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

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

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