The Caged Knickerbocker: A Novel Modification to Targeted False Lumen Management in Complex Aortic Dissection.
Vasc Endovascular Surg
; 57(3): 197-202, 2023 Apr.
Article
em En
| MEDLINE
| ID: mdl-36416309
ABSTRACT
INTRODUCTION:
Targeted false lumen management has been described for complex presentations of aortic dissection. The "Knickerbocker" technique is often referenced and includes dilating a focal portion of an oversized endograft in the true lumen to purposefully rupture the false lumen septum, but at the expense of increased risk for visceral propagation and malperfusion. This case series describes a novel modification of the Knickerbocker technique by caging the distal end of the endograft prior to focal dilation.METHODS:
A retrospective chart review was conducted at a tertiary academic center from 2018-2020. Patients were included if they had a history or current presentation of aortic dissection and underwent a Caged Knickerbocker (CKB) repair. Data were collected to include demographics, indications for repair, technical success, perioperative outcomes, hospital course, mortality, and further aortic interventions.RESULTS:
Five patients were included in our evaluation. Four patients (80%) presented with chronic Type B aortic dissection (cTBAD) and concomitant aneurysmal degeneration of the thoracic aorta; 1 patient (20%) presented with an acute rupture secondary to cTBAD. Three patients (60%) had previous aortic repairs, 2 of which were for Type A Aortic Dissection that additionally required redo sternotomy and total arch replacement prior to CKB. CKB was technically successful in all cases with no peri-operative complications. Two (40%) patients required further aortic intervention due to aneurysmal degeneration.CONCLUSION:
Achieving complete false lumen thrombosis is a considerable challenge when managing complex aortic dissections. Our data demonstrate the technical feasibly and early successful outcomes with the CKB approach. Importantly, CKB facilitates future distal extension into the para-visceral aorta in cases of complex thoracoabdominal aortic aneurysms. Further research should focus on discerning individual patients who will benefit from targeted false lumen management and compare outcomes between different approaches.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Aneurisma da Aorta Torácica
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Implante de Prótese Vascular
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Procedimentos Endovasculares
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Dissecção Aórtica
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article