Parallel Stent Grafts Research Articles

Comparison of branched, fenestrated, and parallel strategies for endovascular treatment of thoracoabdominal aortic pathologies involving visceral regions.

To compare the long-term efficacy of the parallel stent graft (PSG), fenestrated stent graft (FSG), and branched stent graft (BSG) techniques to treat thoracoabdominal aortic pathologies. In total, 291 patients with thoracic aortic aneurysm (TAA) and dissection (TAD) involving visceral arteries who underwent PSG (n = 85; 15 TAA and 70 TAD), FSG (n = 107; 47 TAD and 60 TAA), or BSG (n = 99; 37 TAD and 62 TAA) were included from multiple centers from January 2015 to December 2022, and a total of 1,108 visceral aortic branches were reconstructed. The average reconstruction time of each visceral aortic branch for FSG, BSG, and PSG is 27.5 ± 12.1, 23.2 ± 11.9, and 18.8 ± 11.8 min, respectively (P < 0.01). The free-from-endoleak rate at the last follow-up for FSG, BSG, and PSG was 86.9%, 91.9%, and 60.0%, respectively. The last follow-up patency rate for FSG, BSG, and PSG was 85.0%, 91.9%, and 94.1%, respectively. The average reconstruction price of each visceral aortic branch for FSG, BSG, and PSG was 41.40 ± 3.22 thousand RMB, 41.84 ± 3.86 thousand RMB, and 42.35 ± 4.52 thousand RMB, respectively (P = 0.24). To treat the aortic pathologies involving the visceral segment, BSG had a lower endoleak rate and higher branch patency rate when compared with the FSG and PSG techniques. The expense of BSG was comparable to the other two techniques.

Mid-term outcomes of different treatments of internal iliac artery in endovascular aneurysm repair.

To evaluate the mid-term outcomes of different treatment strategies for the internal iliac artery (IIA) during EVAR. This was a retrospective study. All patients undergoing EVAR, who required treatment of at least one side of IIA from January 2013 to July 2022 in a single center, were included. According to the different treatment strategies for IIA, the patients were divided into UP (unilateral preservation), BP (bilateral preservation) and BE (bilateral embolization) groups. The primary outcomes included buttock claudication, bowel ischemia and iliac-related reintervention. Then patients who underwent IIA reconstruction were divided into IPG (iliac parallel stent graft) and IBG (iliac branch stent graft) groups according to the reconstruction technique. The primary outcomes included endoleak, iliac branch occlusion and iliac-related reintervention. A total of 237 patients were included, including 167 in the UP group, 9 in the BP group and 61 in the BE group. The mean follow-up time was 39.0 ± 27.7, 50.0 ± 22.1 and 25.8 ± 18.9 months in UP, BP and BE groups, respectively. Thirty cases (12.7%) of buttock claudication occurred, and it was significantly higher in the BE group than the UP group (26.2% vs. 7.8%, p < 0.001). There were no significant differences in the other follow-up outcomes among three groups. The K-M analysis indicated that the patients in the BE group had a lower survival rate than those in the other two groups (p = 0.024). 24 patients underwent IIA reconstruction, including 8 in the IPG group and 16 in the IBG group. The endoleak in the IBG group was significantly lower than that in the IPG group (0% vs. 25.0%, p = 0.041). The iliac-related reintervention, iliac occlusion and mortality were similar between the two groups. Overall it is beneficial for patients to preserve at least one side of IIA during EVAR as much as possible. Compared with IPG, IBG might be more applicable for IIA reconstruction.

Endovascular management options and techniques for ruptured thoracoabdominal aortic aneurysm

ObjectiveOpen surgical repair of ruptured thoracoabdominal aortic aneurysms (rTAAAs) carries significant risk of mortality and morbidity; in recent years, endovascular repair has emerged as a suitable alternative. This article aims to review currently available technologies, techniques, and outcomes for endovascular repair of rTAAA. MethodsA narrative review of current literature was performed. ResultsOff-the-shelf branched endografts are available and are often the first-line endovascular therapy for types I, II, and III rTAAA or type IV rTAAA with a lumen diameter ≥24 mm at the level of the renovisceral vessels. In patients with anatomy unsuitable for off-the-shelf branch devices, particularly those with ruptured type IV or pararenal TAAA with a narrow aortic lumen, endovascular repair with in situ laser fenestration is a reasonable alternative. Physician-modified devices as well as endovascular repair with parallel stent grafts (chimney, periscope, sandwich, or Octopus) have been described by select centers with satisfactory outcomes. ConclusionsPatients with rTAAA and suitable anatomy who are at high or prohibitive surgical risk can be managed endovascularly with comparable outcomes. Various techniques are described in the literature, and the choice of technique used should depend on patient anatomy and surgeon expertise.

