title: Use of aortic extension cuffs for preserving hypogastric blood flow in endovascular aneurysm repair with aneurysmal involvement of common iliac arteries.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Angiology and Vascular Surgery, Asturias University Central Hospital, Oviedo, Spain. alvarezmarcos@seacv.es
authors: Francisco
authors: F
authors: Alvarez Marcos
authors: Aurelio
authors: A
authors: Garcia de la Torre
authors: Manuel
authors: M
authors: Alonso Perez
authors: Jose-Manuel
authors: JM
authors: Llaneza Coto
authors: Lino-Antonio
authors: LA
authors: Camblor Santervas
authors: Ahmad-Amer
authors: AA
authors: Zanabili Al Sibbai
authors: Jose-Manuel
authors: JM
authors: Garcia-Cosio Mir
authors: Florentino
authors: F
authors: Vega Garcia
authors: Jose-Eduardo
authors: JE
authors: Rodriguez Menendez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016022:Case-Control Studies; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000098:blood supply*; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D011474:Prosthesis Design; D011877:Radionuclide Imaging; D012039:Regional Blood Flow; D012086:Reoperation; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome