Purpose: Most endografts for an endoluminal AAA repair cannot achieve an ad
equate hemostatic seal in ectatic common iliac arteries larger than 14 mm.
The extension of the endograft into the external iliac artery can alleviate
this problem but requires sacrifice of the internal iliac artery. We have
used the larger diameter aortic extension cuff to obtain adequate endograft
to arterial wall apposition in patients with ectatic, nonaneurysmal common
iliac arteries. Because of the resultant flared configuration of the iliac
limb, the technique is termed bell-bottom. However, it is unknown whether
subsequent enlargement of these ectatic common iliac arteries that will lea
d to endoleaks or endograft migration will occur.
Methods: The records of all 96 patients who have undergone endoluminal abdo
minal aortic aneurysm repair at our institution were reviewed. Fourteen pat
ients were identified in whom aortic extension cuffs were placed into 18 ec
tatic (>14 mm, but <20 mm) common iliac arteries. The mean follow-up time w
as 14 months (range, 6-24 months). The maximal diameter of the common iliac
artery on computed tomography scan before endograft placement was compared
with the maximal diameter at the most recent follow-up. The incidence of e
ndoleaks, ruptures, and endograft migration related to the "bell-bottom" te
chnique were recorded.
Results: The mean preoperative common iliac artery diameter was 18 mm (rang
e, 15-20 mm). Aortic extension cuffs of 20-mm diameter and 24-mm diameter w
ere used in 14 and 4 common iliac arteries, respectively. The diameter did
not change in 11 common iliac arteries (61%), increased by 1 mm in 4 common
iliac arteries (22%), and decreased by 1 mm in 3 common iliac arteries (17
%). No endoleaks, ruptures, or endograft migration related to this techniqu
e was identified.
Conclusion: The use of aortic extension cuffs for ectatic common iliac arte
ries expands the number of patients who can be treated endoluminally withou
t sacrifice of the internal iliac artery. Most common iliac arteries do not
increase in diameter. When enlargement occurs, the degree of dilation is m
inimal. Therefore, the "bell-bottom" technique appears to be an acceptable
option in the management of large, nonaneurysmal iliac vessels during endol
uminal abdominal aortic aneurysm repair.