Technical Pitfalls for Fenestrated-Branched Endovascular Aortic Repair Following PETTICOAT

• Type: Article in International Scientific Journal
• Date: 2023

Authors

Baghbani-Oskouei A. (Author) Other; Tenorio E.R. (Author) Other; Dias-Neto M (Author) FMUP; Vacirca A. (Author) Other; Mirza A.K. (Author) Other; Saqib N. (Author) Other; Mendes B.C. (Author) Other; Ocasio L. (Author) Other; Macedo T.A. (Author) Other; Oderich G.S. (Author) Other

Journal

The Journal is awaiting validation by the Administrative Services.

Title: Journal of Endovascular Therapy

ISSN: 15266028

Indexing

Scopus - 0 Citations

Other information

Authenticus ID: P-010-SCV

DOI: 10.1177/15266028231163439

Abstract (EN): 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.

Language: English

Type (Professor's evaluation): Scientific