BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007
-
Upload
salvatore-ronsivalle -
Category
Healthcare
-
view
130 -
download
0
Transcript of BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007
![Page 1: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/1.jpg)
MODULAR EXTENSION INTOEXTERNAL ILIAC ARTERY
+ HYPOGASTRIC ARTERY
EMBOLIZATION
PERUGIA 2001: BELL BOTTOM TECNIQUE OFFICIAL PRESENTATION
![Page 2: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/2.jpg)
MODULAR EXTENSION INTOEXTERNAL ILIAC ARTERY
+ HYPOGASTRIC ARTERY
EMBOLIZATION
PHOENIX 2003: INTERNATIONAL CONGRESS XVI ENDOVASCULAR INTERVENTION
![Page 3: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/3.jpg)
MODULAR EXTENSION INTOEXTERNAL ILIAC ARTERY
+ HYPOGASTRIC ARTERY
EMBOLIZATION
PHOENIX 2007: INTERNATIONAL CONGRESS XX ENDOVASCULAR INTERVENTION
![Page 4: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/4.jpg)
XX International Congress Endovascular Interventions
THE BELL-BOTTOM TECNIQUE IN AAAS WITH ECTASIA OF THE ILIAC ARTERIES
long term result
Department of Cardiovascular DiseaseDepartment of Cardiovascular Disease Cittadella – Camposampiero ItalyCittadella – Camposampiero Italy
Director Dr. S. RonsivalleDirector Dr. S. Ronsivalle
Phoenix february 11-15, 2007
![Page 5: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/5.jpg)
INCLUSION CRITERIA FOR ENDOVASCULAR INCLUSION CRITERIA FOR ENDOVASCULAR TREATMENT OF AORTO-ILIAC ANEURYSMSTREATMENT OF AORTO-ILIAC ANEURYSMS
proximal neck: diameter 26-28 mm
length 10 mm
common iliac artery: diam. 15 mm
Indication for endovascular repair 50%
![Page 6: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/6.jpg)
ENDOVASCULAR TREATMENT OF ENDOVASCULAR TREATMENT OF ECTATIC COMMON ILIAC ARTERIES ECTATIC COMMON ILIAC ARTERIES
MODULAR EXTENSION INTOEXTERNAL ILIAC ARTERY
+ HYPOGASTRIC ARTERY
EMBOLIZATION
![Page 7: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/7.jpg)
ENDOVASCULAR TREATMENT OF ENDOVASCULAR TREATMENT OF ECTATIC COMMON ILIAC ARTERIES ECTATIC COMMON ILIAC ARTERIES
BELL – BOTTOM TECHNIQUE:
Bell-shaped modular extension
into common iliac artery
![Page 8: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/8.jpg)
BELL – BOTTOM TECHNIQUEBELL – BOTTOM TECHNIQUEaortic cuffaortic cuff
![Page 9: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/9.jpg)
BELL- BOTTOM TECHNIQUEBELL- BOTTOM TECHNIQUE“custom made” cuff“custom made” cuff
![Page 10: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/10.jpg)
PRE POST
BELL – BOTTOMBELL – BOTTOMaorticaortic cuff
![Page 11: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/11.jpg)
PRE
POST
BELL – BOTTOMBELL – BOTTOMTalent “custom made”
![Page 12: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/12.jpg)
BELL – BOTTOMTalent “custom made”
PRE POST
![Page 13: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/13.jpg)
site Talent AneuRx Gore total
Abdominal 232 75 9 316
Thoracic 42 _ 2 44
total 360
STUDY POPULATIONoctober 1999 - december 2006
![Page 14: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/14.jpg)
BELL-BOTTOM TECHNIQUEBELL-BOTTOM TECHNIQUE
BIFURCATED MODULAR EXTENSION
Talent 61 74
AneuRx 17 18
Excluder 1 1
total 79 93
![Page 15: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/15.jpg)
BELL-BOTTOM : WHY?BELL-BOTTOM : WHY?
hypogastric embolization may cause colonic ischemia,erectile dysfunction and buttuck claudication
hypogastric embolization is not feasible technically in all cases
extension into the external iliac artery may predispose to graft limb thrombosis
![Page 16: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/16.jpg)
Ischemic complications after hypogastric Ischemic complications after hypogastric artery coil embolization monolateral in artery coil embolization monolateral in
published datapublished data
34%
66%
total IIA occlusion cases
ischemic cases (% of total)
J Vasc Surg 2002; 35:874-81
3%10% 6%
81%
buttock claudication
sexual dysfuncition
colonic ischemia
other
![Page 17: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/17.jpg)
Ischemic complications after hypogastric Ischemic complications after hypogastric artery coil embolization bilateral in artery coil embolization bilateral in
published datapublished data
13% 9%
87%
buttock claudication
sexual dysfunction
colonic ischemia
J Vasc Surg 2002; 35:874-81
43%
57%
total bilateral IIA occlusion cases
ischemic cases (% of total)
![Page 18: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/18.jpg)
7 YEARS FOLLOW-UP 7 YEARS FOLLOW-UP Mean follow-up: 43.5 ± 22.0 months
Physical exam
Abdomen X-ray ( at discharge and 1 year )
CT- scan ( at 6 months )
Color Duplex Ultrasonography ( at discharge,
1, 3, 6, 12, and every six months thereafter )
![Page 19: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/19.jpg)
BELL-BOTTOM TECHNIQUE BELL-BOTTOM TECHNIQUE 7 YEARS FOLLOW-UP 7 YEARS FOLLOW-UP
Mean follow-up: 43.5 ± 22.0 months
92%
1%7%
decreased
unchanced
increased
Complications: one patient with type 1 distal endoleak
![Page 20: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/20.jpg)
CONCLUSIONSCONCLUSIONS Bell-Bottom technique Bell-Bottom technique
is a valuable adjunct in patients with ectatic common iliac arteries
increases the elegibility to endovascular treatment
artery embolization and endograft extension into the decreases the complications due to hypogastric external iliac artery
![Page 21: BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007](https://reader030.fdocuments.net/reader030/viewer/2022032619/55c47327bb61eb926e8b45df/html5/thumbnails/21.jpg)