16-17 February 2012 Ente Bilaterale del Terziario di Perugia Perugia, Italy.
BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007
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Transcript of BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007
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