The Caged Knickerbocker: A Novel Modification to Targeted False Lumen Management in Complex Aortic Dissection

Area of Science:

• Vascular Surgery
• Cardiovascular Research
• Interventional Cardiology

Background:

• Targeted false lumen management is crucial for complex aortic dissections.
• The traditional Knickerbocker technique risks visceral propagation and malperfusion.
• A novel modification, the Caged Knickerbocker (CKB) technique, is introduced.

Purpose of the Study:

• To describe a novel modification of the Knickerbocker technique for aortic dissection.
• To evaluate the technical feasibility and early outcomes of the Caged Knickerbocker (CKB) repair.
• To assess the CKB approach's potential for managing complex thoracoabdominal aortic aneurysms.

Main Methods:

• Retrospective chart review of patients undergoing Caged Knickerbocker (CKB) repair from 2018-2020.
• Inclusion criteria: history or current presentation of aortic dissection and CKB repair.
• Data collected: demographics, repair indications, technical success, perioperative outcomes, and mortality.

Main Results:

• Five patients were included; 80% had chronic Type B aortic dissection with aneurysmal degeneration.
• 60% had prior aortic repairs, including Type A dissections requiring complex procedures.
• CKB repair was technically successful in all cases with no perioperative complications; 40% required further intervention for aneurysmal degeneration.

Conclusions:

• The Caged Knickerbocker (CKB) approach is technically feasible and demonstrates early successful outcomes in false lumen management for aortic dissection.
• CKB facilitates potential future distal extension into the para-visceral aorta for complex thoracoabdominal aortic aneurysms.
• Further research is needed to identify patient subgroups benefiting from CKB and compare outcomes with other techniques.