Initial experience with a modified "candy-plug" technique for false lumen embolization in chronic type B aortic...

Area of Science:

• Cardiovascular Surgery
• Endovascular Interventions
• Aortic Disease Management

Background:

• Persistent distal false lumen (FL) perfusion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) is a significant risk factor for aneurysmal degeneration and rupture.
• Current management strategies for persistent FL perfusion require further refinement to improve outcomes and prevent complications.

Purpose of the Study:

• To evaluate the initial experience and efficacy of a modified "candy-plug" (CP) technique for embolizing persistent distal FL perfusion in patients with chronic TBAD following TEVAR.
• To assess the technical and clinical success rates of the modified CP technique in preventing aneurysm expansion.

Main Methods:

• Six patients with chronic TBAD and persistent FL perfusion underwent TEVAR with a modified CP technique using a constrained stent graft and an occluding plug.
• The technique involved bilateral femoral artery access, intravascular ultrasound guidance, and deployment of the modified device in the FL.
• Completion angiography confirmed successful FL embolization, and follow-up imaging assessed aneurysm stability.

Main Results:

• The modified CP technique achieved 100% technical success in all six patients.
• No 30-day mortality or major adverse events (myocardial infarction, stroke, spinal cord ischemia) were observed.
• Clinical success, defined as cessation of aneurysm growth, was confirmed in all available follow-up cases at a mean of 10 months.

Conclusions:

• The modified CP embolization technique is a safe and effective adjunct to TEVAR for managing persistent distal FL perfusion in TBAD.
• This technique shows potential for promoting aortic remodeling and warrants further investigation for long-term durability.