Distal Neo-Neck Formation for Chronic Type B Dissection: False Lumen Closure After TEVAR

Abstract

Objectives: Patients with chronic aortic dissection often require repeat interventions due to enlargement of the pressurized false lumen or disseminated intravascular coagulation even after additional thoracic endovascular aortic repair (TEVAR) to occlude the entry tear. Residual false lumen flow can persist even after performing the candy-plug technique or branched stentgraft placement in some cases. We have devised a new method for false lumen closure. Methods: From December 2010 to May 2017, 5 patients (mean age: 57 [13] years, range: 43-77 years) with chronic dissection at the aortic arch and descending aorta, who underwent initial TEVAR, required additional treatment. Using an open surgical approach, the endograft was fixed with an outer felt under cardiopulmonary bypass after the endograft with stent was expanded by fenestration. The false lumen was closed using this procedure, and the aortotomy was repaired by direct closure in 2 cases and by graft replacement in 3 cases. Results: No major operative complications occurred, such as respiratory failure or paraplegia. Postoperative enhanced computed tomography (CT) images showed that the false lumen flow disappeared in all cases. All patients were discharged under normal conditions. They were all followed up and their CT did not indicate any complications for a mean of 33.6 (20.3) months. Conclusions: Our combined procedure was effective and provided a higher success rate compared with endovascular therapy alone. This staged treatment approach, using a combination of TEVAR and false lumen closure, is less invasive compared with open surgery alone and may represent a valid treatment option for chronic type B dissection. Keywords chronic dissection, false lumen closure, open surgery, thoracic endovascular aortic repair formation. This study reports 5 cases treated by distal neo-neck formation after TEVAR.

Management of disseminated intravascular coagulation after thoracic endovascular aortic repair of type B aortic dissection: a case report

“…Particular attention should be paid to the underlying conditions to manage DIC [ 9 ]. Open surgery may be a radical treatment to correct the hemorrhagic diathesis but is quite invasive [ 13 ]. With rapid advances in endovascular technology, different methods for sealing re-entry tears have emerged [ 2 , 4 , 7 , 12 ].…”