Objective

The aim of this study was to evaluate the peri-operative and short term results of institutional experience with the Distal Extended EndoVascular Aortic Repair PETTICOAT (DEEVAR PETTICOAT) procedure.

Methods

This was a single centre, observational study. From January 2015 to December 2019, 53 patients were admitted to the institution for treatment of acute and subacute complicated type B aortic dissection. Among them, data on 16 patients deemed suitable for a PETTICOAT procedure extended at infrarenal and iliac level by means of a bifurcated endograft were prospectively collected. Patients with persistent pain, visceral or lower limb malperfusion, true lumen collapse, and distal extension with computed tomography angiography (CTA) evidence of entry tears in the infrarenal or iliac zone were included. A CTA scan was performed in all patients at the baseline, before hospital discharge and then at six and 12 months post-operatively to assess aortic remodelling. Complete aortic remodelling was defined as stable aortic size (maximum enlargement < 5 mm) with complete true lumen re-expansion and complete false lumen exclusion or disappearance.

Results

Technical success was obtained in all patients. One patient (7%) had intra-operative infrarenal aortic rupture during balloon dilation of the distal end of the bare stent, successfully treated by deployment of a bifurcated endograft. Additional covered stenting of the visceral arteries was necessary in nine patients (56%) and malperfusion resolved immediately in all cases. There were no spinal cord ischaemia or other peri-procedural complications, and no post-operative death, stroke, paraplegia/paraparesis, or acute renal failure was observed. Follow up ranged from one month to 24 months (median 7.5 months). One patient (7%) with a history of drug abuse died from sepsis. At the last CTA check, all patients showed complete remodelling of the thoraco-abdominal aorta and iliac arteries without vessel enlargement.

Conclusion

The present findings suggest that the DEEVAR PETTICOAT procedure provides effective sealing of all distal tears without increased risk of major peri-procedural complications. Further studies with larger number of patients and longer follow up are needed to confirm the safety and durability of this technique.

中文翻译：

---

急性和亚急性复杂性 B 型主动脉夹层远端延长血管内主动脉修复 (DEEVAR) 衬裙的短期结果

客观的

本研究的目的是评估远端延长血管内主动脉修复 PATTICOAT（DEEVAR PATTICOAT）手术的围手术期和机构经验的短期结果。

方法

这是一项单一中心的观察性研究。2015年1月至2019年12月，我院收治急、亚急性复杂B型主动脉夹层患者53例。其中，前瞻性收集了 16 名被认为适合通过分叉内移植物在肾下和髂骨水平扩展的 PATTICOAT 手术的患者的数据。包括持续疼痛、内脏或下肢灌注不良、真腔塌陷和远端延伸的患者，计算机断层扫描血管造影 (CTA) 证据显示肾下区或髂骨区撕裂。在基线、出院前以及术后 6 个月和 12 个月对所有患者进行 CTA 扫描以评估主动脉重构。主动脉完全重构被定义为稳定的主动脉大小（最大扩张<

结果

所有患者均获得技术成功。一名患者 (7%) 在裸支架远端球囊扩张期间发生了术中肾下主动脉破裂，通过部署分叉内移植物成功治疗。9 名患者 (56%) 需要额外的内脏动脉覆膜支架置入术，所有病例的灌注不良都立即得到解决。没有脊髓缺血或其他围手术期并发症，没有观察到术后死亡、中风、截瘫/下肢轻瘫或急性肾功能衰竭。随访时间从 1 个月到 24 个月不等（中位数为 7.5 个月）。一名有药物滥用史的患者 (7%) 死于败血症。在最后一次 CTA 检查中，所有患者均显示胸腹主动脉和髂动脉完全重塑，没有血管扩大。

结论

目前的研究结果表明，DEEVAR PATTICOAT 手术可有效密封所有远端撕裂，而不会增加主要围手术期并发症的风险。需要更多患者和更长时间随访的进一步研究来确认该技术的安全性和耐用性。