PMID- 36342189
OWN - NLM
STAT- Publisher
LR  - 20240216
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
DP  - 2022 Nov 7
TI  - Initial Single-Center Experience With the Knickerbocker Technique During Thoracic 
      Endovascular Aortic Repair to Block Retrograde False Lumen Flow in Patients With 
      Type B Aortic Dissection.
PG  - 15266028221134889
LID - 10.1177/15266028221134889 [doi]
AB  - OBJECTIVE: Effectiveness of thoracic endovascular aortic repair in type B aortic 
      dissection is impaired by persistent retrograde false lumen flow via distal 
      re-entry tears. Controlled, stentgraft-assisted balloon dilatation of the true 
      lumen at its lower end, or Knickerbocker technique, may block retrograde false 
      lumen flow and consequently improve effectiveness by inducing immediate 
      thrombosis along the entire descending thoracic aorta. MATERIALS AND METHODS: A 
      single-center retrospective analysis was performed for all consecutive patients 
      with aortic dissection treated with the Knickerbocker technique to block 
      retrograde false lumen flow. RESULTS: Eleven patients were included for analysis. 
      Intraoperative control angiography showed successful occlusion of the false lumen 
      at the level of balloon dilatation in 9 out of 11 patients (82%). There was one 
      perioperative mortality (9%), due to stroke. There were 2 early reinterventions, 
      due to retroperitoneal bleeding and due to chyle leakage in the neck after left 
      subclavian artery bypass. Median clinical follow-up duration was 6 (interquartile 
      range [IQR] 2-11] months. There were 2 deaths during follow-up, one at 2 months 
      after TEVAR from unknown cause of death, and one after 11 months due to rupture 
      of an ascending aortic pseudoaneurysm. The Knickerbocker technique led to 
      positive aortic remodeling. At 3 months follow-up, 100% of patients showed 
      complete false lumen thrombosis in the thoracic aorta proximal to the level of 
      balloon dilatation, with decreasing false lumen diameters (100%) and stable (44%) 
      or decreasing (56%) total aortic diameters. In most patients, the false lumen 
      distal to the stentgraft (i.e. at visceral level) remained patent (11% false 
      lumen thrombosis rate), leading to >/=2 mm dilatation at this level (78% of 
      patients) and in the infrarenal abdominal aorta (56% of patients) at 3 months 
      postoperatively. No distal stent-graft-induced new entry tears were noticed 
      during follow-up. CONCLUSION: The Knickerbocker technique is feasible and 
      effective, leading to positive aortic remodeling of the aorta covered by 
      stentgraft in all of a small cohort of patients. CLINICAL IMPACT: Persistent, 
      retrograde false lumen perfusion from distal re-entries following thoracic 
      endovascular aortic repair (TEVAR) for Stanford type B aortic dissection, may 
      lead to progressive, aneurysmal dilatation. Controlled, stent graft-assisted 
      balloon dilatation of the true lumen in the distal descending aorta (i.e. 
      Knickerbocker technique) during TEVAR effectively excludes the false lumen from 
      persistent flow resulting in positive aortic remodeling in our small cohort of 
      patients, and hence potentially eliminates the risk of late post-dissection 
      aneurysm formation in the descending thoracic aorta.
FAU - de Beaufort, Hector Willem Livius
AU  - de Beaufort HWL
AUID- ORCID: 0000-0003-1658-9692
AD  - Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The 
      Netherlands.
FAU - Vos, Jan Albert
AU  - Vos JA
AD  - Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The 
      Netherlands.
FAU - Heijmen, Robin H
AU  - Heijmen RH
AD  - Department of Cardiothoracic Surgery, Radboud university medical center, 
      Nijmegen, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20221107
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
OTO - NOTNLM
OT  - TEVAR
OT  - aortic dissection
OT  - balloon dilatation
OT  - false lumen exclusion
EDAT- 2022/11/08 06:00
MHDA- 2022/11/08 06:00
CRDT- 2022/11/07 08:12
PHST- 2022/11/07 08:12 [entrez]
PHST- 2022/11/08 06:00 [pubmed]
PHST- 2022/11/08 06:00 [medline]
AID - 10.1177/15266028221134889 [doi]
PST - aheadofprint
SO  - J Endovasc Ther. 2022 Nov 7:15266028221134889. doi: 10.1177/15266028221134889.