Endovascular treatment of common iliac artery aneurysms using the bell-bottom technique: long-term results
Giovanni Torsello1, Eva Schönefeld, Nani Osada
1Center for Vascular and Endovascular Surgery and, Westfalian University of Münster, Germany. giovanni.torsello@sfh-muenster.de
Insights
The bell-bottom technique offers a safe and effective endovascular repair for common iliac artery aneurysms. This method demonstrates a low risk of complications, with successful management of endoleaks and occlusions.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aneurysm Repair
Background:
- Common iliac artery (CIA) aneurysms pose a significant risk of rupture and systemic complications.
- Endovascular repair has become a preferred alternative to open surgery for aortic and iliac aneurysms.
- The bell-bottom technique is a specific endovascular approach to manage CIA aneurysms, aiming to improve seal and reduce complications.
Purpose of the Study:
- To evaluate the long-term outcomes of the bell-bottom technique for endovascular repair of common iliac artery aneurysms.
- To assess the safety, efficacy, and complication rates associated with this technique.
- To determine the durability of the repair and the need for secondary interventions.
Main Methods:
- A retrospective analysis of 89 patients with CIA aneurysms treated between 2003 and 2008.
- Patients received aortoiliac stent-grafts with an aortic extension cuff or large iliac limb creating a bell-bottom configuration.
- Mean follow-up was 56.5 months, with outcomes assessed via computed tomography and clinical evaluation.
Main Results:
- Technical success rate was high at 97.8% with no early mortality.
- Cumulative survival was 83.1% at 5 years; 8.9% of patients died from non-aneurysm-related causes.
- Low rates of type I (3.4%) and type II (2.2%) endoleaks were observed, with successful endovascular or open repair. Freedom from secondary intervention was 91.6% at 5 years.
Conclusions:
- The bell-bottom technique is a safe and effective method for treating moderate-sized common iliac artery aneurysms (<30 mm).
- The technique is associated with a low risk of distal type I endoleaks.
- Iliac-related complications can be managed effectively using endovascular approaches, supporting the long-term viability of this repair strategy.
Purpose:
To retrospectively evaluate the long-term outcome of the bell-bottom technique for the endovascular repair of common iliac artery (CIA) aneurysms.
Methods:
Between September 2003 and September 2008, 89 patients (84 men; mean age 73.7+/-8.4 years) with aortic and CIA aneurysms were treated at 2 European centers with aortic extension cuffs or large iliac limbs that gave a bell-bottom configuration to the iliac portion of an aortoiliac stent-graft. The mean maximum aortic diameter was 65.7+/-12.3 mm (range 42-98), and the mean diameter of the treated CIA aneurysms was 22.1+/-3.0 mm (range 20-30).
Results:
Technical success was achieved in 97.8% (87/89). There was no early (<30-day) mortality, but 8 (8.9%) patients died (none aneurysm-related) during follow-up. Cumulative survival by Kaplan-Meier analysis was 96.3% at 1 year, 85.5% at 3 years, and 83.1% at 5 years. After a mean follow-up of 56.5 months, computed tomography documented 3 (3.4%) type I endoleaks: one proximal leak was treated by conversion to open repair, and the other 2 distal type I endoleaks were treated by implantation of an iliac extension. Two (2.2%) type II endoleaks were accompanied by an increase in the aneurysm diameter; one was treated by coil embolization of the inferior mesenteric artery and the other by conversion to open repair after repeated coil embolization. One patient underwent thrombectomy for iliac limb occlusion. The freedom from secondary intervention was 91.6% at 5 years. The mean maximum diameter of the CIA aneurysms showed no significant change over time (24.1+/-3 mm at 30 days and 23.4+/-4 mm at latest follow-up).
Conclusion:
Moderate-size CIA aneurysms (<30 mm) can be safely and effectively treated using the bell-bottom technique. The risk of distal type I endoleak is low. Iliac-related complications can be successfully treated by endovascular techniques.
