Modified Petticoat Technique with Pre-placement of a Distal Bare Stent Improves Early Aortic Remodeling after Complicated Acute Stanford Type B Aortic Dissection

Abstract

Combined pre-placement of a distal bare stent as an adjunct to proximal TEVAR to treat cTBAD restricts oversizing of the distal stent graft, reducing the potential for distal true lumen collapse and visceral malperfusion, and improving remodeling of the dissected thoracic aorta. Long-term follow up and prospective studies are needed to assess the overall effectiveness of this treatment strategy.

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

“…Through observation of our patients we noticed which factors were associated with unfavorable remodeling. The breakthrough observation was the negative effect of distal reentry tears left untreated following TEVAR or classic Petticoat (He et al, 2015;Sobocinski et al, 2014). Long term observation of unfavorable outcomes led us to create six rules to improve the prognosis.…”

“…This is because the radial force of Medicut (BMS) is usually not strong enough to overcome the high pressure inside the FL. Therefore, it is important to amplify its radial force by implementing a stent-graft inside (He et al, 2015).As shown of Fig. 3B, the bigger the overlap the better the BMS expansion, so it is important to terminate the covered stent-graft as close as possible to the celiac trunk.…”

“…Nevertheless, these risk factors are not currently taken into account in the treatment options (there are no specific guidelines on how to initially treat patients in order to minimize the risk of further aneurysmal degeneration). New endovascular techniques, alongside several modifications to the old techniques, have given moderate results as far as improving the rate of favorable remodeling following endovascular treatment of aortic dissection (He et al, 2015;Molinari et al, 2019). The problem of aneurysmal degeneration remains unsolved.…”

An unusual case of aortic rupture after deployment of a bare stent in the treatment of aortic dissection in a patient with giant-cell arteritis.

“…They did not report aortic rupture as a complication of bare-metal stenting in AD [5, 6]. Other authors encountered one aortic rupture [7]. However, the rupture was located distally to the distal end of the bare stent, and it concerned only the false lumen, with the intimal flap between both lumens still intact.…”

“…One of the recommended methods of treatment of AD is the coverage of the entry tear with a stent graft [4]. Some vascular surgeons have expanded this method by the use of an additional bare stent deployed distally [5–7]. This report highlights the difficulty of such therapy in a patient with GCA.…”