Successful Aortic Remodeling Through the Candy-Plug Technique for Chronic Type B Aortic Dissection

Abstract

Purpose To describe the efficiency of the candy-plug technique using an Excluder aortic extender and obtain optimal aortic remodeling. Case A 46-year-old male patient had a history of acute type B aortic dissection and progressive dilation of the descending aorta (53 mm diameter) with a patent false lumen. He was treated with the candy-plug technique, using an Excluder aortic extender of 32-45 mm was placed and a 16-mm Amplatzer Vascular Plug II. No technical complications were observed in the patient. Good aortic remodeling was observed after 6 months, CT showed complete thrombosis of the false lumen and reduction of the maximum perpendicular diameter of the descending aorta from 53 to 47 mm. The diameter of the other proximal zones of the descending aorta was 45-47 mm, and the Excluder aortic extender changed into an elliptical shape. This is the first report of good aortic remodeling with an elliptical shape by performing the candy-plug technique. Discussion The candy-plug technique using an Excluder aortic extender is an improved method for occluding the false lumen as it provides improved aortic remodeling. The 2 indications for this surgery are limited. A large entry point in the descending abdominal aorta that is more peripheral than the candy-plug position must be visible on contrast-enhanced CT and the false lumen is not too large. We consider candy-plug placement in the true lumen central to the TEVAR to avoid occluding the artery of Adamkiewicz, since we have to avoid the thrombosis of the peripheral false lumen where a candy-plug was placed. Since it is unclear whether long-term results are satisfactory, we must continue to study chronic aortic type B dissection.

Preemptive treatment in the acute and early subacute phase of uncomplicated type B aortic dissections with poor prognosis factors

“…In INSTEAD and ADSORB (4, 8), the rate of aneurysmal progression in the preemptive treatment group was 27% at 5 years and 37% at 1 year, confirming the poor results of preemptive TEVAR alone in the treatment of aortic dissections. Solutions other than STABILISE may be considered to ensure optimal aortic remodeling: the Knickerbocker ( 21), the candy plug (22), or the embolization of the false channel (23).…”