The document presents an overview of the bell-bottom technique for modular extension into the external iliac artery and hypogastric artery embolization, discussed at multiple international congresses between 2001 and 2007. It outlines the inclusion criteria for endovascular treatment of aorto-iliac aneurysms, and details the complications associated with hypogastric embolization, highlighting the technique's value in improving treatment eligibility and reducing complications. The findings from a seven-year follow-up indicate that the bell-bottom technique is beneficial for patients with ectatic common iliac arteries.

1. MODULAR EXTENSION INTO
EXTERNAL ILIAC ARTERY
+
HYPOGASTRIC ARTERY
EMBOLIZATION
PERUGIA 2001: BELL BOTTOM TECNIQUE OFFICIAL PRESENTATION

2. MODULAR EXTENSION INTO
EXTERNAL ILIAC ARTERY
+
HYPOGASTRIC ARTERY
EMBOLIZATION
PHOENIX 2003: INTERNATIONAL CONGRESS
XVI ENDOVASCULAR INTERVENTION

3. MODULAR EXTENSION INTO
EXTERNAL ILIAC ARTERY
+
HYPOGASTRIC ARTERY
EMBOLIZATION
PHOENIX 2007: INTERNATIONAL CONGRESS XX ENDOVASCULAR
INTERVENTION

4. 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

5. INCLUSION CRITERIA FOR ENDOVASCULARINCLUSION 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%

6. ENDOVASCULAR TREATMENT OFENDOVASCULAR TREATMENT OF
ECTATIC COMMON ILIAC ARTERIESECTATIC COMMON ILIAC ARTERIES
MODULAR EXTENSION INTO
EXTERNAL ILIAC ARTERY
+
HYPOGASTRIC ARTERY
EMBOLIZATION

7. ENDOVASCULAR TREATMENT OFENDOVASCULAR TREATMENT OF
ECTATIC COMMON ILIAC ARTERIESECTATIC COMMON ILIAC ARTERIES
BELL – BOTTOM TECHNIQUE:
Bell-shaped modular extension
into common iliac artery

8. BELL – BOTTOM TECHNIQUEBELL – BOTTOM TECHNIQUE
aortic cuffaortic cuff

9. BELL- BOTTOM TECHNIQUEBELL- BOTTOM TECHNIQUE
“custom made” cuff“custom made” cuff

10. PRE POST
BELL – BOTTOMBELL – BOTTOM
aorticaortic cuff

11. PRE
POST
BELL – BOTTOMBELL – BOTTOM
Talent “custom made”

12. BELL – BOTTOM
Talent “custom made”
PRE POST

13. site Talent AneuRx Gore total
Abdominal 232 75 9 316
Thoracic 42 _ 2 44
total 360
STUDY POPULATION
october 1999 - december 2006

14. BELL-BOTTOM TECHNIQUEBELL-BOTTOM TECHNIQUE
BIFURCATED MODULAR EXTENSION
Talent 61 74
AneuRx 17 18
Excluder 1 1
total 79 93

15. 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

16. Ischemic complications after hypogastricIschemic complications after hypogastric
artery coil embolization monolateral inartery 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

17. Ischemic complications after hypogastricIschemic complications after hypogastric
artery coil embolization bilateral inartery 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 IIAocclusion cases
ischemic cases (% of total)

18. 7 YEARS FOLLOW-UP7 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 )

19. BELL-BOTTOM TECHNIQUEBELL-BOTTOM TECHNIQUE
7 YEARS FOLLOW-UP7 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

20. CONCLUSIONSCONCLUSIONS
Bell-Bottom techniqueBell-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