Geometric Analysis of Aortic Remodeling After PETTICOAT Technique in Type B Aortic Dissection

We aim to examine the impact of thoracic endovascular aortic repair (TEVAR) with provisional extension to induce complete attachment (PETTICOAT) technique on remodeling as it relates to geometric changes of the aorta. Clinical and radiographic data for 10 patients (all male; mean age, 68.3 years) with type B aortic dissection (TBAD) treated with TEVAR + PETTICOAT at a single institution were examined. Indications for intervention included malperfusion (n = 5), false lumen aneurysmal degeneration (n = 3), or refractory pain (n = 2). Geometric analysis of the dissected aorta and associated deformation induced by TEVAR + PETTICOAT were analyzed using patient-specific computational modeling. Utilizing pre- and post-intervention computed tomographic angiography, centerline and cross-section measurements were obtained along the entire aortic wall, as well as true and false lumens. Anatomic locations of the supra-aortic arch and renovisceral branches were extracted. Aortic arclength, curvature, cross-sectional area, and circumferences of the ascending aorta, aortic arch, descending thoracic, and abdominal aorta were computed to quantify pre-to-post-TEVAR + PETTICOAT remodeling (Fig 1). From pre- to post-TEVAR + PETTICOAT, the true lumen exhibited a significant reduction of the peak curvature at the aortic arch (pre: 0.043/mm vs post: 0.030/mm; P = .05) and descending thoracic aorta (pre: 0.038/mm vs post: 0.034/mm; P = .02). Ascending aortic whole lumen had significantly decreased area and circumference (pre: 1136 mm2 vs post: 1062 mm2 [−6.5%]; P = .01 and pre: 119 mm vs post: 116 mm [−2.6%]; P = .01, respectively) post-intervention. Conversely, increased area and circumference of the true lumen was noted in the descending thoracic (pre: 366 mm2 vs post: 657 mm2 [+79.5%]; P = .0001 and pre: 71 mm vs post: 90 mm [+26.8%]; P = .0002, respectively) and abdominal (pre: 229 mm2 vs post: 293 mm2 [+27.9%]; P = .002 and pre: 56 mm vs post: 61 mm [+8.9%]; P = .007, respectively) aorta as a result of TEVAR + PETTICOAT. The false lumen area decreased in the aortic arch (pre: 192 mm2 vs post: 70 mm2 [−63.5%]; P = .03) and descending thoracic aorta (pre: 690 mm2 vs post: 505 mm2 [−26.8%]; P = .01). False lumen geometric remodeling in the abdominal aorta was not significant across any parameter (Table 1). TEVAR + PETTICOAT results in geometric deformations of both the treated thoracoabdominal aorta and untreated ascending and aortic arch. Based on percentage change and statistical significance, the aortic true lumen appeared to have greater early geometric remodeling potential compared with the false lumen in the descending and abdominal aorta. TableParameterLumenPre – TEVAR + PETTICOATPost – TEVAR + PETTICOATAscending aortaAortic archDescending thoracicAbdominal aortaAscending aortaAortic archDescending thoracicAbdominal aortaArclength, mmWhole aorta105 ± 1327 ± 7286 ± 35141 ± 24a106 ± 1627 ± 11290 ± 35146 ± 24aTrue lumen106 ± 1226 ± 6285 ± 33129 ± 23106 ± 1627 ± 11290 ± 35134 ± 19Max curvature, mm-1Whole aorta0.03 ± 0.010.03 ± 0.010.04 ± 0.010.02 ± 0.020.03 ± 0.010.03 ± 0.010.03 ± 0.000.02 ± 0.01True lumen0.04 ± 0.010.04 ± 0.02a0.04 ± 0.01a0.02 ± 0.010.03 ± 0.010.03 ± 0.01a0.03 ± 0.01a0.02 ± 0.02Circumference, mmWhole aorta119 ± 14a111 ± 15a113 ± 1582 ± 9116 ± 14a108 ± 14a119 ± 1684 ± 13True lumen119 ± 15a102 ± 1571 ± 10a56 ± 10a115 ± 15a105 ± 1590 ± 13a61 ± 8aCross-sectional area, mm2Whole aorta1136 ± 272a1005 ± 293a1054 ± 292541 ± 1221062 ± 268a950 ± 263a1161 ± 307570 ± 187True lumen1131 ± 283a854 ± 256366 ± 117a229 ± 96a1056 ± 273a897 ± 257657 ± 178a293 ± 75aFalse lumen10 ± 21192 ± 229a690 ± 234a314 ± 1125 ± 1170 ± 112a505 ± 253a277 ± 176aP < .05 between pre- and post- TEVAR + PETTICOAT geometries. Open table in a new tab