Endovascular Treatment of a Multi-visceral Aortic Conduit Blowout With Parallel Stent Grafts and Coils.

Multi-visceral transplantation (MVT) is a complex surgical procedure involving the transplantation of multiple abdominal organs as a single unit, typically used as bailout treatment of patients with devastating abdominal pathologies. Due to the complexity of the procedure, major and even life-threatening complications can happen. Vascular complications, including anastomotic breakdowns or pseudoaneurysms due to infections, can be universally lethal. Open surgical repair is often not an option due to the hostile operative field. We report a case of endovascular salvage of multi-visceral aortic conduit blowout utilizing parallel stent grafts and coils without sacrifice of the transplanted viscera. This combination can successfully control bleeding and maintain graft perfusion in this rare but devastating complication.

Hemodynamics of different configurations of the left subclavian artery parallel stent graft for thoracic endovascular aortic repair

Background and objectiveParallel (chimney and periscope) graft technique is an effective approach for left subclavian artery (LSA) reconstruction in patients treated by thoracic endovascular aortic repair (TEVAR) for the inadequate landing zone. However, certain stent graft (SG) configurations may promote thrombosis and reduce distal blood flow, increasing risks of cerebral infarction and reintervention. MethodsIn this paper, we first attempt to systematically evaluate the hemodynamic performances of different parallel graft techniques as potential determinants of complication risks. Based on the patient-specific 3D aortic geometry undergoing parallel graft technique, fifteen models in total for five kinds of LSA branched SG configurations (Forward, Backward, Extended, Elliptical and Periscopic) were designed virtually, and the hemodynamic discrepancies between them were analyzed by computational fluid dynamics. ResultsResults show that flow rate of patients undergoing periscope technique reduces by half compared with chimney technique, suggesting that periscope SG may cause more serious flow obstruction to LSA, leading to stroke. For chimney stent structure, the extension length 0has little influence on energy loss and other parameters. Conversely, hemodynamic differences between the retrograde curvature and the antegrade curvature are significant (time average WSS: 47.07%), so the retrograde curvature might prompt SG displacement. Furthermore, the flatter chimney SG induces more aggressive hemodynamic forces, among which the difference of the maximum WSS between the flatter SG and nearly round SG reaches 65.56%, leading to the greater risk of vascular wall damage. ConclusionsResults obtained might provide suggestions for physicians to formulate appropriate parallel graft technique schemes in TEVAR.

Complete zone 0-10 aortic endovascular reconstruction.

To the best of our knowledge, the present report is the first on the safety and efficacy of complete endovascular aortic reconstruction from zone 0 to 10 using a standardized approach and parallel stent graft configurations in high-risk patients considered unfit for surgery. During a 7-year period, five patients with complex thoracoabdominal aortic aneurysms and dissections involving zone 0-10 presented with rupture (n= 1; 20%), were symptomatic (n= 2; 40%), or had an aortic pseudoaneurysm (n= 2; 40%) and underwent complete endovascular zone 0-10 reconstruction using off-the-shelf stent grafts in parallel configurations that included chimneys, periscopes, and endovascular docking stations. The zone 0-5 complete arch chimney thoracic endovascular repair included chimneys that extended from the ascending thoracic aorta to the innominate, left common carotid, and left subclavian arteries and a thoracic stent graft extending from zone 0 to 5. The zone 5-10 aortic reconstructions were staged. Stage 1 included either thoracic stent graft and antegrade four visceral chimney placement or abdominal aortic stent graft and retrograde four visceral chimney placement. Stage II included completion of the remainder of the aortic reconstruction with cerebrospinal fluid drainage. A total of 15 aortic procedures included 34 chimneys (14 aortic arch and 20 visceral). Two patients (40%) underwent zone 0-5 aortic reconstruction first, and three patients (60%) underwent zone 5-10 aortic reconstruction first. The incidence of 30-day mortality, spinal cord ischemia, myocardial infarction, stroke, and visceral ischemia was 0%. At a mean follow-up of 4.5± 3.1 years, the aortic reconstruction-related mortality was 0%. All-cause mortality was 20%; one patient had died of pneumonia at 3years postoperatively. Two endoleaks each occurred in zone 0-5 and zone 5-10 (40% for both groups). All endoleaks were treated with coil embolization. Complete endovascular zone 0-10 aortic reconstruction using parallel stent grafts with a docking station is a feasible and relatively safe technique that offers the ability to customize off-the-shelf devices for the treatment of high-risk patients with limited morbidity and mortality.

