Background: The aim of this paper was to evaluate a new technique called an ''extended'' provisional extension to induce complete attachment (e-PETTICOAT) technique. Methods: 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 24 months. Changes in aortic size and volumes of the false and true lumen were assessed. Results: 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 ± 6.9 mL) contrast-enhanced false lumen in the abdominal aorta was observed in 76% of cases with stable aortic size after 1 and 2 years. No visceral branch occlusion, type I endo-leak, renal insufficiency or paraplegia was recorded in follow-up. Conclusions: 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

The goal of this study was to describe the surgical results of physician-modified endografts (PMEG) utilizing a 3D aortic template in a center with no prior experience in complex endovascular aortic repairs. Forty-three patients underwent physician-modified graft stent implantation using a 3D aortic model. The inclusion criteria were juxtarenal and suprarenal aortic aneurysms, type IV thoracoabdominal aneurysms, and type IA endoleak after endovascular aortic repair. In asymptomatic patients, the diameter threshold for aneurysm repair was 5.5 cm in males and 5.0 cm in females. 3D aortic templates were prepared from the patient’s computed tomography angiography scans and sterilized before use in the operating suite. Forty-three stent grafts were modified with the use of a 3D printing template. A total of 162 reinforced fenestrations (37 celiac, 43 right renal, 39 left renal, 43 superior mesenteric) with a mean of 3.8 per patient were performed. All PMEGs had a posterior reducing-diameter tie and a preloaded guidewire. The mean modification time was 86 ± 12 min. The mean follow-up was 14 ± 12 months. The 30-day mortality was 12%. During the follow-up period, the patency rate was 95% per the superior mesenteric artery, 93% per right renal artery, 95% per left renal artery, and 89% per celiac trunk. Twelve (28%) patients had endoleak, of which type I or III was present in 5 (12%) patients, and type II in 7 (16%). 3D printing can be successfully integrated into the physician’s everyday practice of stent graft modification. However, the use of this approach in centers without experience performing complex aortic procedures results in worse surgical metrics than those previously reported.

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IntroductionDespite the increasing use of carotid angioplasty and stenting (CAS), carotid endarterectomy (CEA) nonetheless remains a more medically beneficial method of treatment for carotid artery stenosis. Therefore, one possibility for progress within this procedure may be to use minimally invasive carotid surgery, especially when the scar is in plain sight: the use of the natural wrinkles (skin crease) as a camouflage of the skin incision provides significant cosmetic improvements.AimTo compare the cosmetic effects of classic and trans-wrinkle CEA. To assess the distance between the carotid artery bifurcation (CAB) and the skin-crease incision whilst attempting CEA.Material and methodsIt was a randomized prospective study with two groups: patients undergoing classic surgery (control group; n = 100) and skin-crease trans-wrinkle camouflaged CEA (study group; n = 100). Follow-up was at 2 months and 1 year.ResultsThe medical results of the treatment were similar in both groups. The cumulative count of strokes and myocardial infarctions was 0.5% within 30 days, and after one year 3.5% (and 5.5% including cases of death). The superiority of the transverse crease being hidden compared to the conventional longitudinal technique was proven in the Patient and Observer Scar Assessment Scale (POSAS) score, respectively 11.4 ±1.0 vs. 14.1 ±3.4 (p = 0.0001) after 2 months and 13.5 ±2.8 vs. 14.1 ±3.4 (p = 0.039) after a year.ConclusionsTrans-wrinkle incision gives better cosmetic results, can be safely performed in most cases, and offers a comfortable approach during CEA.