Full PETTICOAT in acute type B aortic dissection with patent false lumen may offer positive remodeling for the distal aorta

• Published in: General thoracic and cardiovascular surgery Vol. 69; no. 6; pp. 926 - 933
• Main Authors: Hashizume, Kenichi, Honda, Masanori, Mori, Mitsuharu, Yagami, Toshiaki, Takaki, Hidenobu, Matsuoka, Tadashi, Ikebata, Koki, Kanayama, Hiroaki, Ohno, Masatoshi, Shimizu, Hideyuki
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.06.2021; Springer Nature B.V
• Subjects: Abdomen; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - surgery; Aneurysms; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Aortic dissection; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cardiac Surgery; Cardiology; Coronary vessels; Endovascular Procedures; Humans; Ischemia; Medicine; Medicine & Public Health; Original Article; Pulmonary arteries; Retrospective Studies; Stents; Surgery; Surgical Oncology; Thoracic Surgery; Treatment Outcome; Veins & arteries; Aortic remodeling; PETTICOAT; Thoracic endovascular aortic repair; Type B aortic dissection
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-020-01548-3

Objective The provisional extension to induce complete attachment (PETTICOAT) technique is a unique thoracic endovascular aortic repair (TEVAR) for aortic dissection, which consists of proximal descending aortic endografting plus distal bare-metal stenting. This study aimed to investigate the efficacy of the PETTICOAT technique in patients with acute-sub-acute complicated type B aortic dissections. In particular, we compared the remodeling effect of full PETTICOAT covering down to the abdominal aorta with that of simple entry closure. Methods In this retrospective pre-post study, we compared the clinical course of consecutive patients undergoing TEVAR with the PETTICOAT technique in which proximal entry tear was excluded with a covered stent, and extension bare stents were placed down to the abdominal segment for acute-sub-acute complicated type B aortic dissections, between 2015 and 2017, with a control group treated with TEVAR with entry closure between 2011 and 2015. Outcomes included the aortic remodeling rate and the aortic diameter up to 1 year after surgery. Results Subjects consisted of 47 patients (21 in full PETTICOAT group, 26 in the simple entry closure group). The remodeling rate of the abdominal aorta in the full PETTICOAT group was significantly higher than in the simple entry closure group ( p  < 0.05), while that of the thoracic aorta was comparable between the two groups. Conclusions This study suggests that the full PETTICOAT technique achieves better aortic remodeling compared to entry closure alone, and might lead to less reintervention.