Outcomes of bell-bottom technique compared to standard endovascular aneurysm repair

Abstract

Objective The bell-bottom technique is a widely used technique to treat aortoiliac aneurysms with preservation of the hypogastric arteries. The published data are scarce with conflicting results regarding the evolution. The aim of this study was to compare the outcomes of patients submitted to endovascular abdominal aortic aneurysm repair with standard technique (S-EVAR) versus bell-bottom technique. Methods This retrospective cohort study compared the outcomes of standard endovascular aneurysm repair (<16 mm iliac limbs) and bell-bottom technique (≥16 mm iliac limbs) in a tertiary vascular center between 2010 and 2015. The end points of this study were type IB endoleak, reintervention and 30-day mortality. The follow-up protocol included CT scans within 30 days of implantation and 12 months. Duplex ultrasound was performed yearly thereafter. Results Two hundred and three patients were treated with bell-bottom technique ( n = 84, mean age 72.2 ± 8.9) and S-EVAR ( n = 119, mean age 72.7 ± 8.4). The overall 30-day mortality was 1.9%, with no significant difference between groups. There was higher prevalence of coronary heart disease in the bell-bottom technique group compared to the S-EVAR group (41.6% vs. 18.4%, p < 0.01). One patient in the S-EVAR group (0.85%) and four patients in the bell-bottom technique (4.6%) developed type IB endoleak. The mean follow-up period was 35.2 ± 30.4 months. By Kaplan-Meier analysis, freedom from type IB endoleak in 80 months was 85.2% in the bell-bottom technique group and 98.7% in the S-EVAR group ( p = 0.05). The freedom from reintervention in 80 months was 74.0% in the bell-bottom technique group and 94.1% in the S-EVAR group ( p = 0.6). Conclusions This study shows lower freedom from type IB endoleak in the bell-bottom group compared to the standard repair group. There is no significant difference in reoperation rate and 30-day mortality.

Systematic Review on the Mid-Term Outcomes of Elective Endovascular Aneurysm Sealing in Comparison to Endovascular Aneurysm Repair

“…Deery et al 17 reported graft limb occlusion in 2.3% of patients. Massière et al 11 reported 2 (1%) cases of occlusion within the perioperative period. Sirignano et al 12 noted that out of the 20 reinterventions needed at some point during the 35 months follow-up, 7 were due to endograft limb occlusion.…”

“…Throughout long-term follow-up, the freedom from type Ia endoleak was reported in 99% and 97% at 1 and 5 years follow-up, respectively. Massière et al 11 reported on long-term prevalence of type I endoleak and noted 2 cases (1%) of type Ia endoleak and 5 cases (2%) of type Ib endoleak. Sirignano et al 12 reported 6 cases of type Ia endoleak (2%), 3 type Ib endoleak (1%), 7 type II endoleak (2%), and 1 type III endoleak (0.3%).…”

“…A total of 10,225 patients were included of whom 9441 underwent EVAR and 784 EVAS. 5,[10][11][12][13][14][15][16][17][18][19][20] The complete study population consisted largely of men (88.9%) with a mean age of 74.8 ± 7.9 years. A higher age was observed in the EVAS patients (p < 0.0001) with a mean age for the EVAS cohort of 75.9 ± 7.9 and 74.2 ± 7.9 years for the EVAR cohort.…”

“…Overview of Study Characteristics and Outcome Measures Reported per Included Study 5,[10][11][12][13][14][15][16][17][18][19][20]. …”

Navigating Challenges in the Endovascular Treatment of Asymptomatic Aortoiliac Aneurysms: A 10-Year Comparative Analysis

“…To mitigate these complications, preservation strategies for the IIA, such as the bell-bottom technique (BBT) and the iliac branch device (IBD), have been proposed [7,8]. However, the BBT has limitations, as landing a flared iliac limb graft onto the dilatation of a CIA may result in the secondary dilatation of the distal landing zone over time, leading to a type 1B endoleak [9].…”