Symptomatic Aortic Bare-Metal Stent Fracture after PETTICOAT Technique for Complicated Type B Aortic Dissection

Ann Vasc Surg . 2019 Aug;59:311.e1-311.e4. doi: 10.1016/j.avsg.2018.12.098. Epub 2019 Feb 23.

Fecha de la publicación: 23/02/2019

Autor: África Duque Santos (1), Andrés Reyes Valdivia (2), Sergio Gordillo Alguacil (2), Julia Ocaña Guaita (2), Claudio Gandarias Zúñiga (2)



1Department of Vascular and Endovascular Surgery, Ramón y Cajal’s University Hospital, Madrid, Spain. Electronic address:

2Department of Vascular and Endovascular Surgery, Ramón y Cajal’s University Hospital, Madrid, Spain.


Background: Aortic bare-metal stent rupture is an exceptional complication, associated with high risk of aorta rupture and death. We describe a successful endovascular approach for a symptomatic aortic bare-metal stent fracture after the provisional extension to induce complete attachment (PETTICOAT) technique.

Methods: A 53-year-old man with a complicated type B aortic dissection (visceral malperfusion) was treated with thoracic endovascular aortic repair (TEVAR) and «PETTICOAT» technique. The 1-, 6-, and 12-month follow-up scans showed progressive aortic remodeling. After 15 months from the initial procedure, the patient was admitted to the emergency department with severe thoracic pain and two syncopal episodes. Urgent angio-computed tomography (CT) showed bare-metal stent rupture and aortic dilatation to 45 mm at the site of stent fracture.

Results: He was urgently treated with TEVAR to cover the entire length of the bare-metal stent under local anesthesia and motor-evoked potential (MEP) monitoring. If signs of medullary ischemia are observed in the MEP register, a carotid-subclavian bypass was planned. At 12 months of follow-up, the patient remains asymptomatic. CT scan at 1 month and 12 months showed no signs of endoleak and aortic remodeling to 40 mm.

Conclusions: Although unusual, this case demonstrates the possibility of material fatigue/failure and highlights the need of close imaging follow-up after TEVAR for treatment of aortic diseases.