Original Off-Label Endovascular Solution to Occlude False Lumen Rupture in Chronic Type B Aortic Dissection

Marone, Enrico Maria; Leopardi, Marco; Bertoglio, Luca; Mascia, Daniele; Chiesa, Roberto

doi:10.1016/j.avsg.2016.08.034

Cited by 21 publications

(15 citation statements)

References 7 publications

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“…This method affords FL thrombosis throughout the dissected thoraco‐abdominal aorta , but carries significant risks, especially for spinal cord ischemia, as many segmental arteries may be covered. Recently, alternatives were introduced including the “candy‐plug” and “knickerbocker” techniques, relying on FL obstruction by prohibiting distal FL backflow . The “knickerbocker technique” intends to block retrograde FL flow by deploying an oversized stent‐graft in the true lumen followed by controlled rupture of the dissection membrane with a non‐compliant balloon expanding the graft to prevent backflow through abdominal entry tears .…”

Section: Discussionmentioning

confidence: 99%

“…Various endovascular techniques have been proposed to promote FL thrombosis and mitigate aneurysmal degeneration . False lumen management has been reported with devices such as a candy‐plug in the FL or overexpansion of stent‐graft in the true lumen. The FLIRT concept relies on alternative, minimalistic, percutaneous interventions to manage the FL by inducing thrombosis, both proximally and distally, by use of occluder devices, vascular plugs, distal stent‐grafts or coils and glue.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

False lumen intervention to promote remodelling and thrombosis—The FLIRT concept in aortic dissection

Yuan

Mitsis

Semple

et al. 2018

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

False lumen intervention to promote remodelling and thrombosis—The FLIRT concept in aortic dissection

Yuan

Mitsis

Semple

et al. 2018

Cathet Cardio Intervent

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“…3,4 Although reliable, its efficacy for rTBD is scarcely addressed. 5 Our experience demonstrates a safe and effective way to rescue rTBD by interrupting retrograde flow using a modified candy-plug technique. This endovascular treatment is effective in reducing false lumene related hemorrhage and improving survival and thus merits serious consideration in all patients with rTBD.…”

Section: Discussionmentioning

confidence: 85%

Modified Candy-Plug Technique for Rescue Type B Aortic Dissection with False Lumen Rupture

Lin

Chu

et al. 2019

Annals of Vascular Surgery

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Despite recent advances in surgical techniques and endovascular devices, the management of ruptured type B aortic dissection remains challenging. Herein, we describe a patient with a history of chronic type B aortic dissection who presented to the emergency department with a massive left hemothorax and profound shock. Computed tomography demonstrated a thoracic dissecting aneurysm with false lumen rupture. He underwent emergent thoracic endovascular aortic repair and carotidecarotid crossover bypass in a hybrid operating room. Although the thoracic endovascular aortic repair resulted in suitable sealing over the primary entry tear, aortography revealed prominent retrograde flow through the distal re-entry tear into the false lumen. To depressurize the ruptured aortic segment fully, we implanted a modified candyplug device in the false lumen and successfully occluded the retrograde flow. This case report illustrates the preliminary experience of using modified candy-plug device to rescue a critical patient with ruptured type B aortic dissection.

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“…The latter approach has been attempted using coils and/or liquid embolic agents, 5 and even a candy plug. 6 Alternatively a covered stent has been used to close re-entry. 7 Overall, most of these techniques have been applied in elective cases, and the experience with such techniques in rupture cases is limited.…”

Section: Discussionmentioning

confidence: 99%

“… 7 Overall, most of these techniques have been applied in elective cases, and the experience with such techniques in rupture cases is limited. 6 …”

Section: Discussionmentioning

confidence: 99%

Multiple Re-entry Closures After TEVAR for Ruptured Chronic Post-dissection Thoraco-abdominal Aortic Aneurysm

Kinoshita

Ganaha

Ito

et al. 2018

EJVES Short Reports

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IntroductionAlthough thoracic endovascular aortic repair (TEVAR) has become a promising treatment for complicated acute type B dissection, its role in treating chronic post-dissection thoraco-abdominal aortic aneurysm (TAA) is still limited owing to persistent retrograde flow into the false lumen (FL) through abdominal or iliac re-entry tears.ReportA case of chronic post-dissection TAA treatment, in which a dilated descending FL ruptured into the left thorax, is described. The primary entry tear was closed by emergency TEVAR and multiple abdominal re-entries were closed by EVAR. In addition, major re-entries at the detached right renal artery and iliac bifurcation were closed using covered stents. To close re-entries as far as possible, EVAR was carried out using the chimney technique, and additional aortic extenders were placed above the coeliac artery. A few re-entries remained, but complete FL thrombosis of the rupture site was achieved. Follow-up computed tomography showed significant shrinkage of the FL.DiscussionIn treating post-dissection TAA, entry closure by TEVAR is sometimes insufficient, owing to persistent retrograde flow into the FL from abdominal or iliac re-entries. Adjunctive techniques are needed to close these distal re-entries to obtain complete FL exclusion, especially in rupture cases. Recently, encouraging results of complete coverage of the thoraco-abdominal aorta with fenestrated or branched endografts have been reported; however, the widespread employment of such techniques appears to be limited owing to technical difficulties. The present method with multiple re-entry closures using off the shelf and immediately available devices is an alternative for the endovascular treatment of post-dissection TAA, especially in the emergency setting.

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Original Off-Label Endovascular Solution to Occlude False Lumen Rupture in Chronic Type B Aortic Dissection

Cited by 21 publications

References 7 publications

False lumen intervention to promote remodelling and thrombosis—The FLIRT concept in aortic dissection

False lumen intervention to promote remodelling and thrombosis—The FLIRT concept in aortic dissection

Modified Candy-Plug Technique for Rescue Type B Aortic Dissection with False Lumen Rupture

Multiple Re-entry Closures After TEVAR for Ruptured Chronic Post-dissection Thoraco-abdominal Aortic Aneurysm

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