Related Experiment Video
Updated: Jul 13, 2026
A New Murine Model of Endovascular Aortic Aneurysm Repair
Published on: July 7, 2013
A Systematic Review on PETTICOAT and STABILISE Techniques for the Management of Complicated Acute Type B Aortic
Petroula Nana1, George Kouvelos1, Christian-Alexander Behrendt2
1Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece.
Insights
The Provisional Extension To Induce Complete Attachment (PETTICOAT) and stent-assisted balloon-induced intimal disruption and relamination (STABILISE) techniques show high technical success and low 30-day mortality for acute complicated type B aortic dissection. Mid-term mortality was 6%, indicating a need for further research.
Area of Science:
- Cardiovascular Surgery
- Endovascular Interventions
- Aortic Disease Management
Background:
- Acute complicated type B aortic dissection (acTBAD) management often requires extended downstream endovascular repair.
- Techniques like Provisional Extension To Induce Complete Attachment (PETTICOAT) and stent-assisted balloon-induced intimal disruption and relamination (STABILISE) are used for distal TEVAR extension.
- These methods involve bare metal stents, lamina disruption, and balloon inflation.
Purpose of the Study:
- To systematically review the technical success, 30-day mortality, and follow-up mortality in acTBAD patients treated with PETTICOAT or STABILISE.
- To evaluate the efficacy and safety of these advanced endovascular techniques.
Main Methods:
- A systematic review adhering to PRISMA 2020 guidelines.
- Literature search of MEDLINE, EMBASE, and CENTRAL databases up to August 30, 2022.
- Inclusion of randomized controlled trials and observational studies (2000-2022) with >=5 patients, assessing technical success, 30-day, and follow-up mortality.
Main Results:
- Thirteen studies (418 patients) were included; 83% received PETTICOAT, 17% STABILISE.
- Technical success rates were high: 97-100% (PETTICOAT 99%, STABILISE 100%).
- 30-day mortality was 3.7% overall (PETTICOAT 4.4%, STABILISE 1.4%). Follow-up mortality was 5.7% (PETTICOAT 7.0%, STABILISE 0%).
Conclusions:
- Both PETTICOAT and STABILISE techniques demonstrate high technical success and low perioperative mortality (<4%) in acTBAD.
- Mid-term mortality is approximately 6%, with STABILISE showing 0% mortality in this review.
- Further prospective studies with larger cohorts and longer follow-up are necessary due to study heterogeneity.
Background:
Extended downstream endovascular management has been applied in acute complicated type B aortic dissection (acTBAD), distally to standard thoracic endovascular aortic repair (TEVAR), using bare metal stents, with or without lamina disruption, using balloon inflation. The aim of this systematic review was to assess technical success, 30-day mortality, and mortality during follow-up in patients with acTBAD managed with the Provisional Extension To Induce Complete Attachment (PETTICOAT) or stent-assisted balloon-induced intimal disruption and relamination (STABILISE) technique.
Methods:
The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement was followed. A search of the English literature, via Ovid, using MEDLINE, EMBASE, and CENTRAL databases, until 30th August 2022, was executed. Randomized controlled trials and observational studies (published between 2000-2022), with 5 patients, reporting on technical success, 30-day mortality and mortality during the available follow-up among patients that underwent PETTICOAT or STABILISE technique for acTBAD were eligible. The Newcastle-Ottawa Scale was applied to assess the risk of bias. Primary outcomes were technical success and 30-day mortality, and secondary outcome was mortality during the available follow-up.
Results:
Thirteen studies were considered eligible, twelve in the quantitative analysis. In total, 418 patients with acTBAD managed with the PETTICOAT (83%) or STABILISE (17%) technique were included. Technical success ranged between 97-100%, 99% for the PETTICOAT and 100% for the STABILISE sub-cohort. Thirty-day mortality was estimated at 3.7% (12/321), 1.4% for the STABILISE and 4.4% for the PETTICOAT technique. All studies reported the mean available follow-up which was estimated at 20 months (range 3-168 months), 22 months (mean value) for the PETTICOAT and 17 months (mean value) for the STABILISE technique. Twenty-three patients died during follow-up, with an estimated mortality rate at 5.7% for the total cohort. The mortality during follow-up was 0% for the STABILISE and 7.0% for the PETTICOAT approach.
Conclusions:
Both, the PETTICOAT and STABILISE techniques presented less than 4% perioperative mortality in patients with acTBAD with high technical success rate. The mid-term mortality rate was at 6%. However, the heterogeneity in the available studies' highlights the need for further prospective studies, including larger volume and longer follow-up.
Related Concept Videos
01:26Aneurysm III: Interprofessional Care
01:22Aneurysm IV: Nursing Management