Distal Extended Endovascular Aortic Repair PETTICOAT: A Modified Technique to Improve False Lumen Remodeling in Acute Type B Aortic Dissection.

BACKGROUND: Data from the literature suggest that in patients with acute, complicated type B aortic dissection (cTBAD), initial successful treatment with thoracic endovascular aneurysm repair (TEVAR) is not necessarily associated with favorable remodeling of the dissected aorta during follow-up, and long-term results indicate that TEVAR failed to completely suppress false lumen patency. Sealing of all relevant distal reentries, infrarenal and/or iliac, seems to be the key issue to induce total false lumen thrombosis in abdominal aorta as well as the iliac arteries, especially in complicated patients presenting with malperfusion or complete true lumen collapse. MATERIALS AND METHODS: Of the 34 consecutive patients diagnosed with cTBAD at our hospital from January 2015 to April 2018, 30 had complicated dissections receiving endovascular treatment according to the standard Provisional ExTension To Induce COmplete ATtachment (PETTICOAT) technique and were excluded from this study, whereas 4 patients with radiologic evidence of multiple reentry tears at detached lumbar arteries and iliac bifurcation with complete true lumen collapse and clinical evidence of malperfusion were treated with a modified PETTICOAT technique with distal extension of the aortic stent, balloon expansion of the stented true lumen, and use of the AFX bifurcated endograft system to preserve the natural aortic bifurcation and provide complete distal sealing of reentry tears. RESULTS: Primary technical success was achieved in all patients. No postoperative deaths were observed, but 1 patient experienced an hemorrhagic shock on the second postoperative day. No patient suffered postoperative stroke, paraplegia, paraparesis, or acute renal failure. CONCLUSIONS: Using an abdominal aortic bifurcated endograft with PETTICOAT to treat acute cTBAD seems to be a feasible approach in high-risk patients to improve aortic remodeling. The AFX bifurcated endograft system meets the requirements of anatomical fixation and sealing of distal tears.

Mycotic abdominal aortic aneurysm after adjuvant therapy with bacillus Calmette-Guérin in patients with urothelial bladder cancer: a rare but misinterpreted complication.

Bacillus Calmette-Guérin (BCG) therapy is often associated with side effects. The most feared is disseminated sepsis that may occur rarely with the development of mycotic aortic aneurysms. Twenty cases of patients treated with intravesical BCG complicated by mycotic abdominal aortic aneurysm have been reported in the literature, including 2 cases of the present study. Delayed vascular work-up represents a critical aspect. Mycotic aneurysms evidence a rapid progression. Primary care physicians and urologists should be sensitized to recognize unspecified symptoms such as potential clinical manifestations of a mycotic abdominal aortic aneurysm, even several months or years after BCG therapy.

Nine-year experience of bovine pericardium patch angioplasty during carotid endarterectomy.

PURPOSE: This paper examines the clinical results of a 9-year experience in which the incidence of major (stroke and death) perioperative events and of recurrent stenosis (>60%) after carotid endarterectomy performed with a direct suture (DS) of the arteriotomy versus bovine pericardium patch angioplasty (BPPA) are compared. METHODS AND MATERIALS: A total of 517 carotid endarterectomies were included in this nonrandomized study and were divided into two groups: group DS with 194 procedures and group BPPA with 323 procedures. All patients were entered in a follow-up program that ranged from 1 to 108 months (mean, 56.4 months) and included color duplex scan examinations at 1, 3, 6, and 12 months after surgery and every year thereafter. RESULTS: The number of major (stroke and death) perioperative cerebrovascular accidents was eight (4.1%) in the DS Group and five (1.5%) in the BPPA group (P =.066). One death occurred in the DS group, and three occurred in the BPPA Group (P =.517). The four deaths in both groups were the result of strokes. No statistically significant difference was found in terms of early neurologic complications between the two groups. During the first year of follow-up study, the rate of restenosis >60% and occlusion was significantly lower in the BPPA group. Thereafter, the difference was not significant. CONCLUSION: In our experience, the use of BPPA or DS during carotid endarterectomy procedure does not cause a significantly different rate of perioperative major events (stroke or death) in the two groups. The incidence rate of restenosis is lower in the first year after surgery with BPPA, but in subsequent years, no significant difference in restenosis is seen. The early and late postoperative results with BPPA compare favorably with the reported data from literature with the use of other patch materials.