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Amplatzer Vascular Plug for Complicated Residual DeBakey Type 1 Aortic Dissection in the Aortic Arch
Shinichiro Ikeda1, Michael Shih2, Robert Y Rhee1
12042 Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
Insights
Surgical repair of DeBakey type I aortic dissection can leave residual dissection. Treating residual dissection with an Amplatzer plug in the false lumen successfully induced thrombosis and aortic remodeling.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Standard surgical repair for DeBakey type I aortic dissection often involves hemiarch or total arch replacement, but may not address the entire aorta.
- Residual aortic dissection in the aortic arch and descending aorta presents a challenge, sometimes necessitating re-do procedures.
- Previous reports suggest plug placement for entry tears in the aortic arch.
Observation:
- A 79-year-old male with acute DeBakey type I aortic dissection underwent hemiarch replacement.
- One year post-surgery, the patient developed proximal descending aorta dilation (6.3 cm).
- The patient was treated with an Amplatzer plug in the false lumen and a stent graft in the true lumen.
Findings:
- Post-treatment computed tomography confirmed complete thrombosis of the false lumen in the descending aorta.
- The descending aorta diameter reduced from 6.3 cm to 4.0 cm.
- This indicates successful false lumen obliteration and aortic remodeling.
Implications:
- Amplatzer plug placement in the false lumen is a potential strategy for managing complex residual aortic dissections.
- This technique can induce false lumen thrombosis and promote aortic remodeling.
- It offers a less invasive option compared to re-do total arch replacement for specific residual dissections.
Abstract:
Surgical treatment of acute DeBakey type I aortic dissection does not address the entire aorta, which can leave anatomically complex residual aortic dissection in the aortic arch and descending aorta. Open repair has been the standard treatment for this pathology. When the lesions are located in the aortic arch, re-do total arch replacement needs to be performed. Plug placement to close small entry tears in the aortic arch has been reported. This article reports about a 79-year-old man who underwent hemiarch replacement for acute DeBakey type I aortic dissection. One year later, his proximal descending aorta dilated to 6.3 cm. The patient was treated with Amplatzer plug in the false lumen, and a stent graft was placed in the true lumen. Follow-up computed tomography scan confirmed complete thrombosis of the false lumen in the descending aorta which had decreased from 6.3 to 4.0 cm. Plug placement in the false lumen in the aortic arch is a potential treatment strategy for anatomically complex residual aortic dissection to induce thrombosis of the false lumen and encourage remodeling.
