Sage Journals: Discover world-class research

Abstract

Background:

Management of chronic aortic dissection (AD), particularly thoracic endovascular aneurysm repair (TEVAR), has long posed significant challenges in the field of vascular surgery, especially due to the presence of retrograde false lumen (FL) perfusion following TEVAR, which can lead to aortic rupture. This article presents our initial experience with the modified candy plug (CP) for FL embolization.

Objective:

To evaluate the efficacy and safety of a modified CP approach for embolizing the FL in Chronic AD patients, either after or concurrently with TEVAR.

Methods:

Between May 2021 and August 2024, 11 patients diagnosed with Chronic AD underwent FL embolization using the modified CP. The CP was custom-designed based on each patient’s FL anatomy to ensure optimal occlusion. Preoperative imaging was used to measure the extent and the morphology of the FL. Postoperative outcomes were monitored, with a focus on FL thrombosis and complications, to evaluate the effectiveness of the procedure.

Results:

Technical success was 100%, with 10 patients achieving complete thrombosis, and 1 patient partial thrombosis. The aortic diameter was reduced significantly (4.44±4.14 mm, p<0.010). No major adverse events related to the procedure were observed. After surgery, 1 patient developed a mild access site hematoma. One patient experienced mild numbness in both lower limbs after surgery, which was relieved after rehabilitation treatment. During the follow-up, no deaths or re-interventions occurred.

Conclusions:

This approach showed promising outcomes and effectively addresses one of the shortcomings of TEVAR. It offers a promising solution for FL and dissection expansion.

Clinical Impact

This modified CP approach provides a safe, straightforward endovascular option for treating retrograde FL perfusion in patients with chronic AD. Notably, this approach is easy to assemble, requires no customized devices, and feasible in urgent settings. Successful FL embolization using this approach promotes thrombosis and prevents further expansion of the FL, thereby reducing the risk of aortic rupture. This approach serves as an important adjunct to TEVAR.

Keywords

aortic remodeling candy plug false lumen embolization TEVAR chronic aortic dissection

Get full access to this article

View all access options for this article.

References

Spinelli

Benedetto

Donato

, et al. Current evidence in predictors of aortic growth and events in acute type B aortic dissection. J Vasc Surg. 2018;68(6):1925–1935.

Nienaber

Kische

Rousseau

, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6(4):407–416.

Tang

Chen

Yang

, et al. Factors affecting false lumen thrombosis in type B aortic dissection. Arq Bras Cardiol. 2023;120(8):e20220939.

Wang

, et al. Long-term aortic remodeling after thoracic endovascular aortic repair of acute, subacute, and chronic type B dissections. Front Cardiovasc Med. 2022;9:819501.

Mitreski

Flanders

Maingard

, et al. STABILISE; treatment of aortic dissection, a single centre experience. CVIR Endovasc. 2022;5(1):7.

Jordan

FitzGibbon

Kavanagh

, et al. Endovascular versus open surgical repair for complicated chronic type B aortic dissection. Cochrane Database Syst Rev. 2021;12(12):Cd012992.

Miletic

Kindzelski

Hodges

, et al. Impact of endovascular false lumen embolization on thoracic aortic remodeling in chronic dissection. Ann Thorac Surg. 2021;111(2):495–501.

Loschi

Santoro

Rinaldi

, et al. Open and endovascular reinterventions after Candy Plug false lumen embolization of type B aortic dissection. J Vasc Surg. 2023;78(6):1409–1417.

Bertoglio

Bilman

Rohlffs

, et al. Self-occluding candy-plug: implantation technique to obtain false lumen thrombosis in chronic aortic dissections. J Endovasc Ther. 2023;30(6):811–816.

10.

Eleshra

Haulon

Bertoglio

, et al. Custom made candy plug for distal false lumen occlusion in aortic dissection: international experience. Eur J Vasc Endovasc Surg. 2023;66(1):50–56.

11.

Miles

Arbabi

McMackin

, et al. Initial experience with a modified “candy-plug” technique for false lumen embolization in chronic type B aortic dissection. J Vasc Surg Cases Innov Tech. 2023;9(2):101075.

12.

Erbel

Aboyans

Boileau

, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European society of cardiology (ESC). Eur Heart J. 2014;35(41):2873–2926.

13.

Lombardi

Hughes

Appoo

, et al. Society for vascular surgery (SVS) and society of thoracic surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg. 2020;71(3):723–747.

14.

Leshnower

Duwayri

Chen

, et al. Aortic remodeling after endovascular repair of complicated acute type B aortic dissection. Ann Thorac Surg. 2017;103(6):1878–1885.

15.

Fleischmann

Afifi

Casanegra

, et al. Imaging and surveillance of chronic aortic dissection: a scientific statement from the American heart association. Circ Cardiovasc Imaging. 2022;15(3):e000075.

16.

Kostiuk

Chen

Dahl

, et al. Hybrid revision of dysfunctional aneurysmal arteriovenous fistulas. Vasc Endovascular Surg. 2023;57(8):909–913.

