Midterm Outcomes of the Knickerbocker Technique following Thoracic Endovascular Aortic Repair for Chronic Post-dissection Thoracic Aortic Aneurysms: A Single Centre Experience☆

IF 8.5 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2026-10-01 Epub Date: 2026-02-09 DOI:10.1016/j.ejvs.2026.02.003

Anastasia Dean, Kelly Feng, Summer Hassan, Abdelaziz Marzoug, David Lindstrom, Andrew Holden

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This single centre case series evaluated midterm outcomes of KB in patients with post-dissection thoracic aortic aneurysms (TAA).</div><div><h3>Methods</h3><div>This study analysed a retrospective cohort including all TEVARs with the KB technique at an aortic centre between July 2014 and April 2024. Data were obtained from a prospective aortic database and electronic records. The primary outcome was technical KB success with intimal flap disruption and endograft expansion, without any KB related adverse events of aortic rupture, extension of aortic dissection, or distal stent graft induced new entry (dSINE). Secondary outcomes were positive aortic remodelling, FL thrombosis, true lumen (TL) expansion on surveillance imaging, and freedom from aortic re-intervention and aortic related death.</div></div><div>This study analysed a retrospective cohort including all TEVARs with the KB technique at an aortic centre between July 2014 and April 2024. Data were obtained from a prospective aortic database and electronic records. The primary outcome was technical KB success with intimal flap disruption and endograft expansion, without any KB related adverse events of aortic rupture, extension of aortic dissection, or distal stent graft induced new entry (dSINE). Secondary outcomes were positive aortic remodelling, FL thrombosis, true lumen (TL) expansion on surveillance imaging, and freedom from aortic re-intervention and aortic related death.</div><div><h3>Results</h3><div>Twenty-one patients were included (median age 63 years, interquartile range [IQR] 55, 70; 81% men), with TAA following type B (14; 67%) and repaired type A (7; 33%) aortic dissections. The majority (90%) were elective and performed during the chronic period (median time from index dissection 58 months [IQR 22, 108]). The primary outcome was achieved in all cases. There were three peri-operative adverse events (one minor stroke, one retrograde type A dissection, and one iliac rupture). Positive aortic remodelling was achieved in all patients: at 12 months, the median maximum aortic diameter reduced from 60 mm (IQR 55, 64) to 48 mm (IQR 43.5, 53.5) (<em>p</em> < .001), the median FL diameter reduced from 40 mm (IQR 32, 44) to 14 mm (IQR 2.5, 21.5) (<em>p</em> < .001), and the median TL increased from 20 mm (IQR 14, 22) to 35 mm (IQR 32.5, 36) (<em>p</em> < .001). Seventeen patients (81%) had FL thrombosis, with a median time to thrombosis detection of three months. The aortic diameter at the KB site and distally remained stable, and there was no dSINE or extension of dissection. One patient underwent aortic re-intervention at 106 months post-procedure; there were no instances of thoracic aortic re-intervention or aortic rupture (median follow up of 42 months).</div></div><div>Twenty-one patients were included (median age 63 years, interquartile range [IQR] 55, 70; 81% men), with TAA following type B (14; 67%) and repaired type A (7; 33%) aortic dissections. The majority (90%) were elective and performed during the chronic period (median time from index dissection 58 months [IQR 22, 108]). The primary outcome was achieved in all cases. There were three peri-operative adverse events (one minor stroke, one retrograde type A dissection, and one iliac rupture). Positive aortic remodelling was achieved in all patients: at 12 months, the median maximum aortic diameter reduced from 60 mm (IQR 55, 64) to 48 mm (IQR 43.5, 53.5) (<em>p</em> < .001), the median FL diameter reduced from 40 mm (IQR 32, 44) to 14 mm (IQR 2.5, 21.5) (<em>p</em> < .001), and the median TL increased from 20 mm (IQR 14, 22) to 35 mm (IQR 32.5, 36) (<em>p</em> < .001). Seventeen patients (81%) had FL thrombosis, with a median time to thrombosis detection of three months. The aortic diameter at the KB site and distally remained stable, and there was no dSINE or extension of dissection. One patient underwent aortic re-intervention at 106 months post-procedure; there were no instances of thoracic aortic re-intervention or aortic rupture (median follow up of 42 months).</div><div><h3>Conclusion</h3><div>KB appears to be a safe and effective adjunct to TEVAR to manage post-dissection TAA.</div></div><div>KB appears to be a safe and effective adjunct to TEVAR to manage post-dissection TAA.</div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"72 4","pages":"Pages 647-656"},"PeriodicalIF":8.5000,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Vascular and Endovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1078588426001358","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/2/9 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

