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How to exclude the dilated false lumen in patients after a type B aortic dissection? The cork in the bottleneck
Maartje C Loubert1, Victor P M van der Hulst, Cees De Vries
1Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Insights
This study presents techniques to exclude the false lumen in chronic type B aortic dissection after stent-graft placement. An occluder device is preferred for effectively blocking retrograde flow and achieving good results.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Aortic Disease Management
Background:
- Chronic type B aortic dissection can lead to a dilated false lumen, posing risks post-stent graft repair.
- Standard stent-graft placement in the true lumen may not always exclude the false lumen.
- Effective management of persistent false lumen flow is crucial for long-term outcomes.
Observation:
- Two patients with chronic type B aortic dissection had persistent false lumen patency after true lumen stent-grafting.
- Techniques were employed to embolize the false lumen, acting as a "cork in a bottleneck."
- Greenfield filters and detachable balloons were used in one case; an occluder device in the other.
Findings:
- Both methods successfully obliterated the dilated false lumen and excluded it from circulation.
- The occluder device demonstrated more controllable deployment compared to filters and balloons.
- Good clinical results were achieved in both patients using these adjunctive techniques.
Implications:
- An occluder device offers a viable and controllable method for excluding false lumens in chronic type B aortic dissection.
- These techniques provide valuable options for managing complex aortic pathologies.
- Further research may explore the long-term efficacy and broader application of these false lumen exclusion methods.
Purpose:
To report techniques for excluding the dilated false lumen associated with chronic type B aortic dissection following placement of a stent-graft in the true lumen.
Case Reports:
Two patients underwent stent-graft implantation for a dilated false lumen after chronic aortic dissection, but the false lumen was not excluded from the circulation by this procedure. The false lumen was obliterated in one case with Greenfield filters and detachable balloons placed above a renal artery orifice that was perfused via the false lumen. This acted like "a cork in the bottleneck" to block retrograde flow into the thoracic portion of the false lumen above the blockade. In the other patient, an occluder device was used as the "cork." In both cases, a good result was obtained. The occluder device is preferred because deployment is more controllable.
Conclusions:
An occluder device may be used like a cork in a bottle to exclude the dilated false lumen in the thoracic aorta after a type B dissection.