Bell-bottom aortoiliac endografts: An alternative that preserves pelvic blood flow

Abstract

Significant CIA ectasia or small aneurysm is often associated with AAA. In such cases, the bell-bottom procedure that preserves IIA circulation is a new alternative to the common practice of placement of endograft extensions across the iliac artery bifurcation in patients with at least one CIA diameter of less than 26 mm. Additional benefits include reduced total procedure time. Early technical success appears to justify continued use. However, long-term evaluation is necessary to determine durability because the risk of rupture as the result of potential expansion of the excluded iliac artery or late failure is unknown.

Open vs endovascular repair of abdominal aortic aneurysm involving the iliac bifurcation

“…Another less invasive method uses large components or aortic cuffs to anchor the device within the CIA ("bell bottom" technique). [39][40][41][42] Despite concerns about longer-term durability, this technique seems reasonable for patients with CIA ectasia Ͻ25 mm in diameter. However, it has limited benefit for patients with larger aneurysms or with hypogastric aneurysms.…”

Common iliac artery aneurysm: Expansion rate and results of open surgical and endovascular repair

“…22 The incidence of buttock claudication and pelvic ischemic complications after bilateral IIA occlusion is very high, 8,40 however, and patients with a contralateral IIA who are treated with EVAR should also undergo ipsilateral IIA revascularization using either endovascular or open surgical techniques, such as retroperitoneal IIA bypass using the common femoral or EIA as inflow. Early results of branched stent graft repairs of IAAs have been published, 13,16,[19][20][21][22][23]34,39,40 and more frequent use of these devices to assure pelvic perfusion can be expected in the future.…”

“…1,[3][4][5][6][7][8][9][10] With the development of endovascular techniques, an increasing number of reports have been published on stent graft repair of CIAAs with good early-and mid-term results. [11][12][13][14][15][16][17][18][19][20][21][22] At some institutions, endovascular repair (EVAR) and not OR is now offered preferentially to patients with IAAs. 23 The purpose of this study was to define expansion rate in a larger number of patients with CIAAs and to evaluate outcomes after OR and EVAR in patients with or without associated AAA in a contemporary series at a tertiary institution.…”

Impact of endograft design and product line on the device cost of endovascular aneurysm repair

“…In cases of ectasia (common iliac diameters Յ20 mm), flared limbs or "bell-bottom" techniques with aortic cuffs were used. 1 During the latter half of the study period, the Excluder flared contralateral limbs became available (October 2003), whereas flared limbs were available on both ipsilateral and contralateral limbs in the Zenith device since its initial commercial introduction. More recently, Medtronic had introduced the AneuRx AAAdvantage line extension that included flared iliac limbs, but the AneuRx implants included in this study all occurred before this.…”