Occlusion of the false lumen, management of aortic side branches

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Aortic Disease Management

Background:

• Chronic aortic dissection requires false lumen thrombosis for positive aortic remodeling.
• Persistent perfusion via collaterals and dissected arteries complicates false lumen thrombosis.
• Existing treatments often face challenges in achieving complete false lumen occlusion.

Purpose of the Study:

• To describe a comprehensive endovascular strategy for chronic aortic dissection.
• To detail the role of preemptive embolization in facilitating false lumen thrombosis.
• To outline a staged approach for aortic remodeling and long-term success.

Main Methods:

• Integration of thoracic endovascular aortic repair (TEVAR) with custom fenestrated/branched endovascular aortic repair (FBEVAR).
• Preemptive embolization of aortic side branches to prevent endoleaks and promote thrombosis.
• Staged endovascular procedures targeting re-entry tears, collaterals, and false lumen embolization, potentially including false lumen endografts (FLE).

Main Results:

• The described approach facilitates false lumen thrombosis and positive aortic remodeling.
• Preemptive embolization is a key strategy to manage persistent perfusion.
• Iterative embolizations guided by follow-up imaging are often necessary for complete thrombosis.

Conclusions:

• A staged endovascular strategy combining TEVAR, FBEVAR, and preemptive embolization is effective for chronic aortic dissection.
• Aggressive management of endoleaks and iterative embolization are critical for long-term success.
• This approach promotes aortic remodeling by achieving complete false lumen thrombosis.