The Provisional Extension To Induce Complete Attachment (PETTICOAT) technique to promote distal aortic remodelling in repair of acute DeBakey type I aortic dissection: preliminary results

Abstract

The PETTICOAT technique in the management of acute DeBakey type I dissection is a feasible and promising method to promote distal aortic remodelling. However, outcomes are preliminary and further follow-up is required.

Bare Metal Stent Use in Type B Aortic Dissection May Offer Positive Remodeling for the Distal Aorta

“…To address this issue, several groups have placed distal bare metal stents to encourage false lumen thrombosis and cessation of flow. This technique, known as the Proximal ExTension to Induce COmplete ATtachment (PETTICOAT) concept, has shown good initial results, but early complications and mixed results limit its widespread acceptance and use [6][7][8][9][10]. Unfortunately, there are limited remodeling data in the literature with current-generation endografts [8].…”

“…This technique, known as the Proximal ExTension to Induce COmplete ATtachment (PETTICOAT) concept, has shown good initial results, but early complications and mixed results limit its widespread acceptance and use [6][7][8][9][10]. Unfortunately, there are limited remodeling data in the literature with current-generation endografts [8]. This study aimed to demonstrate evidence of aortic remodeling by using a PETTICOAT system in patients with acute complicated TBADs when compared with standard endovascular therapy.…”

Provisional extension to induce complete attachment of an endovascular repair for acute type A aortic dissection with visceral malperfusion

“…Open repair of acute type I aortic dissection concomitant with proximal stent-grafting and distal bare-metal stenting by the PETTICOAT technique has been previously described. 3 A 2-stage strategy has been also mentioned in isolated reports. 4 , 5 The Michigan aortic group, working with an interventional radiology team, pioneered upfront fenestration and stenting in one of the largest series yet reported of patients with acute AAD and visceral malperfusion.…”

Current management of acute aortic syndrome

“…The addition of a bare metal stent graft distal to the proximal covered stent graft [i.e. the Provisional Extension To Induce Complete Attachment (PETTICOAT) technique] allows enhanced obliteration of the false lumen, which can further alleviate the branch‐vessel malperfusion in the short run and promote aortic remodelling in the long run. The hybrid operation theatre allows on‐table angiography to identify visceral malperfusion, and concomitant endovascular correction of malperfusion can be performed in the same setting during the open aortic surgery (Fig.…”