The “Petticoat Procedure” after Acute Type-B Aortic Dissection in Patients with Confirmed Marfan's Syndrome

Objectives: Even though long-term mortality data are missing, patients that were treated with the petticoat technique showed positive aortic remodeling. Aim of this analysis is to report aortic remodeling characteristics in patients with Marfan's syndrome.

Methods: We retrospectively screened a single-center database of endovascular aortic repairs in aortic dissections. Inclusion criteria were (1) acute type-B aortic dissection (2) treated with TEVAR and complemented uncovered stent implantation distal to the thoracic stent graft (Petticoat Technique), (3) genetically confirmed Marfan's syndrome, and (4) complete clinical- and imaging data from pre-TEVAR diagnostics to the latest follow-up.

Result: Between 11/2011 and 02/2014, four patients matched all inclusion criteria. All patients had a pathogenic FBN1 variant, identified by Sanger sequencing. . The mean time between the intervention and the latest CT-scan follow-up was 1186 (± 345) days. In the most recent follow-up CT Scan, the patients showed positive remodeling of the stented segment in the descending aorta (Fig. 1a). The mean maximum cross sectional area in the descending aorta decreased from 896 (±363) mm² to 736 (± 393) mm². The abdominal segments showed negative remodeling. The mean cross sectional areas increased at the level of the celiac trunk from 614 (± 183) mm² to 1,326 (± 465) mm², and the maximum infrarenal cross-sectional area increased from 486 (± 175) mm² to 1,265 (± 125) mm².

Conclusion: The petticoat technique is an adequate therapy for malperfusion syndrome, but in this analysis of four cases it did not prevent negative aortic remodeling in Marfan's syndrome patients.

Publication History

Article published online:
19 February 2021