Use of Aortic Extension Cuffs for Preserving Hypogastric Blood Flow in Endovascular Aneurysm Repair With Aneurysmal Involvement of Common Iliac Arteries

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• 作者：Francisco Alvarez Marcos¹ ; ^{alvarezmarcos@seacv.es} ; Aurelio Garcia de la Torre¹ ; Manuel Alonso Perez¹ ; Jose-Manuel Llaneza Coto¹ ; Lino-Antonio Camblor Santervas¹ ; Ahmad-Amer Zanabili Al Sibbai¹ ; Jose-Manuel Garcia-Cosio Mir² ; Florentino Vega Garcia² ; Jose-Eduardo Rodriguez Menendez²
• 刊名：Annals of Vascular Surgery
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：27
• 期：2
• 页码：139-145
• 全文大小：542 K

文摘

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Background

Intentional hypogastric artery covering during endovascular repair of abdominal aortic aneurysms (EVAR) can carry a non-negligible rate of complications; to preserve pelvic blood flow, several approaches are in use, such as sandwich techniques, branched iliac devices, or the use of aortic extender cuffs in a bell-bottom configuration. We assess the performance of the latter for treatment of common iliac artery aneurysms during EVAR.

Methods

Prospective gathering of data in 21 dilated common iliac arteries (18-25 mm) with coexisting abdominal aorta aneurysm, which were treated from 2005 to 2010 and received a GORE^? Excluder endograft and one (n = 14) or several aortic extenders in a bell-bottom configuration. Control group consisted of 136 EVARs performed with the same device in the same time frame. Median follow-up was of 47 months, with contrast-enhanced computed tomography assessment 1 month after the procedure and yearly thereafter.

Results

Age and comorbidities were homogeneously distributed among groups, although the aortic aneurysm diameter was lower in the bell-bottom group (50 mm vs. 58.2 mm, P < 0.001). There was no 30-day mortality registered in this group, and only one patient died during follow-up (5.3 % ), without relation with the aneurysmal disease. No significant differences were found in reintervention (15.8 % vs. 14.7 % , P = 0.707) or endoleak rates (36.8 % vs. 38.9 % , Fisher P = 1). There were no type I and four type II endoleaks, two of which precised treatment for sac growth. Endoleak-free survival (P = 0.994) and reintervention-free survival (P = 0.563) did not show differences either.

Conclusion

Bell-bottom technique is a feasible and safe alternative for preserving hypogastric blood flow, and does not imply a higher risk of reintervention or endoleak at 3-year follow-up.