Faculty, Staff and Student Publications
Publication Date
10-1-2024
Journal
Journal of Endovascular Therapy
Abstract
Purpose: The Provisional Extension to Induce Complete Attachment Technique (PETTICOAT) uses a bare-metal stent to scaffold the true lumen in patients with acute or subacute aortic dissections. While it is designed to facilitate remodeling, some patients with chronic post-dissection thoracoabdominal aortic aneurysms (TAAAs) require repair. This study describes the technical pitfalls of fenestrated-branched endovascular aortic repair (FB-EVAR) in patients who underwent prior PETTICOAT repair.
Technique: We report 3 patients with extent II TAAAs who had prior bare-metal dissection stents treated by FB-EVAR. Two patients required maneuvers to reroute the aortic guidewire, which was initially placed in-between stent struts. This was recognized before the deployment of the fenestrated-branched device. A third patient had difficult advancement of the celiac bridging stent due to a conflict of the tip of the stent delivery system into one of the stent struts, requiring to redo catheterization and pre-stenting with a balloon-expandable stent. There were no mortalities and target-related events after a follow-up of 12 to 27 months.
Conclusion: FB-EVAR following the PETTICOAT is infrequent, but technical difficulties should be recognized to prevent complications from the inadvertent deployment of the fenestrated-branched stent-graft component in-between stent struts.
Clinical impact: The present study highlights a few maneuvers to prevent or overcome possible complications during endovascular repair of chronic post-dissection thoracoabdominal aortic aneurysm following PETTICOAT. The main problem to be recognized is the placement of the aortic wire beyond one of the struts of the existing bare-metal stent. Moreover, encroachment of catheters or the bridging stent delivery system into the stent struts may potentially cause difficulties.
Keywords
Humans, Aortic Aneurysm, Thoracic, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Stents, Aortic Dissection, Treatment Outcome, Prosthesis Design, Aged, Male, Endovascular Procedures, Metals, Aortography, Female, Time Factors, Aged, 80 and over, Middle Aged, Endovascular Aneurysm Repair
DOI
10.1177/15266028231163439
PMID
36995081
PMCID
PMC11395163
PubMedCentral® Posted Date
3-30-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes