication and mortality rates than open procedures that involve repairing your blood vessel through a large incision.

Potential complications include:

In a 2019 study researchers examined the results of 22 people treated with CERAB from 2012–2016 at one hospital. The researchers reported a 0% mortality rate at a median follow-up of 20 months, meaning all 22 people were still alive at this time.

Complications developed in three people:

  • One person developed a blood clot in the artery supplying their kidney.
  • One person developed an embolization, or dislodged blood clot.
  • One person developed a problem with their stent.

In the same 2019 study, 82% were alive with blood flow through their stented arteries 2 years after their surgery.

In a 2021 study from China, researchers reviewed the effectiveness of endovascular reconstruction on 156 people treated for blockages causing low blood flow to their legs.

The researchers found the initial 1-year success rate was 98.7%, and the complication rate was 4.5%. The success rate decreases with time. The rates of proper blood flow at various follow-up periods were:

12 months96.5%
36 months88.3%
60 months80.4%

Here’s a general idea of what you can expect before, during, and after endovascular reconstruction.

Before the procedure

You’ll likely undergo many tests before your procedure, such as:

If you receive general anesthesia, you won’t be able to eat or drink for about 6 hours before your procedure. Make sure to follow the specific instructions from your doctor.

During the procedure

In the 2019 study above, researchers found that half of operations lasted 130 minutes and that they ranged from 70 to 270 minutes.

Here’s a general idea of what to expect:

  1. You’ll be given general anesthesia through an intravenous (IV) to put you to sleep. A catheter will be inserted into your bladder to help drain urine.
  2. Your surgeon will make a small incision in a blood vessel in your groin. For extensive procedures, they might make an incision near your shoulder.
  3. A wire is threaded through your bloodstream using X-ray guidance to the blocked or narrowed part of your artery.
  4. A balloon is inflated near the blockage to expand your blood vessel, and a stent is placed to keep the blood vessel open. In general, multiple stents are needed to reconstruct the aortic bifurcation.

After the procedure

You’ll be closely monitored after your surgery to make sure you don’t develop complications and will be encouraged to start moving around as soon as possible after your procedure.

In the same 2019 study, the average length of hospital stay was 3 days. You may have to stay longer depending on whether you develop complications.

If you smoke, it’s generally highly recommended to quit smoking before your procedure.

Smoking increases your chances of getting a chest infection and can slow your recovery. Continued smoking after the surgery can lead to re-narrowing of vascular reconstructions, such as stents.

It can be difficult to quit, but your doctor can build a cessation plan that works for you.

You’ll need to arrange a drive home in advance since you won’t be able to drive after your procedure.

You’ll likely feel weak after your procedure and more tired than usual. It can take weeks to months for your energy to fully come back.

You won’t be able to drive until you can perform an emergency stop without pain. This may take weeks or longer.

To give you a general idea of the cost, the nonprofit FAIR Health estimates that 80% of surgeries to repair a ruptured aneurysm of the abdominal aorta are under $26,670 in New York City without insurance.

Surgeries in areas with cheaper costs of living are often less. The costs of endovascular reconstruction vary widely.

Many insurance providers, including Medicare, cover at least most of the cost if your surgery is deemed medically necessary.

Blockages or damage to major blood vessels can also be treated with open surgery. Open surgery involves making the repair through a large incision in the abdomen instead of from within your blood vessel.

Repair of major blood vessels such as your aorta requires intensive surgery and can come with serious complications. Your surgical team can best explain the potential risks of your procedure.