Aortic Remodeling After Extended PETTICOAT Technique in Acute Aortic Dissection Type III B.

Abstract

The aim of this paper was to evaluate a new technique called an "extended" provisional extension to induce complete attachment (e-PETTICOAT) technique. In this prospective single-center clinical study, the primary safety end mid-term remodeling is evaluated for the new endovascular technique. It was based on a standard Petticoat and limited Stabilize technique, extended by the placement of 2 covered stents within the abdominal bare metal stent as parallel iliac stent grafts down to the iliac bifurcations. Computed tomographic angiography was performed postoperatively to assess aortic remodeling after 12 and 24months. Changes in aortic size and volumes of the false and true lumen were assessed. Between January 2014 and December 2015, 17 patients were treated due to acute, complicated aortic dissection type III B, according to the DaBekey classification. All patients presented with branch vessel obstruction/compromise, including six cases with aortic impending rupture. A 100% technical success rate was recorded regarding the resolution of complications. Favorable remodeling was achieved in 100% of the cases. Complete false lumen thrombosis in the thoracic, infra-renal aorta and the iliac artery was noted. A small volume (9.51±6.9mL) contrast-enhanced false lumen in the abdominal aorta was observed in 76% of cases with stable aortic size after 1 and 2years. No visceral branch occlusion, type I endo-leak, renal insufficiency or paraplegia was recorded in follow-up. The expanded PETTICOAT technique was feasible in achieving favorable remodeling in acute extensive aortic dissection. Extended followup is needed to ascertain long-term results. This article presents a series of 17 cases of a new endovascular method called E-PETTICOAT (EJVES 2018 https://doi.org/10.1016/j.ejvs.2018.07.038) used in complicated acute and extensive type IIIB dissections. Favorable remodeling was achieved in 100% cases with stable aorta diameter after 1 and 2years. It was shown that the extended PETTICOAT technique gives good remodeling in acute and extensive aortic dissection. This method can potentially provide a one-step solution and an easier alternative to FEVAR/BEVAR procedures. In order to ensure favorable results, further research is needed on a wider scale with long-term followup.