Laboratory "In-vitro" Evaluation of the Parallel Stent Graft Association for the Iliac Sandwich Technique.

The Iliac Sandwich is an off-label technique that uses parallel stent grafts to treat aortoiliac aneurysms. The purpose of this experimental study is to evaluate the conformability and juxtaposition of stent grafts combinations used in this technique through in-vitro mechanical evaluation, computed tomography (CT) analyses, and a controlled pulsatile flow system. The combinations of two Viabahn® ("V-V") or Viabahn® and Excluder® iliac extension ("V-E") were analysed using CT imaging with measurement of the gutter area by two independent analysts before and after balloon angioplasty. In a second phase, the parallel stent combinations were also evaluated using CT imaging after being implanted in the aortic aneurysm model with a pulsatile flow system with controlled temperature, viscosity, and density. The "V-E" group had a better conformability when compared to the "V-V" group, ensuring smaller gutter areas (0.0064cm2 ± 0.01 vs. 0.0228cm2 ± 0.03, p < 0.001). Post dilatation with two non-compliant balloons resulted in enlargement of the gutter area (Area A, p 0.065; Area B, p 0.071). Conversely, post dilatation with a non-compliant balloon for the internal iliac component and a compliant balloon for the external iliac device reduced the gutter area (Area A, p 0.008; Area B, p 0.010). The combination of Viabahn® and Excluder® iliac extension device ("V-E") had a smaller gutter area compared to two Viabahn® parallel stents for the Iliac Sandwich Technique. Post dilatation using a non-compliant balloon for the internal iliac device and a compliant balloon for the external iliac provided superior conformability and juxtaposition.

Female Sex is Associated with Worse Outcomes following Complex Fenestrated or Branched Endovascular Aortic Repair

Sex-related discrepancies after standard endovascular aneurysm repair (EVAR) are noted to disproportionally affect females. A growing body of literature suggests similar disparities may extend to complex fenestrated or branched endovascular aneurysm repair (FBEVAR). However, recent examination of complex FBEVAR by a consortium of high-volume centers noted equivalent mortality among sexes. Whether similar results extend to non-trial data is unknown. We examined all juxta-renal through type IV thoraco-abdominal aneurysms (sealing zones 6-8) which underwent elective FBEVAR within the Vascular Quality Initiative (VQI) database from January 2012 to December 2020. Urgent, symptomatic, ruptured, and staged cases were excluded, as were parallel stent grafts. Demographics, comorbid conditions, and technical factors were compared between sexes. Univariate analysis with Wilcoxon ranked sum tests and Chi-square tests of proportion were performed, followed by multivariate logistic regression for failure of target vessel technical success, reintervention, complications, and in-hospital mortality. Our analysis included 1,521 patients, 1,180 males (77.6%) and 341 females (22.4%). There were noted differences in pre-operative demographics, medical optimization, and technical aspects of the procedure. However, no difference was noted in proximal or distal sealing stents, number of fenestrations, or immediate endoleaks. On a multi variate logistic regression, female sex was an independent predictor of failure of target vessel technical success (odds ratio (OR) 3.339, 95% confidence interval (CI): 2.173-5.132, P < 0.001), reintervention (OR 2.192, 95% CI: 1.304-3.683, P = 0.003), complications (OR 1.747, 95% CI: 1.282-2.381, P < 0.001), and in-hospital mortality (OR 2.836, 95% CI: 1.510-5.328, P = 0.001). Females suffer worse outcomes after FBEVAR despite similar extent of disease, number of fenestrations, and incidence of immediate endoleak. Notable discrepancies were higher rates of chronic obstructive pulmonary disease (COPD) and lower rates of pre-operative aspirin, statin, and beta blocker therapy in females. Controlling for pre-operative demographics, female sex remained an independent predictor of worse outcomes. These discrepancies warrant further examination and should impact case planning for female patients undergoing complex aortic aneurysm repair.

