"Hotwire Knickerbocker" Technique To Facilitate Distal Landing Zone For Thoracic Endovascular Aortic Repair In Chronic Type B Aortic Dissection
Alexander P. Nissen, MD, Yazan M. Duwayri, MD, William D. Jordan, MD, Vasilis C. Babaliaros, MD, Bradley G. Leshnower, MD.
Emory University, Atlanta, GA, USA.
Objective: Efficacy of thoracic endovascular aortic repair (TEVAR) for chronic Type B aortic dissection (CTABD) is dependent upon aortic remodeling. In CTBAD, specifically DeBakey IIIB dissection, the presence of a thick aortic septum, with continued retrograde false lumen perfusion, and pressurization, remains a significant obstacle for successful TEVAR. Various strategies to optimize TEVAR in chronic type B aortic dissection have been described, including creation of a single lumen at or near the distal TEVAR landing zone in order to prevent retrograde false lumen perfusion.Methods: Transcatheter electrosurgical techniques, well-described in alternative access transcatheter aortic valve replacement, may offer improved precision for creation of a single lumen in chronic type B aortic dissection, and is the basis for the so-called "hotwire knickerbocker" technique.Results: Presented herein we treat a 7.6cm chronic residual Type B dissection after previous Type A dissection repair, in a high-risk patient, with transcatheter electrosurgical distal aortic fenestration and TEVAR, with successful obliteration of false lumen perfusion.Conclusions: We believe the use of electrosurgical aortic fenestration, or the so-called Emory Hotwire Knickerbocker technique offers a means to improve precision when creating a single lumen at the distal landing zone. Until tailored devices for chronic type B aortic dissection are available, multidisciplinary teams of aortic and endovascular experts will need to continue to innovate and devise optimal treatment strategies for this complex pathology.
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