P155. The step-wise false lumen occlusion procedures of complete false lumen thrombosis and consequent aortic remodeling after PETTICOAT technique for aortic dissection
Presented During: Adult Cardiac Poster Session II
Kishiwada City Hospital
Osaka
Japan - Contact Me
Dept of Cardiovascullar surgery, Yao Tokusyukai General Hospital, Yao-City, Osaka, Japan
Monday, May 4, 2026: 9:00 AM - 4:00 PM
McCormick Place Lakeside Center
Room: Exhibit Hall, Poster Area
Description
Objective: The PETTICOAT technique has been used in the treatment of complicated TBAD. Recently this technique has also been applied to the residual persistent false lumen (FL) of the post-operative TAAD. However, recent studies have shown that the PETTICOAT technique alone may fail to induce thrombosis of the abdominal aortic FL. Because in Japan abdominal aortic branch devices are not covered by insurance, we applied the FL occlusion procedures to accomplish complete FL thrombosis. This study objective was to evaluate the clinical outcomes of this procedures.
Methods: From October 2015 to December 2024, we performed the PETTICOAT technique in 158 nonconsecutive patients (TBAD 83, post operative TAAD 75), of which 83 patients' consent was obtained to apply FL occlusion procedures. All the ancillary procedures were planned based on the computed tomography imaging and done in a stepped approach to avoid spinal cord ischemia. The FL occlusion procedures consist of the way hereinafter prescribed. When the branch artery is dissected with a distal re-entry or avulsed, a peripheral stent graft is deployed through the interstices of the aortic bare metal stent across the distal re-entry or the detached ostium. When there is no branch around the re-entry, the re-entry is simply occluded by an aortic or peripheral stent graft with or without FL coil embolization.
Results: Total 83 cases (TBAD 37/ postoperative TAAD 46: AAR 27/ PAR 1/ TAR 7/ TAR+FET 6/ Bentall 4/ Bentall+TAR+CET 1), 66 men, average age was 59.5 years. The average duration from the onset to PETTICOAT procedure was 363 days (0-5730) and from the PETTICOAT technique to the 1st re-intervention was 4.0 months (1-21). The average re-intervention was 1.86 times (1-4), and No complications were found. Complete FL thrombosis was observed in 57 cases and consequently aorta was completely remodeled in 41 cases. In cases with incomplete FL thrombosis, open conversion was observed in one case, and minor FL flow in the thoracoabdominal region remains in the remaining cases. The false lumen complete thrombosis/aortic remodeling rates by intervention timing after dissection onset were as follows: acute phase (up to 2 weeks: 7 cases) 7/6, subacute phase (2 weeks to 3 months: 31 cases) 25/22, and chronic phase (3 months or longer: 45 cases) 25/13.
Conclusion: Although longer follow-up results are needed, our FL occlusion procedures may be the simplest and relatively easy procedure to induce FL thrombosis.
Authors
Masatoshi Komooka (1), Shinichi Higashiue (2), Satoshi Kuroyanagi (3), Onichi Furuya (4), Saburo Kojima (1), Kensuke Kasuga (1), Masaaki Kobayashi (3), Motonari Shimizu (5)
Institutions
(1) Yao Tokushukai General Hospital, Yao, Osaka, Japan, (2) Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan, (3) Kishiwada Tokushukai hospital, Kishiwada, Osaka, Japan, (4) Kishiwada Tokushukai hospital, Kishiwada, Osaka Japan, (5) Yao Tokushukai General Hospital, Yao, Osaka
Methods: From October 2015 to December 2024, we performed the PETTICOAT technique in 158 nonconsecutive patients (TBAD 83, post operative TAAD 75), of which 83 patients' consent was obtained to apply FL occlusion procedures. All the ancillary procedures were planned based on the computed tomography imaging and done in a stepped approach to avoid spinal cord ischemia. The FL occlusion procedures consist of the way hereinafter prescribed. When the branch artery is dissected with a distal re-entry or avulsed, a peripheral stent graft is deployed through the interstices of the aortic bare metal stent across the distal re-entry or the detached ostium. When there is no branch around the re-entry, the re-entry is simply occluded by an aortic or peripheral stent graft with or without FL coil embolization.
Results: Total 83 cases (TBAD 37/ postoperative TAAD 46: AAR 27/ PAR 1/ TAR 7/ TAR+FET 6/ Bentall 4/ Bentall+TAR+CET 1), 66 men, average age was 59.5 years. The average duration from the onset to PETTICOAT procedure was 363 days (0-5730) and from the PETTICOAT technique to the 1st re-intervention was 4.0 months (1-21). The average re-intervention was 1.86 times (1-4), and No complications were found. Complete FL thrombosis was observed in 57 cases and consequently aorta was completely remodeled in 41 cases. In cases with incomplete FL thrombosis, open conversion was observed in one case, and minor FL flow in the thoracoabdominal region remains in the remaining cases. The false lumen complete thrombosis/aortic remodeling rates by intervention timing after dissection onset were as follows: acute phase (up to 2 weeks: 7 cases) 7/6, subacute phase (2 weeks to 3 months: 31 cases) 25/22, and chronic phase (3 months or longer: 45 cases) 25/13.
Conclusion: Although longer follow-up results are needed, our FL occlusion procedures may be the simplest and relatively easy procedure to induce FL thrombosis.
Authors
Masatoshi Komooka (1), Shinichi Higashiue (2), Satoshi Kuroyanagi (3), Onichi Furuya (4), Saburo Kojima (1), Kensuke Kasuga (1), Masaaki Kobayashi (3), Motonari Shimizu (5)
Institutions
(1) Yao Tokushukai General Hospital, Yao, Osaka, Japan, (2) Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan, (3) Kishiwada Tokushukai hospital, Kishiwada, Osaka, Japan, (4) Kishiwada Tokushukai hospital, Kishiwada, Osaka Japan, (5) Yao Tokushukai General Hospital, Yao, Osaka
Presentation Duration
There is no formal presentation for posters. Your poster will be on display on your assigned day from 9:00AM - 4:00PM
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ADULT CARDIAC
Aorta and Great Vessels