Parallel grafts and physician modified endografts for endovascular repair of the aortic arch.

Aortic arch aneurysms are a challenging clinical problem especially in high-risk patients. Open aortic arch replacement, even in the best of centers, carries significant risk of stroke or death in this high-risk population. Many high-risk patients are deemed inoperable and not offered repair. Branched and fenestrated thoracic endografts are currently undergoing clinical trials in the United States but are not yet commercially available. Many elderly and frail patients have significant brachiocephalic occlusive disease or anatomy excluding them for consideration for such clinical trials. These patients also present with acute aortic syndromes requiring urgent or emergent repair and are unable to participate in clinical trials due to the time required to have such devices available. Alternative endovascular therapies, including parallel stent grafts (including Chimneys, Snorkels and Periscopes) and physician modified thoracic endografts, have been used to treat such high-risk patients combined with commercially available thoracic endovascular aneurysm repair (TEVAR) devices. This paper aims to review the techniques and current reported outcomes from parallel stent grafts and physician modified devices used to treat high risk patients undergoing repair for aortic arch pathologies.

New endovascular techniques for false lumen thrombosis in aortic dissection after thoracic endovascular aortic repair

Over the past decades, both open surgery and endovascular treatment of aortic dissection have made great progress with good clinical outcomes. However, despite this progress, the presence of distal re-entry tears can sustain perfusion of false lumen (FL) and induce aneurysm formation or growth. In particular, about 20% of patients undergoing thoracic endovascular aortic repair (TEVAR) for aortic dissection require reintervention because of incomplete FL thrombosis promoting aortic wall degeneration, post-dissection aortic aneurysm, and rupture. Endovascular techniques to promote FL thrombosis after TEVAR show good early results together with minimal invasiveness, offering different alternatives depending on the case and the level of urgency. Endovascular techniques include FL embolization (with coils, vascular plugs, etc.), candy-plug techniques, parallel stent graft, and branched and fenestrated aortic endoprosthesis. Each of these solutions has advantages and disadvantages. We herein describe the available endovascular options.

Patient-Specific Analysis of Renal Artery Hemodynamics After EVAR with Fenestrated or Branched Versus Parallel Stent-Graft Techniques for Renal Vascularization

Patient-Specific Analysis of Renal Artery Hemodynamics After EVAR with Fenestrated or Branched Versus Parallel Stent-Graft Techniques for Renal Vascularization

Impact of renal chimney intra-aortic stent length on branch and end-stent angle in chimney endovascular aneurysm repair and endovascular aneurysm sealing configurations.

Practice patterns and durability of parallel stent graft techniques in complex endovascular aneurysm repair (EVAR) remain poorly defined. We aimed to quantify and compare the impact of renal chimney intra-aortic stent length (IASL) on geometric deformations of renal arteries in complex EVAR. Thirty-eight nonconsecutive patients underwent EVAR utilizing parallel stent graft techniques (chimney EVAR [chEVAR], n = 28; chimney endovascular aneurysm sealing [chEVAS], n = 10) between 2010 and 2016. A total of 59 renal chimney stent grafts were used. Geometric quantification was derived from three-dimensional model-based centerline extraction. Renal chimney intra-aortic stent length (IASL) was defined as the length of chimney stent that extended from the proximal edge of the chimney stent to the ostium of the corresponding renal artery. Mean IASL for both left and right renal arteries in the cohort was 35.7mm. Renal arteries containing chimney IASL <30mm trended toward a greater branch angle (135.4 vs. 127.8°, p = .06). Left renal arteries showed significantly greater branch angle among those with IASL <40mm (135.5 vs. 121.7°, p = .045). Mean IASL for renal arteries in chEVAR was significantly longer compared to chEVAS (39.2 vs. 26.3mm, p = .003). No difference was noted in overall branch angle or end-stent angle based on procedure type. ChEVAR with IASL <30mm had significantly greater end-stent angle (48.2 vs. 33.5°, p = .03). In contrast, chEVAS patients showed no difference in end-stent angle based on IASL thresholds, but did have significantly greater branch angle among those with IASL <30mm when grouped by both all renal arteries (133.5 vs. 113.5°, p = .004) and right renal arteries (134.3 vs. 111.6°, p = .02). Renal chimney stents with longer IASL appear to exhibit less renal artery deformation, suggesting a more gradual and perpendicular transition of the chimney stent across the renal ostium.

