The Provisional Extension to Induce Complete Attachment (PETTICOAT) technique using distal bare stents can enhance the effect of proximal thoracic endovascular aortic repair. Here, we present the case of a patient who underwent open surgical conversion and bare stent removal due to progressive thoraco-abdominal aortic enlargement. Previously placed bare-metal stents were embedded deeply in the aortic wall. After explantation of the bare stents, reno-visceral arterial orifices became fragile due to considerable intimal defects, and special care was necessary to make buttons and subsequent separate branch graft anastomoses. As bare stent removal makes open surgical conversion technically difficult, the indication for the PETTICOAT technique should be considered.
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