The Knickerbocker (KB) technique selectively manages the thoracic false lumen (FL) following thoracic endovascular aortic repair (TEVAR). This single centre case series evaluated midterm outcomes of KB in patients with post-dissection thoracic aortic aneurysms (TAA).

Methods

This study analysed a retrospective cohort including all TEVARs with the KB technique at an aortic centre between July 2014 and April 2024. Data were obtained from a prospective aortic database and electronic records. The primary outcome was technical KB success with intimal flap disruption and endograft expansion, without any KB related adverse events of aortic rupture, extension of aortic dissection, or distal stent graft induced new entry (dSINE). Secondary outcomes were positive aortic remodelling, FL thrombosis, true lumen (TL) expansion on surveillance imaging, and freedom from aortic re-intervention and aortic related death.

Results

Twenty-one patients were included (median age 63 years, interquartile range [IQR] 55, 70; 81% men), with TAA following type B (14; 67%) and repaired type A (7; 33%) aortic dissections. The majority (90%) were elective and performed during the chronic period (median time from index dissection 58 months [IQR 22, 108]). The primary outcome was achieved in all cases. There were three peri-operative adverse events (one minor stroke, one retrograde type A dissection, and one iliac rupture). Positive aortic remodelling was achieved in all patients: at 12 months, the median maximum aortic diameter reduced from 60 mm (IQR 55, 64) to 48 mm (IQR 43.5, 53.5) (p < .001), the median FL diameter reduced from 40 mm (IQR 32, 44) to 14 mm (IQR 2.5, 21.5) (p < .001), and the median TL increased from 20 mm (IQR 14, 22) to 35 mm (IQR 32.5, 36) (p < .001). Seventeen patients (81%) had FL thrombosis, with a median time to thrombosis detection of three months. The aortic diameter at the KB site and distally remained stable, and there was no dSINE or extension of dissection. One patient underwent aortic re-intervention at 106 months post-procedure; there were no instances of thoracic aortic re-intervention or aortic rupture (median follow up of 42 months).

Conclusion

KB appears to be a safe and effective adjunct to TEVAR to manage post-dissection TAA.

查看原文本刊更多论文

Knickerbocker技术治疗慢性夹层后胸主动脉瘤血管内修复的中期结果：单中心经验。

目的：利用Knickerbocker （KB）技术选择性地处理胸主动脉血管内修复术（TEVAR）后的胸假腔（FL）。该单中心病例系列评估了夹层后胸主动脉瘤（TAA）患者KB的中期预后。方法：本研究分析了2014年7月至2024年4月在主动脉中心采用KB技术的所有tevar患者的回顾性队列。数据来自前瞻性主动脉数据库和电子记录。主要结果是KB技术的技术成功，内膜瓣破裂和内移植物扩张，没有任何KB相关的不良事件，如主动脉破裂、主动脉夹层延伸或远端支架移植诱导的新进入（dsin）。次要结果为主动脉重构阳性、FL血栓形成、监测成像显示真管腔（TL）扩张、免于主动脉再干预和主动脉相关死亡。结果：纳入21例患者（中位年龄63岁，四分位间距[IQR] 63,70； 81%男性），TAA为B型（14例；67%）和修复型A型（7例；33%）主动脉夹层。大多数（90%）是选择性的，并在慢性期（指数剥离后的中位时间为58个月[IQR 22, 108]）进行。所有病例均取得了主要成果。围手术期有3个不良事件（1例轻微中风，1例逆行性A型夹层，1例髂破裂）。所有患者均实现了主动脉重构阳性：在12个月时，中位最大主动脉直径从60 mm （IQR 55,64）降至48 mm (IQR 43.5, 53.5) (p结论：KB似乎是一种安全有效的TEVAR辅助治疗夹层后TAA。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.