Renovisceral Stents in Complex Aortic Grafts: Assessing Endoleaks, Patency, and Reintervention

Endovascular techniques for complex aortic aneurysm repair include fenestrated endovascular aortic repair, branched aortic grafts, and parallel stent-grafts. These require durable stent-grafts to maintain renovisceral perfusion and limit endoleak and gutter leaks, specifically the occurrence of type Ic endoleaks between stent-graft and distal target vessel attachment and the occurrence of type IIIc endoleaks between renovisceral stent placement and fenestration of the main aortic graft. Others have anecdotally reported an increase in type IIIc endoleaks with VBX stents (W.

Lateral Axillary Exposure for Antegrade Access during Endovascular Repair of Complex Abdominal Aortic and Thoracoabdominal Aneurysms

Retrospective, single-center review between 2006 and 2018. Fifty-three patients were treated with 260 parallel renovisceral stents or stent grafts to treat pararenal and thoracoabdominal aortic aneurysms using a lateral axillary artery exposure. The axillary artery was exposed using a vertical skin incision in the axilla with retraction of the lateral border of the pectoralis major distal to the pectoralis minor to expose the axillary artery and then directly accessed with multiple sheaths (5F-12F). There were two local complications (hematoma managed conservatively and brachial vein thrombosis managed with anticoagulation). Left axillary exposure is a valid approach for upper extremity access during endovascular repair of complex aortic aneurysms requiring simultaneous delivery of multiple renovisceral devices.

Endovascular Outcomes in Aortic Arch Repair with Double and Triple Parallel Stent Grafts

PurposeTo report early and midterm outcomes of treating thoracic aortic aneurysm (TAA) and aortic dissection (AD) involving zone 1 and zone 0 with multiple parallel stent grafts (PSGs). Materials and MethodsFrom February 2011 to August 2018, 31 of 1,806 patients (1.7%) who underwent thoracic endovascular aortic repair (TEVAR) with double PSGs (DPSGs) (n = 20) or triple PSGs (TPSGs) (n = 11) were retrospectively reviewed. Procedures were performed in high-risk patients who had TAA or AD involving zone 1 or zone 0. ResultsFifteen patients (48.4%) who presented with symptomatic or impending rupture underwent urgent or emergent TEVAR with DPSGs or TPSGs. Nineteen patients (61.3%) were treated for zone 0 disease. Technical and clinical success rates were 70.0% for DPSG cohort and 45.5% for TPSG cohort. Intraoperative type Ia endoleak was observed in 30% of DPSG cohort and 45.5% of TPSG cohort. One patient in the DPSG cohort died of aortic sinus rupture intraoperatively. Minor stroke during the 30-day postoperative period was more frequent in the TPSG cohort (P = .042). Mean duration of follow-up was 28.9 months ± 17.7. The TPSG cohort had a higher incidence of major adverse events (72.7% vs 25.0%, P = .021). The most common adverse events were endoleaks (12.9%), endograft migration (9.7%), PSG stenosis or occlusion (6.5%), retrograde dissection (6.5%), and stroke (3.2%). Endograft migrations were more common in TPSG cohort (27.3%, P = .037). Overall mortality rate was 16.1% (5/31) perioperatively and during follow-up. There were no statistical differences in overall survival and reintervention-free survival. ConclusionsIn the context of TEVAR with multiple PSGs for aortic arch repair, TPSGs may have a high risk of major complications.

Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries

Endovascular aortic aneurysm repair of complex aortic aneurysms requires incorporation of side branches using specially designed aortic stent grafts with fenestrations, directional branches, or parallel stent grafts. These techniques have been increasingly used and reported in the literature. The purpose of this document is to clarify and to update terminology, classification systems, measurement techniques, and end point definitions that are recommended for reports dealing with endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms involving the renal and mesenteric arteries.

Treatment Results of Endovascular Aneurysm Repair Using the Parallel Stent Graft Double D Technique for Distal Aortic and Common Iliac Aneurysms

Endovascular aneurysm repair (EVAR) using a bifurcated stent graft may involve technical challenges when asymmetric distal abdominal aortic aneurysms (AAAs) and iliac artery aneurysms (IAAs) are encountered, especially with inferior renal artery aortic bifurcation <70 mm or narrow aortic bifurcation. We use EVAR with the double D technique (DDT-EVAR) for such cases. This involves a stent graft limb with the same diameter as the left and right diameters that is deployed parallel to an aortic cuff that has been previously placed (Fig).

