Physician-modified vascular plug for entry closure of a chronic aneurysmal aortic dissection

For patients with a chronic aneurysmal aortic dissection (CAAD), closure of all entries and reentries, leading to complete exclusion of the false lumen, likely results in shrinkage of the false lumen and aortic remodeling. One technique to interrupt the false lumen blood flow and achieve complete exclusion is to occlude the entry with a vascular plug. However, depending on the size and location of the target entry, sufficient occlusion of the entry and resolution of false lumen blood flow may not be achieved even if the vascular plug is placed in the expected position due to the porous nature of the plug. Herein, we present a technique for entry closure in CAAD using a physician-modified vascular plug, which combines the Amplatzer Vascular Plug and an expanded polytetrafluoroethylene prosthetic patch to create a water-tight seal. This technique enables effective and reliable entry closure in CAAD, even when the entry site is close to a vital side branch, such as the arch vessels and the mesenteric artery, and standard stent graft use is not possible.