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The Knickerbocker Technique: Technical Aspects and Single-Center Results of a New Endovascular Method for False Lumen
Fiona Rohlffs1, Nikolaos Tsilimparis1, Giuseppe Panuccio1
1Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Insights
The Knickerbocker Technique offers a minimally invasive endovascular approach for chronic aortic dissection, successfully achieving false lumen occlusion and promoting aortic remodeling.
Area of Science:
- Cardiovascular Surgery
- Endovascular Interventions
- Aortic Disease Management
Background:
- Chronic aortic dissection presents complex challenges for treatment.
- False lumen patency and aneurysm formation require effective management strategies.
- Traditional open repair methods carry significant risks.
Purpose of the Study:
- To detail the technical aspects of the Knickerbocker Technique.
- To report early clinical outcomes of this novel fenestration method.
- To evaluate its efficacy in false lumen occlusion for chronic aortic dissection.
Main Methods:
- Retrospective observational study of 16 patients undergoing thoracic endovascular aortic repair.
- Utilized the Knickerbocker Technique for false lumen occlusion in chronic aortic dissection.
- Assessed technical success, clinical success (false lumen occlusion), survival, morbidity, and aortic remodeling via CT angiography.
Main Results:
- Achieved 94% technical success and 100% 30-day survival.
- Demonstrated effective false lumen occlusion and thoracic aortic remodeling in 75% of patients with imaging follow-up.
- Reported low invasiveness with one reintervention and no aneurysm growth observed.
Conclusions:
- The Knickerbocker Technique is a feasible and minimally invasive endovascular fenestration method.
- It effectively achieves false lumen occlusion and promotes aortic remodeling in chronic aortic dissection.
- This technique represents a promising advancement in managing complex aortic pathologies.
Purpose:
To describe the technical aspects and early results of a new endovascular fenestration method for false lumen occlusion in chronic aortic dissection: the Knickerbocker Technique.
Methods:
A retrospective observational study including all consecutively treated patients between November 1, 2012, through May 31, 2016, who underwent thoracic endovascular aortic repair with false lumen occlusion using the Knickerbocker Technique for thoracic false lumen aneurysm in chronic aortic dissection in a tertiary care center. Primary endpoints consisted of technical (correct deployment of the stent-graft) and clinical (false lumen occlusion) success. Secondary endpoints included overall survival and morbidity after 30 days. In 12 patients, follow-up computed tomography angiogram (CTA) was available and aortic remodeling was evaluated.
Results:
We identified 16 eligible patients (75% men, mean age: 69 years, range: 52-80 years). Technical success was 94%. Overall survival after 30 days was 100%; there was 1 aortic reintervention (additional false lumen embolization due to endoleak type 1a in 1 patient). Median total follow-up was 31.5 months (range: 3-66 months). Four (25%) of 16 patients died during follow-up, in 3 of those patients the cause of death is unknown, and 1 patient developed cardiac tamponade after being treated by fenestrated thoracic endovascular aortic repair. Imaging follow-up with CTA was available in 12 patients (median imaging follow-up: 27.5 months, range: 1-57 months). Nine (75%) of 12 patients showed thoracic aortic remodeling, and in 3 patients aneurysm size was stable. No patient showed aneurysm growth.
Conclusion:
The Knickerbocker Technique is a feasible endovascular fenestration method to achieve false lumen occlusion and aortic remodeling in chronic aortic dissection with low invasiveness.
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