AAA 2. Long-term Survival After Endovascular Treatment of Aortoiliac Aneurysms With the Bell-Bottom Technique

We evaluated a cohort of patients submitted to the treatment of abdominal aortic aneurysms with bell-bottom technique (BBT) and standard endovascular aneurysm repair (EVAR). The objective of this study was to compare the survival rates and the incidence of type IB endoleak. This retrospective cohort study compared the outcomes of standard EVAR and BBT in a tertiary vascular center between 2010 and 2015. The inclusion criteria were treatment of abdominal aortic aneurysm or aortoiliac aneurysm with a bifurcated or monoiliac stent graft with available imaging after the implantation. The bell-bottom device was implanted in 84 patients, and standard EVAR was performed in 119 patients. The follow-up protocol included a computed tomography scan within 30 days of implantation and at 12 months. Duplex ultrasound was performed yearly thereafter, and only patients with a suspected endoleak received a computed tomography scan. Long-term results were reported by the Kaplan-Meier method. During the study period, 203 patients were submitted to the endovascular treatment of abdominal aortic and aortoiliac aneurysms. Twenty patients were female and 183 were male; the mean age was 72.56 years (46-99 years). Technical success was 98.5%. Bell-bottom iliac limbs were implanted in 84 patients, and regular iliac limbs were implanted in 119 patients. The 30-day morbidity rate was 0.9%, and mortality was 1.9%. One patient with a regular limb (0.85%) developed type IB endoleak, and four patients with bell-bottom limbs (4.6%) developed type IB endoleak. The mean follow-up period was 34.2 ± 29.9 months. The freedom from type IB endoleak in 80 months was 71.4% in the BBT group and 97.7% in the standard EVAR group (P = .05). By life-table analysis, the BBT group had lower 60-month (74.3% vs 84.1%) and 80-month (49.5% and 84.1%) survival (P = .04; Fig). Patients with aortoiliac aneurysms have a lower life expectancy compared with patients with isolated aortic aneurysms. The BBT is associated with a significantly higher risk of type IB endoleak development in the long term. Lifetime surveillance is necessary for the early detection and treatment of late related complications.