eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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3/2022
vol. 18
 
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abstract:
Original paper

The extended PETTICOAT technique does not guarantee favorable remodeling after acute type B aortic dissection

Maciej Molski
1
,
Marta Jankowska
1
,
Krystian Mross
1
,
Anita Rybicka
2
,
Tomasz Jędrzejczak
3
,
Arkadiusz Kazimierczak
1

  1. Vascular Surgery Department, Pomeranian Medical University, Szczecin, Poland
  2. Department of Nursing, Pomeranian Medical University, Szczecin, Poland
  3. Cardiac Surgery Department, Pomeranian Medical University, Szczecin, Poland
Adv Interv Cardiol 2022; 18, 3 (69): 283–289
DOI: https://doi.org/10.5114/aic.2022.120375
Online publish date: 2022/11/02
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Introduction
Favorable remodeling is not always observed after thoracic endovascular aortic repair (TEVAR) in acute complicated type B aortic dissection (TBAD). Existing distal re-entries might be the cause of that. Many more extensive techniques have been introduced and evaluated. None of them achieve proven benefit in long-term follow-up. Aim: A new technique called extended PETTICOAT (provisional extension to induce complete attachment) or e-PETTICOAT technique was published in 2018. It allows one to cover proximal and distal re-entries and consists of: combined implantation of a thoracic stent graft to seal the proximal entry; self-expandable stents in the visceral aorta to expand the true lumen; plus two parallel kissing iliac stent grafts below the renal arteries. Despite encouraging medium term results, it has unknown long-term consequences.

Material and methods
The prospective observational single center study included 11 patients with complicated acute TBAD qualified for endovascular treatment using the e-PETTICOAT technique. Complicated acute TBAD was identified only in cases of clinical manifestation before or at the time of intervention; radiological findings were not sufficient to identify complications in our study. Method: The 5-year follow-up, based on clinical outcome including survival, re-interventions and angio-CT-assessed remodeling, was examined.

Results
The e-PETTICOAT technique achieves good remodeling in 38% of primary and 88% of secondary procedures.

Conclusions
The E-PETTICOAT does not guarantee favorable remodeling during a 5-year follow-up in acute complicated TBAD. Complex aortic repair after e-PETTICOAT might be needed.

keywords:

TEVAR, extended PETTICOAT, TBAD, remodeling
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