Molski Maciej, Jankowska Marta, Mross Krystian, Rybicka Anita, Jędrzejczak Tomasz, Kazimierczak Arkadiusz
Vascular Surgery Department, Pomeranian Medical University, Szczecin, Poland.
Department of Nursing, Pomeranian Medical University, Szczecin, Poland.
Postepy Kardiol Interwencyjnej. 2022 Sep;18(3):283-289. doi: 10.5114/aic.2022.120375. Epub 2022 Nov 2.
Favorable remodeling is not always observed after thoracic endovascular aortic repair (TEVAR) in acute complicated type B aortic dissection (TBAD). Existing distal re-entries might be the cause of that. Many more extensive techniques have been introduced and evaluated. None of them achieve proven benefit in long-term follow-up.
A new technique called extended PETTICOAT (provisional extension to induce complete attachment) or e-PETTICOAT technique was published in 2018. It allows one to cover proximal and distal re-entries and consists of: combined implantation of a thoracic stent graft to seal the proximal entry; self-expandable stents in the visceral aorta to expand the true lumen; plus two parallel kissing iliac stent grafts below the renal arteries. Despite encouraging medium term results, it has unknown long-term consequences.
The prospective observational single center study included 11 patients with complicated acute TBAD qualified for endovascular treatment using the e-PETTICOAT technique. Complicated acute TBAD was identified only in cases of clinical manifestation before or at the time of intervention; radiological findings were not sufficient to identify complications in our study. Method: The 5-year follow-up, based on clinical outcome including survival, re-interventions and angio-CT-assessed remodeling, was examined.
The e-PETTICOAT technique achieves good remodeling in 38% of primary and 88% of secondary procedures.
The E-PETTICOAT does not guarantee favorable remodeling during a 5-year follow-up in acute complicated TBAD. Complex aortic repair after e-PETTICOAT might be needed.
在急性复杂性B型主动脉夹层（TBAD）的胸主动脉腔内修复术（TEVAR）后，并非总能观察到良好的重塑效果。现有的远端再入口可能是其原因。已经引入并评估了更多广泛的技术。但在长期随访中，没有一项技术显示出已证实的益处。
一种名为扩展PETTICOAT（临时扩展以诱导完全附着）或e-PETTICOAT技术的新技术于2018年发表。它可以覆盖近端和远端再入口，包括：联合植入胸主动脉覆膜支架以封闭近端入口；在内脏主动脉中植入自膨式支架以扩张真腔；以及在肾动脉下方植入两个平行的髂动脉吻合覆膜支架。尽管中期结果令人鼓舞，但其长期后果尚不清楚。
这项前瞻性观察性单中心研究纳入了11例符合使用e-PETTICOAT技术进行血管内治疗的复杂性急性TBAD患者。仅在干预前或干预时出现临床表现的情况下才确定为复杂性急性TBAD；在我们的研究中，影像学检查结果不足以确定并发症。方法：基于包括生存、再次干预和血管CT评估的重塑在内的临床结果进行了5年随访。
e-PETTICOAT技术在38%的初次手术和88%的二次手术中实现了良好的重塑。
在急性复杂性TBAD的5年随访中，E-PETTICOAT不能保证良好的重塑效果。可能需要在e-PETTICOAT术后进行复杂的主动脉修复。
