Document Detail

A comparative study of the bell-bottom technique vs hypogastric exclusion for the treatment of aneurysmal extension to the iliac bifurcation.
MedLine Citation:
PMID:  22226182     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: A significant proportion of patients undergoing endovascular aneurysm repair (EVAR) have common iliac artery aneurysms (CIAA). Aneurysmal involvement at the iliac bifurcation potentially undermines long-term durability.
METHODS: Patients with CIAA who underwent EVAR were identified in two teaching hospitals. Bell-bottom technique (BBT; iliac limb ≥20 mm) or internal iliac artery embolization and limb extension to the external iliac artery (IIE + EE) were used. Outcome between these two approaches was compared.
RESULTS: We identified 185 patients. Indication for EVAR included asymptomatic abdominal aortic aneurysm (AAA) in 157, symptomatic or ruptured aneurysm in 19, and CIAA in nine. Mean AAA diameter was 59 mm. Among 260 large CIAAs that were treated, BBT was used to treat 166 CIAA limbs, and 94 limbs underwent IIE + EE. Total reintervention rates were 11% for BBT (n = 19) and 19.1% for IIE + EE (n = 18; P = .149). Rates of reintervention for type Ib or III endoleak were 4% for BBT (n = 7) and 4% for IIE + EE (n = 4; P > .99). The difference in limb patency rates was not significant. The 30-day mortality rate was 1%. Median follow-up was 22 months. Complications did not differ significantly between the two groups; however, the combined incidence of perioperative complications and reinterventions was higher in the IIE + EE group (49% vs 22%; P = .002).
CONCLUSIONS: The combined incidence of perioperative complications and reinterventions is significantly higher with IIE + EE than with BBT; therefore, when feasible, BBT is desirable.
Peter A Naughton; Michael S Park; Elrasheid A H Kheirelseid; Sean M O'Neill; Heron E Rodriguez; Mark D Morasch; Prakash Madhavan; Mark K Eskandari
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2012-01-05
Journal Detail:
Title:  Journal of vascular surgery     Volume:  55     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-02     Completed Date:  2012-05-30     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  956-62     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Division of Vascular Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill, USA.
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MeSH Terms
Aged, 80 and over
Aneurysm, Ruptured / mortality,  radiography,  surgery*
Angioplasty / methods
Aortic Aneurysm / complications,  radiography,  surgery*
Aortography / methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation / methods*,  mortality
Cohort Studies
Embolization, Therapeutic / methods*
Follow-Up Studies
Iliac Aneurysm / complications,  radiography,  therapy*
Middle Aged
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Tomography, X-Ray Computed / methods
Treatment Outcome
Vascular Patency / physiology
Grant Support

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