Objectives The aim of this study was to describe the factors affecting mid- and late aortic remodelling following TEVAR with PETTICOAT technique among patients with complicated acute or subacute type B aortic dissection. Methods A retrospective single center study that evaluates clinical and morphological outcomes among 65 consecutive patients. The area and diameter of the true- and false-lumen, overall aortic diameter, as well as false lumen perfusion were trended. Results Concomitant direct visceral artery stenting was conducted in 32 (49%) patients. There was one (1.5%) postoperative stroke, three (4.6%) patients developed spinal cord ischaemia, two (3%) patients suffered retrograde Type A dissection and two (3%) patients had mesenteric ischaemia despite successful reperfusion, requiring bowel resection. Median post-operative follow-up was 63.1 (IQR is 32.1– 91.8) months. The probability of survival was 96.9% (95% CI 88.3%—99.2%) at 30 days, 93.9% (95% CI 84.4%—97.6%) at 1 year, 78.0 (95% CI 64.2%—87.0%) at 5 years and 72.8% (95% CI at 57.9%—83.2%) at 10 years postoperatively. There was a statistically significant postoperative increase in true-lumen area, diameter, and true-lumen index in all the five aortic levels measured. Complete false lumen (FL) thrombosis at the coeliac trunk, renal arteries and aortic bifurcation levels was observed in 47%, 15% and 24% of patients at midterm (6–15 months) and 29%, 21% and 29% on late (later than 21 months) CT angiograms. Persistent FL perfusion at the coeliac level was associated with a larger extent of late aortic growth (p = 0.042), and was in the majority of cases caused by iliac re-entries either alone (28.57), or in combination with visceral and lumbar (28.57%) or distal aortic (10.71%) re-entries. A larger abdominal aortic diameter at midterm was associated with an increased probability of distal aortic reinterventions (HR 7.26, 95% CI 2.41–21.9, p < 0.001). Conclusions Persistent FL perfusion of the distal aorta at midterm following TEVAR with PETTICOAT technique among patients with acute and subacute type B dissection, is caused mainly by illiac, visceral, lumber and distal aorta re-entries. Patients with persistent FL perfusion have an increased risk for aortic aneurysmal growth on late follow-up.

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Cardiac resynchronization therapy-defibrillator device upgrades may represent a challenging scenario, especially because unexpected findings can increase procedure difficulty. One such unexpected finding represents insulation failure with unremarkable device interrogation. Insulation failure due to an externalized conductor of an implantable cardiac defibrillator-lead has been recently described for the Kentrox lead (Biotronik). Another challenging aspect of device upgrades is the presence of venous thrombosis as in this case. Here, we report an inside-out abrasion of a Kentrox lead, an unexpected second insulation failure found during pocket revision and the successful recanalization in a patient with known left subclavian vein thrombosis.