PETTICOAT for acute type B aortic dissection: a systematic review

Abstract

INTRODUCTIONː The provisional extension to induce complete attachment (PETTICOAT) technique was developed as an attempt to deal with the limitations of thoracic endovascular aortic repair (TEVAR) in the treatment of acute type B aortic dissection (TBAD). However, the benefit of PETTICOAT for TBAD remains unclear. EVIDENCE ACQUISITIONː A systematic review of literature on TBAD managed with the PETTICOAT technique was conducted to assess outcomes and aortic remodelling. EVIDENCE SYNTHESISː Eleven studies were included with a total of 360 patients. All patients had complicated TBAD. Mean technical success rate was 99.7%. Mean last-available FU date was 21.6 months. Mortality was 0.5% perioperatively, 0.9% at 30-day, 4.4% at 12-month and 9.5% at last FU. Rupture happened in 1.9% perioperatively and at 30-day, 2.3% at 12-month and 2.4% at last FU. Spinal cord ischemia developed in 0.5% perioperatively, 0.9% at 30-day, 0% at 12-month and 0.7% at last FU. Peripheral malperfusion occurred in 0.5% perioperatively and at 30-day and none at 12-month and last FU. Acute renal failure happened in 2.2% perioperatively, 2.9% at 30-day and none at 12-month and last FU. There were no cases of stent fracture, stent misalignment, device migration, penetrating aortic ulcer or stent graft-induced new entry. CONCLUSIONSː Mortality after PETTICOAT was lower than TEVAR and open surgery. Aortic rupture and clinical complications had similar rates to TEVAR. Technical success was high. There was favourable aortic remodelling, particularly in patients presenting with patent and complete FL thrombosis, but no comparison could be made with TEVAR due to heterogeneity between reports.