Distal Extended Endovascular Aortic Repair PETTICOAT: A Modified Technique to Improve False Lumen Remodeling in Acute Type B Aortic Dissection

Autor: Stefano A. Ferrari, Enrico Leo, Alessandro L.C. Molinari, Marco Ferraresi, Simona Sommaruga, Gian Paolo Rossi, Angelo Terzi
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Time Factors
Computed Tomography Angiography
medicine.medical_treatment
Lumen (anatomy)
030204 cardiovascular system & hematology
Vascular Remodeling
Endovascular aneurysm repair
Aortography
Risk Assessment
030218 nuclear medicine & medical imaging
03 medical and health sciences
Aortic aneurysm
Blood Vessel Prosthesis Implantation
0302 clinical medicine
Aneurysm
Postoperative Complications
Risk Factors
medicine.artery
medicine
Humans
Aged
Aortic dissection
Aorta
Aortic Aneurysm
Thoracic
business.industry
Abdominal aorta
Endovascular Procedures
General Medicine
Aortic bifurcation
Middle Aged
medicine.disease
Surgery
Blood Vessel Prosthesis
Aortic Dissection
medicine.anatomical_structure
Treatment Outcome
Acute Disease
Feasibility Studies
Stents
Cardiology and Cardiovascular Medicine
business
Zdroj: Annals of vascular surgery. 59
ISSN: 1615-5947
Popis: Background Data from the literature suggest that in patients with acute, complicated type B aortic dissection (cTBAD), initial successful treatment with thoracic endovascular aneurysm repair (TEVAR) is not necessarily associated with favorable remodeling of the dissected aorta during follow-up, and long-term results indicate that TEVAR failed to completely suppress false lumen patency. Sealing of all relevant distal reentries, infrarenal and/or iliac, seems to be the key issue to induce total false lumen thrombosis in abdominal aorta as well as the iliac arteries, especially in complicated patients presenting with malperfusion or complete true lumen collapse. Materials and Methods Of the 34 consecutive patients diagnosed with cTBAD at our hospital from January 2015 to April 2018, 30 had complicated dissections receiving endovascular treatment according to the standard Provisional ExTension To Induce COmplete ATtachment (PETTICOAT) technique and were excluded from this study, whereas 4 patients with radiologic evidence of multiple reentry tears at detached lumbar arteries and iliac bifurcation with complete true lumen collapse and clinical evidence of malperfusion were treated with a modified PETTICOAT technique with distal extension of the aortic stent, balloon expansion of the stented true lumen, and use of the AFX bifurcated endograft system to preserve the natural aortic bifurcation and provide complete distal sealing of reentry tears. Results Primary technical success was achieved in all patients. No postoperative deaths were observed, but 1 patient experienced an hemorrhagic shock on the second postoperative day. No patient suffered postoperative stroke, paraplegia, paraparesis, or acute renal failure. Conclusions Using an abdominal aortic bifurcated endograft with PETTICOAT to treat acute cTBAD seems to be a feasible approach in high-risk patients to improve aortic remodeling. The AFX bifurcated endograft system meets the requirements of anatomical fixation and sealing of distal tears.
Databáze: OpenAIRE
Externí odkaz: