Outcomes of bell-bottom technique compared to standard endovascular aneurysm repair.

OBJECTIVE: The bell-bottom technique is a widely used technique to treat aortoiliac aneurysms with preservation of the hypogastric arteries. The published data are scarce with conflicting results regarding the evolution. The aim of this study was to compare the outcomes of patients submitted to endovascular abdominal aortic aneurysm repair with standard technique (S-EVAR) versus bell-bottom technique. METHODS: This retrospective cohort study compared the outcomes of standard endovascular aneurysm repair (<16 mm iliac limbs) and bell-bottom technique (≥16 mm iliac limbs) in a tertiary vascular center between 2010 and 2015. The end points of this study were type IB endoleak, reintervention and 30-day mortality. The follow-up protocol included CT scans within 30 days of implantation and 12 months. Duplex ultrasound was performed yearly thereafter. RESULTS: Two hundred and three patients were treated with bell-bottom technique (n = 84, mean age 72.2 ± 8.9) and S-EVAR (n = 119, mean age 72.7 ± 8.4). The overall 30-day mortality was 1.9%, with no significant difference between groups. There was higher prevalence of coronary heart disease in the bell-bottom technique group compared to the S-EVAR group (41.6% vs. 18.4%, p < 0.01). One patient in the S-EVAR group (0.85%) and four patients in the bell-bottom technique (4.6%) developed type IB endoleak. The mean follow-up period was 35.2 ± 30.4 months. By Kaplan-Meier analysis, freedom from type IB endoleak in 80 months was 85.2% in the bell-bottom technique group and 98.7% in the S-EVAR group (p = 0.05). The freedom from reintervention in 80 months was 74.0% in the bell-bottom technique group and 94.1% in the S-EVAR group (p = 0.6). CONCLUSIONS: This study shows lower freedom from type IB endoleak in the bell-bottom group compared to the standard repair group. There is no significant difference in reoperation rate and 30-day mortality.

Reperfusão reversa na cintigrafia miocárdica de perfusäo com tecnécio-99m isonitrila: incidência e implicaçäes clínicas / Reverse reperfusion in myocardial scintigraphy perfusion with technetium-99m isonitrile: incidence and clinical implications

PURPOSE--Evaluation of the incidence and clinical implications of perfusion defects that appear worse in the rest than the stress myocardial perfusion imaging with technetium-99m isonitrile (MIBI), similar to the reverse redistribution described with thallium-201. METHODS--The studies of 730 consecutive patients with known or suspected coronary artery disease who underwent either diagnostic or prognostic (after myocardial infarction) technetium-99mMIBI planar scans were reviewed. Usual planar images were subjective and semi-quantitative analyzed. Patients were divided in two groups according to the indication of the test. The incidence of the reverse reperfusion pattern, the correlative findings with the angiographic coronary anatomy, when available, and its clinical implications were assessed. RESULTS--Three in the 540 (0.55 per cent ) patients of the diagnostic group and 6 out of the 190 (3.15 per cent ) patients of the myocardial infarction group have shown the reverse reperfusion pattern, with an overall incidence of 1.23 per cent . Perfusion defects were anterior in 2 and inferior in 1 patient of the diagnostic group, compared to 4 anterior and 2 inferior within the prognostic population patients. One patient of the diagnostic group and 4 of the prognostic group showed ST-T changes on the exercise ECG. All of them achieved at least 85 per cent of the maximum predicted heart rate during the stress test. The only patient with the reverse reperfusion pattern in the diagnostic group had no coronary disease at angiography, while the 6 patients in the post myocardial infarction group have shown either an occluded (2 cases) or recanalized infarct related artery (2 cases) and remote coronary disease (2 cases). Three of them underwent successful coronary angioplasty based on clinical and laboratory evidences of ischemia. CONCLUSION--The reverse reperfusion with technetium 99-m MIBI is an uncommon finding and may be associated with jeopardized myocardium after infarction, although its predictive value for recanalized infarct related artery seems to be very low. It seems to provide no added value towards coronary artery disease diagnosis. Additional experience is required in selected subgroups of patients in order to clarify the clinical value of the reverse reperfusion pattern with the technetium-99m MIBI