Full PETTICOAT in acute type B aortic dissection with patent false lumen may offer positive remodeling for the distal aorta

Hashizume, Kenichi; Honda, Masashi; Mori, Mitsuharu; Yagami, Toshiaki; Takaki, Hidenobu; Matsuoka, Tadashi; Ikebata, Koki; Kanayama, Hiroaki; Ohno, Masatoshi; Shimizu, Hideyuki

doi:10.1007/s11748-020-01548-3

Cited by 9 publications

(24 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly a recent analysis by Nienaber and colleagues of the patients from the ASSIST study found significantly more false lumen thrombosis in the abdominal aorta among patients undergoing the PETTICOAT technique compared to propensity matched patients who underwent TEVAR alone [ 17 ]. These results are similar to those found by Hashizume et al and Huang et al in their cohorts of patients [ 16 , 21 ]. However, other studies have reached the opposite conclusions.…”

Section: Discussionsupporting

confidence: 93%

Aortic remodelling and late outcomes following thoracic endovascular repair with a bare-metal stent distal extension among patients with complicated type-B aortic dissection

Wamala

Nazari-Shafti

Heck

et al. 2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 93%

Aortic remodelling and late outcomes following thoracic endovascular repair with a bare-metal stent distal extension among patients with complicated type-B aortic dissection

Wamala

Nazari-Shafti

Heck

et al. 2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Confirming the therapeutic efficacy of the stent gradually reduced when closing to the bifurcation of iliac artery. For these patients, the treatment of auxiliary technologies to increase the range of stents at appropriate positions was suggested to improve long-term prognosis ( 17 , 18 ). Since the TL was supported with the stent, the preoperative state of the TL had little impact on postoperative remodeling.…”

Section: Discussionmentioning

confidence: 99%

Preoperative diameters of aorta influence the remodeling after surgery for type A aortic dissection

Zhang,

Yang,

Gao

et al. 2023

J Thorac Dis

View full text Add to dashboard Cite

Background Although current research revealed the preoperative diameter of the aorta is related to aortic remodeling, prognosis should consider the true lumen (TL) and false lumen (FL) respectively too. Methods The cohort of this retrospective analysis included 161 type A aortic dissection (TAAD) patients who underwent surgery at a single institution from September 1, 2017, to September 1, 2018. Computed tomography angiography (CTA) images were reviewed to assess changes of the diameters of the TL, FL and total aorta at the levels of the stented segment, distal end of the stent, celiac trunk, and below the renal artery. Results During the study period, positive remodeling was observed in 33 (20.5%) patients. The probability of negative remodeling far from the stent segment was greater than the aorta close to the stent. Only the TL diameter was associated with each levels’ changes and underwent significant change (P<0.05). Multivariate analysis identified aortic regurgitation as a risk factor for remodeling in the distal end of the stent. The maximum diameter of the FL was the only risk factor related to the remodeling type (odds ratio =0.10; 95% confidence interval: 0.01–0.51), a maximum diameter of the FL of >1.28 cm was associated with a higher probability of negative remodeling after surgery (specificity =0.994; sensitivity =0.571; area under the receiver operating characteristic curve =0.76). Conclusions The TL and FL diameters on preoperative CTA images can be used to assess the risk of negative remodeling after surgery.

show abstract

“… 20 Conversely, others have reported that bare-metal stenting may offer positive remodeling in the distal aorta. 21 , 22 , 23 , 24 , 25 Concerns have also been raised that the PETTICOAT technique may jeopardize future adjunctive endovascular procedures because of stent strut interference. Other investigators have countered that a more expanded true lumen facilitates adjunctive procedures by virtue of the increase in workspace.…”

Section: Discussionmentioning

confidence: 99%

A reversed strategy for treating type B aortic dissection with open aortoiliac replacement prior to thoracic endovascular aortic repair

Gusev¹,

Leong²,

Patel³

2022

Journal of Vascular Surgery Cases, Innovations and Techniques

View full text Add to dashboard Cite

Full PETTICOAT in acute type B aortic dissection with patent false lumen may offer positive remodeling for the distal aorta

Cited by 9 publications

References 20 publications

Aortic remodelling and late outcomes following thoracic endovascular repair with a bare-metal stent distal extension among patients with complicated type-B aortic dissection

Aortic remodelling and late outcomes following thoracic endovascular repair with a bare-metal stent distal extension among patients with complicated type-B aortic dissection

Preoperative diameters of aorta influence the remodeling after surgery for type A aortic dissection

A reversed strategy for treating type B aortic dissection with open aortoiliac replacement prior to thoracic endovascular aortic repair

Contact Info

Product

Resources

About