Patients Turned Down for Non-Emergency Abdominal Aortic Aneurysm (AAA) Surgery: Are We Doing The Right Thing? Factors that Influence Decision Making and the Long-term outcome – A Single Centre Experience

Introduction - Decision to intervene once an AAA has reached the threshold size for repair relies on a careful balancing of risks and benefits. Advances in endovascular treatment have made it possible to intervene in patients that were previously considered unfit for open surgery. Despite this, there will always be patients in whom the survival benefit will not prevail the risks of AAA repair. Our study aims to determine the outcome of AAA patients turned down for non-emergency open and endovascular (including fenestrated or parallel stent graft) treatment as well as the factors involved in the decision-making process. Methods - All patients deemed unfit for open/endovascular AAA repair following multidisciplinary team (MDT) discussion at a tertiary referral hospital from 1st of January to 31st of December 2015 were included. Data was retrospectively analysed from the MDT database and the follow-up period extended until the 1st of June 2017. Reasons for not intervening were recorded using both MDT discussion outcomes and pre-operative assessments. AAAs were stratified according to size at the time of MDT discussion. Cause of death was accepted as “ruptured AAA’’ in those proven on CT scan. Survival was calculated from the date of the MDT discussion and the end point was either death or the close of the study. Results - 118 patients met the study inclusion criteria. 89 (75%) were men and the median age was 77 years. Median survival was 29 months. 77 (65%) patients were dead at the end of the study. Median survival according to AAA sizes were: 36 months (5.5-5.9 cm), 26 months (6.0-6.9 cm). 23 months (7.0-7.9 cm), 8 months (≥ 8.0 cm) (p<0.05, Log Rank test). 16 (14%) patients died of rupture - one patient had open surgery and another one underwent endovascular treatment but unfortunately both died. Cardiopulmonary exercise test (CPEX) was performed in 52% of cases and considered inappropriate in frail patients. Mortality rates were comparable in patients who had (65%) and had not (64%) undergone CPEX (p = 0.94, Chi square test) with a median survival 32 vs 28 months respectively (p = 0.001, Mann-Whitney U test). Median survival was similar for anaerobic threshold: 5-7.9 (32 months) and 8-11(31 months) (p = 0.42 Mann-Whitney U test). The reasons for not intervening included: patient choice (19%), cardiovascular, (67%) respiratory (48%), dementia (14%), malignancy (19%), renal failure (36%), poor CPEX (15%), frailty/not suitable for endovascular intervention (66%). Conclusion - It is reasonable to turn down patients based on their fitness, since they appeared to have a correlated poor life expectancy. 86% of patients turned down for non-emergency AAA repair died of unrelated illness within 2.5 years. 14% of patients during the study period had a documented AAA rupture. None of the patients who underwent emergency repair survived.

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

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.

Expanded Petticoat technique to promote the reduction of contrasted false lumen volume in patients with chronic type B aortic dissection

ObjectiveThis study examined the outcomes of our novel concept of expanded provisional extension to induce complete attachment strategy (Petticoat) for safety, durability, and remodeling of chronic type B dissections. MethodsTwenty patients with chronic type B aortic dissection with aneurysmal degeneration qualified for an expanded Petticoat strategy (stent graft in the thoracic, plus additional distal bare stent into the abdominal and infrarenal aorta, followed by parallel stent grafts into common iliac arteries). Computed tomography was performed preoperatively and at 1, 6, and 12 months after surgery. ResultsThe primary technical success was 100%. The 30-day mortality rate was 0%. At 12 months, favorable aortic remodeling and complete false lumen (FL) thrombosis were noted as 100% in the thoracic and infrarenal aorta. The volume of contrast-enhanced FL decreased from 186 ± 75.4 mL all along the dissection preoperatively (range, 70-360 mL), to 6.32 ± 5.4 mL postoperatively (range, 0.0-19.6 mL) and was only observed in the visceral aorta (P = .000089). Despite persistent flow in a small area of the FL, the maximal aortic size was stable in follow-up. Neither paraplegia nor visceral branch occlusion were noted in the follow-up. ConclusionsThe treatment of aortic dissections with an expanded Petticoat strategy seems to be safe and offers good early results. It significantly reduced the volume of contrast enhanced FL. Further investigation of any subsequent results will be necessary.