17.

Sayed

Munir

Bahbah

EI.

Aortic dissection: a review of the pathophysiology, management and prospective advances. Curr Cardiol Rev. 2021;17(4):e230421186875.

18.

Riambau

Böckler

Brunkwall

, et al. Editor’s choice—management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017;53(1):4–52.

19.

Andersen

Keenan

Ganapathi

, et al. Current management and outcome of chronic type B aortic dissection: results with open and endovascular repair since the advent of thoracic endografting. Ann Cardiothorac Surg. 2014;3(3):264–274.

20.

Arnaoutakis

Khan

Scali

, et al. Remodeling, reintervention, and survival after endovascular repair of chronic type B dissection. Ann Thorac Surg. 2021;111(5):1560–1569.

21.

Eleshra

Rohlffs

Spanos

, et al. Aortic remodeling after custom-made candy-plug for distal false lumen occlusion in aortic dissection. J Endovasc Ther. 2021;28(3):399–406.

22.

Fanelli

Cannavale

O’Sullivan

, et al. Endovascular repair of acute and chronic aortic type B dissections: main factors affecting aortic remodeling and clinical outcome. JACC Cardiovasc Interv. 2016;9(2):183–191.

23.

Zha

Qiu

Xie

, et al. Surgical outcomes and postoperative descending aorta morphologic remodeling after thoracic endovascular aortic repair for acute and chronic type B aortic dissection. Clin Interv Aging. 2019;14:1925–1935.

24.

Tenorio

Oderich

Farber

, et al. Outcomes of endovascular repair of chronic postdissection compared with degenerative thoracoabdominal aortic aneurysms using fenestrated-branched stent grafts. J Vasc Surg. 2020;72(3):822–836.

25.

Mougin

Schwein

Postiglione

, et al. Management of the false lumen in post type A aortic dissection arch aneurysms treated with branched endografts. J Endovasc Ther. 2024;31(5):927–935.

26.

Tshomba

Melissano

Logaldo

, et al. Clinical outcomes of hybrid repair for thoracoabdominal aortic aneurysms. Ann Cardiothorac Surg. 2012;1(3):293–303.

27.

Kuzniar

Wanhainen

Tegler

, et al. Endovascular treatment of chronic aortic dissection with fenestrated and branched stent grafts. J Vasc Surg. 2021;73(5):1573–1582.

28.

Rohlffs

Tsilimparis

Diener

, et al. Chronic type B aortic dissection: indications and strategies for treatment. J Cardiovasc Surg. 2015;56(2):231–238.

29.

Loubert

van der Hulst

De Vries

, et al. How to exclude the dilated false lumen in patients after a type B aortic dissection? The cork in the bottleneck. J Endovasc Ther. 2003;10(2):244–248.

30.

Magee

Potter

, et al. False lumen intercostal artery embolization to halt type R entry flow in chronic type B aortic dissection. Ann Vasc Surg. 2023;88:1–8.

31.

Rakestraw

Feghali

Nguyen

, et al. False lumen embolization as a rescue technique in the setting of acute and chronic dissecting aneurysms as adjunct to thoracic endovascular aortic repair. J Vasc Surg Cases Innov Tech. 2020;6(1):110–117.

32.

Geisbüsch

Stefanovic

Koruth

, et al. Endovascular coil embolization of segmental arteries prevents paraplegia after subsequent thoracoabdominal aneurysm repair: an experimental model. J Thorac Cardiovasc Surg. 2014;147(1):220–226.

33.

Pellenc

Roussel

De Blic

, et al. False lumen embolization in chronic aortic dissection promotes thoracic aortic remodeling at midterm follow-up. J Vasc Surg. 2019;70(3):710–717.

34.

Kölbel

Lohrenz

Kieback

, et al. Distal false lumen occlusion in aortic dissection with a homemade extra-large vascular plug: the candy-plug technique. J Endovasc Ther. 2013;20(4):484–489.

35.

Eleshra

Kölbel

Haulon

, et al. Urgent Candy-plug technique for distal false lumen occlusion in chronic aortic dissection. J Vasc Surg. 2024;80(5):1418–1424.

36.

Palm

Valtola

Manninen

, et al. A modified candy-plug technique to occlude false lumen in aortic dissection. CVIR Endovasc. 2022;5(1):57.

37.

Cheng

Clymer

Po-Han Chen

, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res. 2018;229:134–144.

38.

Fairman

Beck

Malas

, et al. Reinterventions in the modern era of thoracic endovascular aortic repair. J Vasc Surg. 2020;71(2):408–422.

39.

Eleshra

Kölbel

Tsilimparis

, et al. Candy-plug generation II for false lumen occlusion in chronic aortic dissection: feasibility and early results. J Endovasc Ther. 2019;26(6):782–786.

Modified Candy Plug for False Lumen Embolization in Chronic Aortic Dissection: Technical Aspects and Initial Experience

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

Clinical Impact

Keywords

Get full access to this article

References