Outcomes after false lumen embolization with covered stent devices in chronic dissection

Area of Science:

• Cardiovascular Surgery
• Endovascular Aortic Repair
• Aortic Dissection Management

Background:

• Persistent retrograde false lumen perfusion is a frequent complication following thoracic endovascular aortic repair (TEVAR) for chronic aortic dissection.
• This complication can lead to re-dissection, aneurysm formation, and treatment failure.
• Identifying and addressing persistent false lumen perfusion is critical for long-term TEVAR success.

Purpose of the Study:

• To introduce and evaluate a novel endovascular technique for occluding the false lumen in chronic aortic dissection.
• To assess the safety and efficacy of this adjunctive false lumen embolization strategy.
• To determine the impact on aortic remodeling and long-term outcomes after TEVAR.

Main Methods:

• Twenty-one high-risk patients with chronic thoracoabdominal dissection underwent false lumen embolization using covered stent devices between 2009 and 2013.
• The procedure was performed as an adjunct to initial TEVAR or as a standalone treatment in select cases.
• Various covered stent devices, including iliac plugs and nitinol embolization plugs, were utilized, often in combination.

Main Results:

• False lumen thrombosis was achieved in all patients, with incomplete thrombosis requiring re-intervention in four cases.
• Mean maximum aortic diameter decreased significantly post-procedure (64 mm to 59 mm).
• No strokes, paraplegia, myocardial infarctions, or renal failures occurred; one hospital death and one late death were reported.

Conclusions:

• Adjunctive false lumen embolization with covered stent devices is an effective strategy to promote thrombosis and aortic remodeling after TEVAR for chronic dissection.
• This endovascular approach offers a viable solution for managing persistent false lumen perfusion.
• Further investigation into this technique is warranted to solidify its role in aortic dissection management.