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Volume changes in aortic true and false lumen after the “PETTICOAT” procedure for type B aortic dissection  Germano Melissano, MD, Luca Bertoglio, MD,

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Presentation on theme: "Volume changes in aortic true and false lumen after the “PETTICOAT” procedure for type B aortic dissection  Germano Melissano, MD, Luca Bertoglio, MD,"— Presentation transcript:

1 Volume changes in aortic true and false lumen after the “PETTICOAT” procedure for type B aortic dissection  Germano Melissano, MD, Luca Bertoglio, MD, Enrico Rinaldi, MD, Efrem Civilini, MD, Yamume Tshomba, MD, Andrea Kahlberg, MD, Eustachio Agricola, MD, Roberto Chiesa, MD  Journal of Vascular Surgery  Volume 55, Issue 3, Pages (March 2012) DOI: /j.jvs Copyright © 2012 Society for Vascular Surgery Terms and Conditions

2 Fig 1 The Zenith Dissection Endovascular System (William Cook Europe, Bjaerverskov, Denmark) is a modular system specifically designed to treat aortic dissection that consists of a proximal component, the Zenith TX2-P TAA Endovascular Graft and a distal component, the Zenith Dissection Endovascular stent. The figure shows preoperative and postoperative computed tomography (CT) scan of acute type B dissection treated with these devices. Preoperative CT shows a typical case of type B dissection with collapse of the true lumen (yellow arrow head) and renal malperfusion (note the absence of contrast enhancement of the right renal artery and perfusion of the left kidney from the false lumen). Postoperative CT shows exclusion of the thoracic false lumen and complete re-expansion of the true lumen in the thoracic and abdominal segment with restoration of perfusion of the right kidney (left renal stenting was performed in this case to perfuse the left renal artery from the re-expanded true lumen). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

3 Fig 2 In each patient, we performed volumetric analysis of contrast-enhanced helical computed tomography (CT) covering the entire aorta starting from the innominate artery to the aortic bifurcation. Segmentations of the true lumen (TL, green) and false lumen (FL, red) were performed and volumes were calculated separately. The celiac trunk divided the thoracic segment from the abdominal portion of the aorta. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

4 Fig 3 True lumen (TL, green) and false lumen (FL, red) were selected separately from the innominate artery to the aortic bifurcation for all follow-up computed tomography (CT) scans and compared with preoperative examinations. This example demonstrated the behavior over the time of lumina in the different aortic segment after treatment with the PETTICOAT technique. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Postoperative computed tomography (CT) scan after deployment of the Zenith Dissection system. In only this single case, we observed the rupture of the dissection lamella at the distal part of the thoracic aorta where the bare stent was deployed. There were no clinical consequences in this case. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Transesophageal echocardiography shows the flapping movement of the dissecting lamella in case of acute aortic dissection during cardiac cycle (A, systole and B, diastole). Bare stenting of the true lumen (TL) avoids the motion of the lamella promoting false lumen (FL) thrombosis (note visualization of a secondary entry tear during diastole). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

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