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

Kazimierczak, Arkadiusz; Rynio, Paweł; Jędrzejczak, Tomasz; Mokrzycki, Krzysztof; Samad, Rabih; Brykczyński, Mirosław; Rybicka, Anita; Zair, Labib; Gutowski, Piotr

doi:10.1016/j.jvs.2019.01.073

Cited by 21 publications

(13 citation statements)

References 36 publications

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“…18 The "petticoat technique" and "expanded petticoat technique" have been reported to expand the true lumen with a bare stent and collapsing the false lumen with ballooning, aiming to promote false lumen thrombosis and keep perfusion of the visceral arteries. 19,20 However, there is still a concern for the risk of late bare stent graft endothelialization, and there are small areas with persistent flow in the false lumen (in the visceral part of the aorta), which is the weakest link in this technique. 20 In 2001, Chuter et al 21 first reported the total endovascular repair of atherosclerotic thoracoabdominal aortic aneurysms with a modular endograft system.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 However, there is still a concern for the risk of late bare stent graft endothelialization, and there are small areas with persistent flow in the false lumen (in the visceral part of the aorta), which is the weakest link in this technique. 20 In 2001, Chuter et al 21 first reported the total endovascular repair of atherosclerotic thoracoabdominal aortic aneurysms with a modular endograft system. Multitudinous endografts, including the surgeon-modified stents and commercial devices, have since been reported with satisfactory primary results.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fenestrated/Branched Endovascular Repair for Postdissection Thoracoabdominal Aneurysms: A Systematic Review with Pooled Data Analysis

Jia

Sun

et al. 2020

Vasc Endovascular Surg

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Purpose: Patients who have survived an acute aortic dissection remain at risk for postdissection thoracoabdominal aortic aneurysms (PD-TAAAs). Fenestrated/branched endovascular repair for PD-TAAA is increasingly used in some high-volume centers, but outcomes are still limited because of the additional challenges compared to atherosclerotic thoracoabdominal aneurysms. This study was performed to evaluate the literature on fenestrated/branched endovascular repair for PD-TAAAs. Methods: PubMed, Embase, and the Cochrane Database were searched for relevant studies published until September 2019. Outcome data were extracted to evaluate the technical success, 30-day mortality, later survival, major complications, endoleaks, target vessel patency, and reintervention. Studies were analyzed in a pooled proportion meta-analysis. Results: In total, 143 patients from 4 studies were identified for the pooled data analysis. The pooled technical success rate was 98% (95% CI: 86%-100%). After the treatment, the overall estimated 30-day mortality rate was 3% (95% CI: 1%-8%), early spinal cord ischemia rate was 10% (95% CI: 4%-21%), early renal injury rate was 5% (95% CI: 1%-19%), endoleak rate was 33% (95% CI: 22%-47%), reintervention rate at a median follow-up of 22.5 months was 34% (95% CI: 27%-42%), and all-cause mortality rate was 12% (95% CI: 6%-24%). Conclusions: The use of fenestrated/branched stent grafts for the treatment of PD-TAAA appears generally feasible based on the limited literature, but endoleaks and reinterventions are frequent.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fenestrated/Branched Endovascular Repair for Postdissection Thoracoabdominal Aneurysms: A Systematic Review with Pooled Data Analysis

Jia

Sun

et al. 2020

Vasc Endovascular Surg

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“…Combining the benefits of Covered Endovascular Reconstruction of Aortic Bifurcation (CERAB) (using amplification of the radial force of the infra-renal stent and lower radial mismatch) and Kissing Stents technique (sparing the branches) is called Extended Petticoat (e-Petticoat) and is compatible with the CERN protocol (Goverde et al, 2013;Groot Jebbink et al, 2017;Jebbink et al, 2015). Using BMS instead of covered stents in CERAB allows the flow to the branches along the gutters between the iliac parallel stent-grafts (Kazimierczak et al, 2018(Kazimierczak et al, , 2019a. It spares the small branches along the abdominal and infra-renal aorta (Fig.…”

Section: Rule F Spare the Small Branchesmentioning

confidence: 99%

Complete Entry and Re-entry Neutralization protocol in endovascular treatment of aortic dissection

Jędrzejczak

Rynio

Samad

et al. 2020

Reviews in Cardiovascular Medicine

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There have been indisputable developments in techniques for stabilizing acute aortic syndromes. However, aneurysmal degeneration following aortic dissection remains a problem to be solved. The currently available treatment options for aortic dissection still fail to take into account the known risk factors for aneurysmal degeneration. This is why we introduced a new approach to treating patients with an aortic dissection, called Complete Entry and Reentry Neutralization (CERN). This is our initial report on the promising interim results. Material and Methods: 68 patients qualified for endovascular treatment of an acute or chronic aortic dissection. Computed tomography was performed post-operatively to assess aortic remodeling after 1/6/12/24/36 months. Results: the 30-day mortality rate was 4.4%. In 29 cases (43%) unfavorable remodeling was noted in the follow-up. The most important factors leading to unfavorable remodeling were: uncovered reentry tear including the infra-renal segment, no relining of dissection membranes and insufficient coverage of the descending aorta. We analyzed these factors to develop the CERN protocol. This concept consists of six basic rules: A. cover all entry tears, B. amplify the BMS radial force, C. use the STABILISE technique, D. consider using thrombus plugs, E. avoid stenting the visceral branches, F. spare the intercostal and lumbar side branches. CERN improves the rate of favorable remodeling from 25% to 85% (P = 0.0067). Conclusion: Introduction of the Complete Entry and Re-entry Neutralization protocol improves the rate of favorable remodeling following endovascular treatment of aortic dissection in mid-term follow-up in patients with diffused aortic dissection.

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“… 17 , 18 Adjunctive endovascular techniques to address the thickened, noncompliant dissecting septum include the following: obliteration of the false lumen, including embolization, by using coils or plugs; or, common aortic lumen creation by fenestration, stent-graft–assisted balloon aortic septal fracture, or provisional extension to induce complete attachment techniques. 19 , 20 , 21 , 22 …”

mentioning

confidence: 99%

Open repair remains the gold standard

Hong¹,

Coselli²

2021

JTCVS Techniques

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

Cited by 21 publications

References 36 publications

Fenestrated/Branched Endovascular Repair for Postdissection Thoracoabdominal Aneurysms: A Systematic Review with Pooled Data Analysis

Fenestrated/Branched Endovascular Repair for Postdissection Thoracoabdominal Aneurysms: A Systematic Review with Pooled Data Analysis

Complete Entry and Re-entry Neutralization protocol in endovascular treatment of aortic dissection

Open repair remains the gold standard

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