A modified candy-plug technique to occlude false lumen in aortic dissection

Abstract

Purpose Aim of this technical note article is to introduce a modified, novel way to custom create a candy-plug (CP) device to endovascularly occlude false lumen. The technique is illustrated by a patient case with significant backflow to false lumen (FL). The patient had already undergone surgical repair of the ascending aorta, aortic arch and subsequent TEVAR procedure down to the ostium of the celiac trunk because of type A aortic dissection, but the descending thoracic aorta continued to dilate due to backflow to the FL from an uncovered tear at the level of the renal arteries. Materials and methods We modified a Gore Excluder 36–45 mm aortic extender (W. L. Gore & Associates, Inc. Flagstaff, USA) endoprosthesis into a CP device that was subsequently positioned under local anesthesia into the FL of the distal descending thoracic aorta. Results In 1 month control the backflow to false lumen had ceased and the aorta had decreased in diameter from 69 to 66 mm, FL from 37 to 34 mm, true lumen (TL) remained the same 32 mm. Conclusion We describe a modified, effective candy-plug technique to occlude retrograde false lumen filling in aortic dissection.

Effect of False Lumen Occlusion Treatment With AFX VELATM, Candy-Plug Technique for Chronic Aortic Dissection

“…However, with the Candy-Plug technique, there is a known issue of blood flow residue seeping through the gap between the false lumen wall and the deployed device, leading to gutter leaks. Although several modifications have been attempted, [14][15][16][17][18][19][20] the fundamental form remains similar, and this issue has not been completely resolved. Circular stent grafts have not been able to fully occlude this gap in cases of crescent-shaped false lumen morphology (Figure 3A).…”