title: Modified Petticoat Technique with Pre-placement of a Distal Bare Stent Improves Early Aortic Remodeling after Complicated Acute Stanford Type B Aortic Dissection.
abstract: OBJECTIVE
  This study evaluates the safety and efficacy of pre-placement of a distal bare stent as an adjunct to thoracic endovascular aortic repair (TEVAR) in the setting of complicated acute Stanford type B aortic dissection (cTBAD).
  
  
  METHODS
  The records of all patients diagnosed with cTBAD at the institution between 2010 and 2013 were reviewed. Indications for the pre-placement of a distal bare stent included symptomatic malperfusion and/or radiological evidence of true lumen collapse. Computed tomography angiography was performed post-operatively to assess aortic remodeling.
  
  
  RESULTS
  148 patients were treated for cTBAD: 113 patients (76.4%) were treated with standard TEVAR and 35 (23.6%) were treated by combined proximal TEVAR with pre-placement of an adjunctive distal bare stent. Primary technical success was 95.9%. The 30 day mortality rate was 4.1% and was not different between groups. The 30 day morbidity included transient renal failure (10.1%), endoleak (7.4%), and paraplegia (2.7%), and was not different between groups. The mean follow up was 10 months (range 2-12 months). No late stent complications were observed; patients with an adjunctive bare stent had less distal re-dissection (0% vs. 15%; p = .01) and fewer endovascular re-interventions (5.7% vs. 20.4%; p = .04). At 1 year, patients treated with TEVAR and an adjunctive distal bare stent had increased true lumen volume (166 vs. 110 mL; p = .022), decreased false lumen volume (60 vs. 90 mL; p = .043), and increased complete false lumen thrombosis in the thoracic (76.5% vs. 29.5%; p < .001) and abdominal (20.6% vs. 3.8%; p = .002) segments.
  
  
  CONCLUSIONS
  Combined pre-placement of a distal bare stent as an adjunct to proximal TEVAR to treat cTBAD restricts oversizing of the distal stent graft, reducing the potential for distal true lumen collapse and visceral malperfusion, and improving remodeling of the dissected thoracic aorta. Long-term follow up and prospective studies are needed to assess the overall effectiveness of this treatment strategy.
authors.affiliation: Department of Vascular Surgery, The Third Xiangya Hospital of Central South University, Changsha, China; Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT, USA; The Department of Surgery, Yale University School of Medicine, New Haven, CT, USA. Electronic address: jimmyhehao@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: He
authors.affiliation: Department of Vascular Surgery, The Third Xiangya Hospital of Central South University, Changsha, China.
authors.forename: K
authors.initials: K
authors.lastname: Yao
authors.affiliation: Department of Vascular Surgery, The Third Xiangya Hospital of Central South University, Changsha, China.
authors.forename: W P
authors.initials: WP
authors.lastname: Nie
authors.affiliation: Department of Vascular Surgery, The Third Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Radiology, The Third Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Liang
authors.affiliation: Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.
authors.forename: C
authors.initials: C
authors.lastname: Shu
authors.affiliation: Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT, USA; The Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dardik
mesh_terms: D000208:Acute Disease; D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D002681:China; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D066253:Vascular Remodeling
keywords: Aortic remodeling; Bare stent; Stent graft; Type B aortic dissection