Modified Candy Plug for False Lumen Embolization in Chronic Aortic Dissection: Technical Aspects and Initial...

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Dissection Management

Background:

• Chronic aortic dissection (AD) poses challenges, particularly retrograde false lumen (FL) perfusion post-thoracic endovascular aneurysm repair (TEVAR).
• This perfusion can lead to aortic rupture, necessitating effective management strategies.

Purpose of the Study:

• To evaluate the efficacy and safety of a modified candy plug (CP) for FL embolization in chronic AD patients.
• To assess the modified CP's utility either after or concurrently with TEVAR.

Main Methods:

• Retrospective analysis of 11 chronic AD patients undergoing FL embolization with a modified CP between May 2021 and August 2024.
• Custom CP design based on FL anatomy, with preoperative imaging for FL assessment.
• Postoperative monitoring focused on FL thrombosis, complications, and aortic diameter changes.

Main Results:

• 100% technical success rate for FL embolization.
• Complete FL thrombosis achieved in 10 patients; partial in one.
• Significant reduction in aortic diameter (4.44±4.14 mm, p<0.010) with no major adverse events.
• Minor complications included access site hematoma and transient lower limb numbness, both resolved.

Conclusions:

• The modified CP approach is a safe and effective endovascular option for treating retrograde FL perfusion in chronic AD.
• This technique promotes FL thrombosis, prevents dissection expansion, and reduces the risk of aortic rupture, serving as an adjunct to TEVAR.
• The approach is straightforward, requires no custom devices, and is feasible in urgent settings.