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.