Abstract
BackgroundEndovascular abdominal aortic aneurysm repair (EVAR) is considered the primary option for abdominal aortic aneurysm but the management of concomitant wide or aneurysmal iliac arteries (CIAs) is still controversial.MethodsWe retrospectively evaluated mid-term results of patients receiving standard EVAR combined with bell-bottom technique (BBT) using Medtronic Endurant endograft between January 2009 and December 2018. Patients were followed up by CT scan performed 1 month after the procedure and by duplex ultrasound annually (with or without contrast medium) followed by CT scan in case of evolution.ResultsSeventy-one patients (67 males; mean age of 77,1 years) with abdominal aortic aneurysm and wide or aneurysmal common iliac artery (distal landing zone diameter up to 25 mm and length more than 20 mm) were treated with standard EVAR and BBT (107 limbs) using Endurant stent graft. The median aortic diameter was 56,1 mm (31.0-85.0). Technical success was obtained in 100%. Mean procedural time was of 100.1 min. No 30 days’ mortality, renal failure or limb ischaemia occurred. The median follow-up was of 36.56 months (1–136). 5-year aneurysm related mortality was not found. At 5 years, the number of all-cause deaths was seven. The freedom from secondary intervention was 91.6% at 5 years. Three patients (4.4%) were treated for iliac related complications at 5 years: internal iliac artery aneurysm, iliac obstruction, type 1b endoleak, all successfully treated by endovascular technique.ConclusionsAccording with this study BBT using Endurant stent graft is effective and safe with good mid-term results, with low rate of iliac related complications and no aneurysm related mortality.
Highlights
There are some reports of secondary dilatation of the distal landing zone over time resulting in a type 1b endoleak, especially when the common iliac arteries are wide or aneurysmal
The aim of our study is to retrospectively evaluate short and mid-term efficacy of standard Endovascular abdominal aortic aneurysm repair (EVAR) and bell-bottom technique (BBT) using Endurant Medtronic (Medtronic Cardiovascular, Santa Rosa, CA, USA) stent graft in patients treated in our centre from 2009 to 2018
Patients selection In our study we retrospectively included all patients treated with standard EVAR combined with BBT technique using Endurant stent graft from January 1st, 2009 to December 31th, 2018
Summary
In most patients with suitable anatomy and reasonable life expectancy, endovascular abdominal aortic aneurysm repair (EVAR) is considered the primary treatment option (Wanhainen et al 2019); the management of concomitant wide or aneurysmal iliac arteries (CIAs) is still controversial. (AAA) and concomitant wide or aneurysmal CIA with distal landing zone diameter from 18 up to 25 mm and length more than 20 mm (Torsello et al 2010; Gray et al 2017). This anatomical feature can be suitable for iliac branch device (IBD) that in the last years has become the most popular treatment (Donas et al 2017; Simonte et al 2017). Endovascular abdominal aortic aneurysm repair (EVAR) is considered the primary option for abdominal aortic aneurysm but the management of concomitant wide or aneurysmal iliac arteries (CIAs) is still controversial
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