Journal of Vascular Surgery Cases, Innovations and Techniques · Published 2026-06-23 · DOI 10.1016/j.jvscit.2026.102363
Ga-Young Suh, Johan Bondesson, Shanmugesh Raja, Keith Naqvi, Christopher P. Cheng, Brant W. Ullery
Objective: Aortic remodeling after thoracic endovascular aortic repair (TEVAR) for complicated type B aortic dissection remains insufficiently characterized, particularly when the Provisional ExTension To Induce COmplete ATtachment (PETTICOAT) technique is applied. This study evaluated early geometric remodeling of the true and false lumens and the whole aorta following TEVAR with PETTICOAT using patient-specific computational modeling. Methods: A single-center retrospective review of 20 patients (16 men; age, 65 ± 11 years; nine acute, seven subacute, and four chronic) with type B aortic dissection treated with TEVAR and PETTICOAT was performed. Pre- and postintervention computed tomography angiography was used to extract centerlines and cross-sectional measurements along the entire aorta. Patient-specific computational simulations quantified changes in aortic arclength, curvature, cross-sectional area, and circumference across the ascending aorta, arch, descending thoracic aorta, and abdominal aorta. Remodeling was assessed by comparing geometric parameters from preoperative and the first available postoperative computed tomography angiography (mean interval from surgery, 82 ± 305 days; median, 14 days). Results: In the first 30 days, one patient died, and the rest were free from reintervention. False lumen thrombosis was documented in 10 patients (50%) during early (<30 day) imaging and in 14 patients (70%) within 24-month surveillance. TEVAR with PETTICOAT produced significant true lumen expansion, including reduced curvature in the aortic arch and descending thoracic aorta (P < .05), and increased abdominal aortic arclength (13.1 ± 2.6 to 13.8 ± 2.3 cm; P < .05). True-lumen circumference increased at the arch (10.1 ± 1.7 to 10.5 ± 1.4 cm), descending thoracic aorta (7.1 ± 1.2 to 9.1 ± 1.2 cm), and abdominal aorta (5.7 ± 1.0 to 6.5 ± 1.0 cm; P < .05). The whole aorta circumference increased only in the descending thoracic segment (P < .05), whereas the false lumen cross-sectional area showed no significant change. Conclusions: TEVAR with the PETTICOAT technique results in measurable geometric remodeling in the first 30 days, most pronounced within the true lumen across thoracic and abdominal segments. Whole aorta and false lumen changes were limited, suggesting a preferential true lumen response to intervention.
Abstract from DOAJ. Public domain (CC0 1.0).
Read the article at the publisher →
Suh, G., Bondesson, J., Raja, S., et al. (2026). Aortic remodeling after thoracic endovascular aortic repair and Provisional ExTension To Induce COmplete ATtachment to treat complicated type B aortic dissection. Journal of Vascular Surgery Cases, Innovations and Techniques. https://doi.org/10.1016/j.jvscit.2026.102363