20 - Freie Mitteilung
15. Mai 2019, 13:30 - 15:00, Sopra Grande, 4. OG
Early results after distal false lumen occlusion using the candy-plug technique in chronic aortic dissection
T. Wolff, E. Mujagic, L. Gürke, Presenter: T. Wolff (Basel)
Aneurymal false lumen dilatation and rupture are feared consequences of type A or B aortic dissections. Typically, the proximal inflow into the false lumen can be controlled by covering the proximal intimal tear with true lumen TEVAR and / or aortic arch replacement. Preventing false lumen perfusion in the descending aorta from distal intimal tears is challenging. We describe technical details and early postoperative outcome of false lumen occlusion using the candy-plug technique.
Retrospective single-center analysis
From Sep to Nov 2018 we treated 3 patients with the candy-plug technique. The first patient presented with a contained rupture of the false lumen of a 7.7cm dissecting aneurysm 8 years after conservatively treated type B dissection. The second patient presented with acute dyspnea and a 7.7cm dissecting aneurysm of the descending aorta after chronic type B dissection, which had not been diagnosed previously. The third patient presented with acute chest and back pain and rapid false lumen dilatation 18 years after ascending aorta replacement for type A dissection and 18 months after aortic arch replacement with an elephant trunk prosthesis for re-dissection of the arch. All patients were treated with TEVAR of the true lumen from the proximal descending aorta to the coeliac trunk using Gore C-TAG stent grafts and distal false lumen occlusion using a Gore C-TAG stent-graft, modified before deployment by tying a non-resorbable suture around the middle of the stent-graft to restrict the diameter to approx.. 10mm. The remaining opening in the deployed modified stent-graft was occluded with an Amplatzer plug. The procedure was technically successful in all three patients. There was no 30-day mortality and no postoperative neurological deficits. In early postoperative CT-scans no patient had a distal type 1 endoleak into the false lumen but all patients showed type 2 endoleaks into the false lumen vial intercostal arteries.
The modified candy-plug technique using Gore C-TAG stent-grafts appears a technically simple and safe method for distal false lumen occlusion in chronic aortic dissection. It may be particularly useful in cases with contained or imminent rupture, where repair with a custom-made fenestrated graft or open repair are not possible or feasible. Long-term follow is necessary to establish the durability of the treatment.