MODULAR EXTENSION INTOEXTERNAL ILIAC ARTERY

+ HYPOGASTRIC ARTERY

EMBOLIZATION

PERUGIA 2001: BELL BOTTOM TECNIQUE OFFICIAL PRESENTATION

MODULAR EXTENSION INTOEXTERNAL ILIAC ARTERY

+ HYPOGASTRIC ARTERY

EMBOLIZATION

PHOENIX 2003: INTERNATIONAL CONGRESS XVI ENDOVASCULAR INTERVENTION

MODULAR EXTENSION INTOEXTERNAL ILIAC ARTERY

+ HYPOGASTRIC ARTERY

EMBOLIZATION

PHOENIX 2007: INTERNATIONAL CONGRESS XX ENDOVASCULAR INTERVENTION

XX International Congress Endovascular Interventions

THE BELL-BOTTOM TECNIQUE IN AAAS WITH ECTASIA OF THE ILIAC ARTERIES

long term result

Department of Cardiovascular DiseaseDepartment of Cardiovascular Disease Cittadella – Camposampiero ItalyCittadella – Camposampiero Italy

Director Dr. S. RonsivalleDirector Dr. S. Ronsivalle

Phoenix february 11-15, 2007

INCLUSION CRITERIA FOR ENDOVASCULAR INCLUSION CRITERIA FOR ENDOVASCULAR TREATMENT OF AORTO-ILIAC ANEURYSMSTREATMENT OF AORTO-ILIAC ANEURYSMS

proximal neck: diameter 26-28 mm

length 10 mm

common iliac artery: diam. 15 mm

Indication for endovascular repair 50%

ENDOVASCULAR TREATMENT OF ENDOVASCULAR TREATMENT OF ECTATIC COMMON ILIAC ARTERIES ECTATIC COMMON ILIAC ARTERIES

MODULAR EXTENSION INTOEXTERNAL ILIAC ARTERY

+ HYPOGASTRIC ARTERY

EMBOLIZATION

ENDOVASCULAR TREATMENT OF ENDOVASCULAR TREATMENT OF ECTATIC COMMON ILIAC ARTERIES ECTATIC COMMON ILIAC ARTERIES

BELL – BOTTOM TECHNIQUE:

Bell-shaped modular extension

into common iliac artery

BELL – BOTTOM TECHNIQUEBELL – BOTTOM TECHNIQUEaortic cuffaortic cuff

BELL- BOTTOM TECHNIQUEBELL- BOTTOM TECHNIQUE“custom made” cuff“custom made” cuff

PRE POST

BELL – BOTTOMBELL – BOTTOMaorticaortic cuff

PRE

POST

BELL – BOTTOMBELL – BOTTOMTalent “custom made”

BELL – BOTTOMTalent “custom made”

PRE POST

site Talent AneuRx Gore total

Abdominal 232 75 9 316

Thoracic 42 _ 2 44

total 360

STUDY POPULATIONoctober 1999 - december 2006

BELL-BOTTOM TECHNIQUEBELL-BOTTOM TECHNIQUE

BIFURCATED MODULAR EXTENSION

Talent 61 74

AneuRx 17 18

Excluder 1 1

total 79 93

BELL-BOTTOM : WHY?BELL-BOTTOM : WHY?

hypogastric embolization may cause colonic ischemia,erectile dysfunction and buttuck claudication

hypogastric embolization is not feasible technically in all cases

extension into the external iliac artery may predispose to graft limb thrombosis

Ischemic complications after hypogastric Ischemic complications after hypogastric artery coil embolization monolateral in artery coil embolization monolateral in

published datapublished data

34%

66%

total IIA occlusion cases

ischemic cases (% of total)

J Vasc Surg 2002; 35:874-81

3%10% 6%

81%

buttock claudication

sexual dysfuncition

colonic ischemia

other

Ischemic complications after hypogastric Ischemic complications after hypogastric artery coil embolization bilateral in artery coil embolization bilateral in

published datapublished data

13% 9%

87%

buttock claudication

sexual dysfunction

colonic ischemia

J Vasc Surg 2002; 35:874-81

43%

57%

total bilateral IIA occlusion cases

ischemic cases (% of total)

7 YEARS FOLLOW-UP 7 YEARS FOLLOW-UP Mean follow-up: 43.5 ± 22.0 months

Physical exam

Abdomen X-ray ( at discharge and 1 year )

CT- scan ( at 6 months )

Color Duplex Ultrasonography ( at discharge,

1, 3, 6, 12, and every six months thereafter )

BELL-BOTTOM TECHNIQUE BELL-BOTTOM TECHNIQUE 7 YEARS FOLLOW-UP 7 YEARS FOLLOW-UP

Mean follow-up: 43.5 ± 22.0 months

92%

1%7%

decreased

unchanced

increased

Complications: one patient with type 1 distal endoleak

CONCLUSIONSCONCLUSIONS Bell-Bottom technique Bell-Bottom technique

is a valuable adjunct in patients with ectatic common iliac arteries

increases the elegibility to endovascular treatment

artery embolization and endograft extension into the decreases the complications due to hypogastric external iliac artery