Purpose: To present a new endovascular technique to avoid open surgical arch reconstruction in selected patients with aneurysmal dilatation due to small chronic dissection entries in the aortic arch. Technique: The true and the false lumen of the aortic arch are catheterized from the femoral arteries. An Amplatzer Vascular Plug II (AVP II) is advanced through the proximal entry from the false lumen side and deployed as a sealing button in the entry hole, with 1 disc in the true lumen and the remaining 2 discs in the false lumen. This technique was used in 4 patients with chronic dissection involving the aortic arch, three of whom had had previous surgery for acute type A aortic dissection. In 3 patients, the false lumen of the thoracic aorta was successfully obliterated, with thrombosis and aortic diameter reduction during follow-up. In 1 patient, false lumen flow persisted, and he was subsequently treated with a total arch reconstruction and frozen elephant trunk. Conclusion: Endovascular closure of small proximal dissection entries in the aortic arch with an AVP II used as a sealing button is feasible and may be an alternative to open surgical arch reconstruction in selected patients with chronic aortic dissection and secondary aneurysm expansion.
DakeMDKatoNMitchellRSEndovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340:1546–1552.
2.
LönnLDelleMFalkenbergMEndovascular treatment of type B aortic dissections. J Card Surg. 2003;18:539–544.
3.
ReschTADelleMFalkenbergMRemodeling of the thoracic aorta after stent grafting of type B dissection: a Swedish multicenter study. J Cardiovasc Surg (Torino). 2006;47:503–508.
4.
FattoriRCaoPDe RangoPInterdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol. 2013;61:1661–1678.
5.
HaulonSGreenbergRKSpearRGlobal experience with an inner branched arch endograft. J Thorac Cardiovasc Surg. 2014;148:1709–1716.
6.
HalsteadJCMeierMEtzCThe fate of the distal aorta after repair of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2007;133:127–135.
7.
LeMaireSACarterSACoselliJS. The elephant trunk technique for staged repair of complex aneurysms of the entire thoracic aorta. Ann Thorac Surg. 2006;81:1561–1569.
8.
WangWLiHTamMDThe Amplatzer vascular plug: a review of the device and its clinical applications. Cardiovasc Intervent Radiol. 2012;35:725–740.
9.
KimuraNItohSYuriKReoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015;149(2 Suppl):S91–S98.
10.
KölbelTCarpenterSWLohrenzCAddressing persistent false lumen flow in chronic aortic dissection: the Knickerbocker technique. J Endovasc Ther. 2014;21:117–122.
11.
KölbelTLohrenzCKiebackADistal false lumen occlusion in aortic dissection with a homemade extra-large vascular plug: the candy-plug technique. J Endovasc Ther. 2013;20:484–489.
12.
IdreesJRoselliEEShafiiSOutcomes after false lumen embolization with covered stent devices in chronic dissection. J Vasc Surg. 2014;60:1507–1513.
13.
ZinkJNManessMRPowellCSCoil embolization of persistent false lumen after type A dissection repair. Ann Thorac Surg. 2014;97:2193–2196.
14.
KimTHLeeJHShimWH. Embolization of persistent false lumen through re-entry tear in a patient who underwent hemiarch replacement operation due to type A dissection. Ann Thorac Surg. 2015;99:e43–e45.
