Is TEVAR with Full Petticoat Technique Effective for Complicated Acute Type B Dissection Cases?

Abstract

Treatment by thoracic endovascular aortic repair (TEVAR) for type B dissection has improved outcomes. We tried the procedure named “Full Petticoat technique” in which the proximal entry tear was excluded with a covered stent and extended bare metal stents were placed to the aortic bifurcation for three complicated type B dissection cases with dynamic obstruction of the common iliac artery. Follow-up computed tomography revealed favorable aortic remodeling in which the true lumen was expanded. The short-term result of this procedure has shown acceptable aortic remodeling. The significance of this procedure is still unknown in the long term; hence long-term follow-up is necessary to completely understand the usefulness of this technique.

Successful “PETTICOAT” procedure assisted by aortic angioscopy for complicated type B aortic dissection: Case report

“…A PETTICOAT procedure is a combination of closure of the primary entry tear by TEVAR and implantation of bare stents at the distal lesion [ 3 ]. Although this procedure promotes false lumen thrombosis and aortic remodeling, there is no consensus on where and how far the proximal stent graft or distal bare stent should be implanted [ 6 ] while keeping in view the risk of a drop in the pressure gradient of the abdominal branch vessels supplied by the false lumen [ 7 ].…”

The Rate of Postoperative Complications in Complicated Acute, and Subacute Type B Aortic Dissections after TEVAR vs. PETTICOAT Procedures: Systematic Review and Meta-Analysis

“…Over the years, few studies have been published that have tested the efficiency of this new endovascular technique. Nishina et al [23] analyzed the cases of three patients who underwent the full PETTICOAT and confirmed its significance in aortic remodeling; however, a long-term study was not conducted. In a study…”

“…Over the years, few studies have been published that have tested the efficiency of this new endovascular technique. Nishina et al [23] analyzed the cases of three patients who underwent the full PETTICOAT and confirmed its significance in aortic remodeling; however, a long-term study was not conducted. In a study from 2019, the PETTICOAT was proposed as a selective treatment for patients with multiple distal reentry tears [4], as patients experienced complete false lumen remodeling at the aortoiliac level.…”

Acute type A aortic dissection and the consequences of a patent false lumen

“… 75 , 76 , 77 This is referred to as the PETTICOAT (Provisional Extension to Induce Complete Attachment) technique, whereby a short segment of covered stent graft is used to seal the primary entry tear and then bare metal stents are placed to the level of aortic bifurcation. 78 , 79 Despite sealing of the primary entry tear, continued FL pressurization can occur in a retrograde fashion via distal re-entry tears. This may prevent complete thrombosis of the FL despite a reduction in FL pressurization.…”