Dilatation of common iliac arteries after endovascular infrarenal abdominal aortic repair with bell-bottom extension

Telles, Gustavo José Politzer; Filho, Alvaro Razuk; Karakhanian, Walter Khegan; Saad, Paulo Fernandes; Saad, Karen Ruggeri; Park, Jong‐Hun; Siqueira, Leticia Cristina Dalledone; Caffaro, Roberto Augusto

doi:10.5935/1678-9741.20160032

Cited by 3 publications

(4 citation statements)

References 22 publications

(31 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the first two years after EVAR, younger patients showed significantly more dilatation of the vessel within the first two years compared to older patients. Similar results were shown in a study by Telles et al [ 15 ]. Our study suggests that next to oversizing, age also plays a possible role in changes in the iliac anatomy.…”

Section: Discussionsupporting

confidence: 93%

Age and Oversizing Influence Iliac Dilatation after EVAR

Gray

Samaan

Oikonomou

et al. 2022

JCM

View full text Add to dashboard Cite

In the past two decades, endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) has become the first line treatment for infrarenal AAA repair in many countries. While short-term results are good, concerns have been raised about long-term durability. Changes in aortoiliac anatomy, especially at the landing zones, could play a role in EVAR failure over time. The current study aimed to determine certain morphological changes in the distal iliac landing zone after EVAR implantation, as well aspossible risk factors associated with iliac sealing failure. In a retrospective analysis of a tertiary single-centre registry, including patients treated with EVAR between January 2008 and July 2018, clinical follow-up data were assessed, and computer tomography (CT) imaging was evaluated regarding morphological changes in the iliac anatomy during follow-up. For clinical analysis all patients with a minimum follow-up of one year were included; for morphological analysis of iliac anatomy all patients with available CT follow-up of a minimum of one year and a minimum of two CT scans were included. Overall, 127 out of 241 treated patients (92.1% male) were included in the clinical follow-up. Complete CT imaging of 99 iliac arteries in 55 patients was available for morphological analysis. Median postoperative follow-up (FU) for these patients was 33 months (IQR 31; min–max: 12–124). Incidence of type 1b endoleak was 3% but iliac limb detachment from the vessel wall was seen in 18.2% of the target vessels. There was a significant difference in oversizing in iliac limbs with detachment (median 13.9%, IQR 23.1) vs. without detachment (median 23.1%, IQR 19.1) (p = 0.034). Iliac arteries at the landing zone showed a significant diameter increase independent of an endoleak presence (overall cohort median diameter increase at one year 23.1 mm; at two years 0 mm; at three years 4.9 mm). Iliac arteries with detachment (median 14.4%; IQR 23.9) showed a significantly higher diameter increase at the landing zone after four years compared to arteries without detachment (median 5.3%; IQR 9) (p = 0.042). Oversizing correlated positively with an iliac diameter increase at the landing zone over time (3 m: p= 0.001; one year: p < 0.001; two years: p < 0.001; three years: p = 0.006). Older patients showed a significantly lower diameter increase at the distal landing zone over time than younger patients in the first two years after EVAR (p < 0.001/r = −0.606 after two years). In the current study, iliac limb oversizing was associated with increased dilatation of the distal landing zone during a three-year follow-up, while iliac limb detachment was observed less often. An older age was inversely associated to the iliac diameter increase. Future studies should clarify the association between stent graft oversizing, age, and changes in the iliac anatomy in order to identify parameters that affect EVAR durability.

show abstract

Section: Discussionsupporting

confidence: 93%

Age and Oversizing Influence Iliac Dilatation after EVAR

Gray

Samaan

Oikonomou

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…Progressive dilatation of ectatic iliac arteries has been described by several authors and is also associated with the displacement of the iliac grafts. 14,15 Griffin et al. reported that the rate of CIA diameter increase is significantly higher in patients with BBT than the control group.…”

Section: Discussionmentioning

confidence: 99%

“…Telles et al. 15 described a series of patients with CIAs larger than 15 mm with the incidence of type IB endoleak of 17.6% and reoperation rate of 15.7%. Studies with longer follow-up periods demonstrate higher type IB endoleak rates in consonance with our finding of higher type IB endoleak rate in late follow-up.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

“…The other studies which include the bell-bottom technique report a higher rate of type Ib endoleak and reintervention, 18,19 suggesting that a longer follow-up period (usually after 3 years) is needed to observe the degeneration of an aneurysm at the distal stent graft location. Agu et al 20 reported a 2.4% incidence of developing iliac artery aneurysm in a 5 to 9 years of follow-up in 297 patients treated with EVAR with suitable distal landing zones, and they suggest Fig.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Aorta-Iliac Aneurysms with a Flared Iliac Limb

Duvnjak

Balezantis

2019

Int J Angiol

View full text Add to dashboard Cite

Endovascular abdominal aneurysm repair (EVAR) relies on the quality of the proximal and distal landing zone. Reinterventions are higher in patients with suboptimal landing zone. The study aimed to evaluate reintervention rate after endovascular treatment of an aorta-iliac aneurysm using the flared iliac limbs.The retrospective study included 179 patients treated with EVAR at a single university hospital institution from January 2011 to January 2014 of which 75 patients (42%) were treated with flared iliac limb stent graft and 104 patients (58%) were treated with a nonflared iliac limb stent graft. There were 165 male patients (92%), mean age was 75.8 ± 6.6 years.Thirty-six patients underwent secondary treatment accounting for overall reintervention rate of 20%. Endoleak type 1b occurred in 13 patients (7%), followed by endoleak type 1a in six patients (3%). Endoleak type 2 occurred in seven patients (4%) requiring the treatment due to abdominal aortic aneurysm (AAA) enlargement, endoleak type 3 in three patients (2%), and leg stent graft thrombosis in seven patients (4%). In 143 patients (80%), there were no secondary interventions during the follow-up period. Reintervention due to endoleak type 1b was statistically significantly higher in a flared iliac limb group (p < 0.02) with the rate of 7.2% compared with 1.9% rate in nonflared iliac limb group. The mean follow-up was 44.3 ± 20.4. Overall mortality was 33%.Flared iliac limb with a distal diameter of ≥ 20 mm, show a higher rate of iliac limb reintervention in a follow-up period due to endoleak type 1b.

show abstract

Dilatation of common iliac arteries after endovascular infrarenal abdominal aortic repair with bell-bottom extension

Cited by 3 publications

References 22 publications

Age and Oversizing Influence Iliac Dilatation after EVAR

Age and Oversizing Influence Iliac Dilatation after EVAR

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

Endovascular Treatment of Aorta-Iliac Aneurysms with a Flared Iliac Limb

Contact Info

Product

Resources

About