The PETTICOAT technique is associated with abdominal aortic remodeling in sub-acute, uncomplicated type B aortic dissection.

Abstract

It remains unclear whether the provisional extension to induce complete attachment (PETTICOAT) technique is superior to standard thoracic endovascular aortic repair for type B aortic dissection. This study evaluated the efficacy of the PETTICOAT technique for type B and postoperative residual type B aortic dissection in the subacute phase. This single-center retrospective cohort study evaluated sequential aortic morphological changes in consecutive patients with uncomplicated type B and residual postoperative type B aortic dissection treated using the PETTICOAT technique in the subacute phase between March 2018 and March 2023. The outcomes included thoracic and abdominal aortic remodeling at 3 years postoperatively. Fifty-one patients were included. The mean age was 62 ± 9.8 years, and 74.5% were male. Technical success and perioperative mortality rates were 100% and 0%, respectively. Aortic-related complications occurred in two cases, including distal stent graft-induced new entry and aortic dilatation requiring endovascular reintervention. The mean follow-up period was 707.7 ± 415.1 days (median, 680.5 days). Reintervention was performed in one case (1.96%). Both thoracic and abdominal areas showed significant true lumen enlargement and false lumen reduction over time compared with baseline. The true lumen index of the abdominal aorta increased significantly immediately after surgery and remained elevated compared with the preoperative state. The PETTICOAT technique for uncomplicated type B aortic dissection showed good remodeling not only in the thoracic aorta but also in the abdominal aorta. Further studies are required to confirm these findings.