Physician-modified endograft in ruptured aortic arch.

We present the case of a 27-year-old motorcyclist after a multi-organ trauma. He suffered a rupture of the aortic arch located in zone 2 and was disqualified from surgical replacement of the aortic arch due to active bleeding from parenchymal organs. Instead, he was provided with a physician-modified endograft (PMEG) to complete fenestrated thoracic endovascular aortic repair as a damage control procedure. No reports in the world literature are found regarding the use of PMEG technology in truly ruptured post-traumatic pseudo-aneurysm on the border of zone 1 and 2 of the aortic arch in emergency settings. The surgery provided temporary supply of the aorta and allowed all of the other surgical and orthopedic procedures to be completed. Endovascular treatment of aortic arch damage with PMEG is possible and can be effectively used for urgent indications when an open operation is not possible.

The extended PETTICOAT technique does not guarantee favorable remodeling after acute type B aortic dissection.

Introduction: Favorable remodeling is not always observed after thoracic endovascular aortic repair (TEVAR) in acute complicated type B aortic dissection (TBAD). Existing distal re-entries might be the cause of that. Many more extensive techniques have been introduced and evaluated. None of them achieve proven benefit in long-term follow-up. Aim: A new technique called extended PETTICOAT (provisional extension to induce complete attachment) or e-PETTICOAT technique was published in 2018. It allows one to cover proximal and distal re-entries and consists of: combined implantation of a thoracic stent graft to seal the proximal entry; self-expandable stents in the visceral aorta to expand the true lumen; plus two parallel kissing iliac stent grafts below the renal arteries. Despite encouraging medium term results, it has unknown long-term consequences. Material and methods: The prospective observational single center study included 11 patients with complicated acute TBAD qualified for endovascular treatment using the e-PETTICOAT technique. Complicated acute TBAD was identified only in cases of clinical manifestation before or at the time of intervention; radiological findings were not sufficient to identify complications in our study. Method: The 5-year follow-up, based on clinical outcome including survival, re-interventions and angio-CT-assessed remodeling, was examined. Results: The e-PETTICOAT technique achieves good remodeling in 38% of primary and 88% of secondary procedures. Conclusions: The E-PETTICOAT does not guarantee favorable remodeling during a 5-year follow-up in acute complicated TBAD. Complex aortic repair after e-PETTICOAT might be needed.