Candy-Plug Generation II for False Lumen Occlusion in Chronic Aortic Dissection: Feasibility and Early Results

Purpose: To present the early results of false lumen (FL) occlusion in chronic aortic dissection using the Candy-Plug generation II (CP II), which has a self-closing fabric channel that obviates the need for separate occlusion of its center. Materials and Methods: Fourteen consecutive patients (mean age 60±11 years; 10 men) with persistent FL backflow and aneurysm formation at the thoracic segment in chronic aortic dissection underwent thoracic endovascular aortic repair (TEVAR) with FL occlusion using the refined CP II. Primary endpoints were technical success (successful deployment) and clinical success (no FL backflow at the CP II level). Secondary endpoints included 30-day mortality and morbidity and aortic remodeling during follow-up. Results: Technical success was 100%. One patient required additional intraprocedural FL embolization at the CP II level due to persistent FL backflow on final angiography (clinical success 93%), though there was no flow through the CP II center. There were no intraprocedural complications. Immediate complete FL occlusion was achieved in 12 patients; the other 2 required reintervention. One had contrast enhancement in the distal FL proximal to the CP II and was treated with coil embolization. The other patient had persistent type I endoleak at the level of the left subclavian artery (LSA) and underwent left carotid–LSA bypass and proximal stent-graft extension. One patient died due to retrograde type A aortic dissection that was not related to CP II placement. Over a mean 8-month follow-up (range 3–12), 9 patients had computed tomography angiography; 8 patients had evidence of aortic remodeling, while 1 aneurysm sac was stable. Conclusion: The CP II reduces the number of procedural steps and offers good seal, with minimal morbidity and mortality and a high rate of aortic remodeling.

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Aortic Remodeling After Custom-Made Candy-Plug for Distal False Lumen Occlusion in Aortic Dissection

Journal of Endovascular Therapy ◽

10.1177/1526602821996722 ◽

2021 ◽

pp. 152660282199672

Author(s):

Ahmed Eleshra ◽

Fiona Rohlffs ◽

Konstantinos Spanos ◽

Giuseppe Panuccio ◽

Franziska Heidemann ◽

...

Keyword(s):

Aortic Dissection ◽

Clinical Success ◽

False Lumen ◽

High Rate ◽

Single Center ◽

Original Design ◽

Mortality And Morbidity ◽

Custom Made ◽

Aortic Remodeling

Purpose: To report a single-center experience with the use of a custom-made Candy-Plug (CP) for distal false-lumen (FL) occlusion in subacute and chronic aortic dissection (AD). Materials and Methods: A retrospective single-center analysis was conducted on consecutive patients with subacute and chronic AD who were treated with a custom-made CP for distal FL occlusion using 3 design generations (CP I to CP III) from October 2013 to September 2019. Results: A custom-made CP was used in 57 patients. Of these, 34 patients (29 males, mean age 62±10 years) were treated with a CP I vs 23 patients (16 males, mean age 59±17 years) with CP II/III. Technical success was achieved in 57 (100%) patients. Clinical success was achieved in 54 (95%) patients; 33 (97%) in CP I group vs 21 (91%) patients in CP II/III group, p=0.116. The mean hospital stay was 10±8 days (9±5 days in CP I group vs 13±9 days in CP II/III, p=0.102). The 30-day computed tomography angiography (CTA) confirmed successful CP placement at the intended level in all patients within both groups. Early complete FL occlusion was achieved in 50 (88%) patients; 30 (88%) patients in CP I group vs 20 (87%) in CP II/III group, p=0.894. Follow up CTA was available in 44 (77%) patients. Of these; 30/34 (88%) patients in CP I group with mean follow-up 29±17 months) vs. 14/23 (61%) patients with mean follow-up 14±5 months in CP II/III group. Thoracic aortic remodeling was achieved in 34/44 (77%) patients; 25/30 (83%) patients in CP I group vs 9/14 (64%) patients in CP II/III group, p=0.197. The aneurysm size remained stable in 9/44 (20%) patients; 5/30 (17%) patients in CP I group vs 4/14 (29%) patients in CP II/III group, p=0.741. The thoracic aneurysm increased size was seen in 1/44 (2%) patient. This patient was in CPII/III group. Conclusion: CP technique using custom-made devices is technically feasible with a low mortality and morbidity, and a high rate of aortic remodeling. Both, the original design (CP I) and newer designs with a self-closing central sleeve (CP II and CP III) showed similar excellent outcomes.

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False lumen embolization in chronic aortic dissection promotes thoracic aortic remodeling at midterm follow-up

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.11.038 ◽

2019 ◽

Vol 70 (3) ◽

pp. 710-717 ◽

Cited By ~ 11

Author(s):

Quentin Pellenc ◽

Arnaud Roussel ◽

Romain De Blic ◽

Antoine Girault ◽

Pierre Cerceau ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Chronic Aortic Dissection ◽

Aortic Remodeling

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Complete Shrinkage of the Obliterated False Lumen After Open and Endovascular Chronic Aortic Dissection Stanford Type A Repair

Aorta ◽

10.12945/j.aorta.2017.16.035 ◽

2017 ◽

Vol 05 (02) ◽

pp. 61-63

Author(s):

George Samanidis ◽

Meletios Kanakis ◽

Constantinos Ieromonachos ◽

George Stavridis

Keyword(s):

Aortic Dissection ◽

Circulatory Arrest ◽

False Lumen ◽

Type A ◽

Frozen Elephant Trunk ◽

Descending Thoracic Aorta ◽

Elephant Trunk ◽

Chronic Aortic Dissection ◽

Antegrade Cerebral Perfusion

AbstractA 48-year-old man was admitted to our hospital with chronic aortic dissection Stanford Type A. His diagnosis was confirmed by chest multi-detector computed tomography (CT). The patient underwent combined (i.e., hybrid) open and endovascular repair (frozen elephant trunk) in a one-stage operation with moderate hypothermic circulatory arrest and antegrade cerebral perfusion. His postoperative course was uneventful, and he was discharged home on postoperative day 9. At 2-year follow-up, chest CT angiography revealed complete shrinkage of the obliterated false lumen in the distal aortic arch and descending thoracic aorta.

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The Candy-Plug Technique: Technical Aspects and Early Results of a New Endovascular Method for False Lumen Occlusion in Chronic Aortic Dissection

Journal of Endovascular Therapy ◽

10.1177/1526602817709252 ◽

2017 ◽

Vol 24 (4) ◽

pp. 549-555 ◽

Cited By ~ 33

Author(s):

Fiona Rohlffs ◽

Nikolaos Tsilimparis ◽

Beatrice Fiorucci ◽

Franziska Heidemann ◽

Eike Sebastian Debus ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Technical Aspects ◽

Chronic Aortic Dissection ◽

Early Results

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Rescue EVAR for ruptured AAA: Clinical success does not mean technical success

Vascular ◽

10.1177/1708538113516318 ◽

2013 ◽

Vol 22 (5) ◽

pp. 368-370 ◽

Cited By ~ 3

Author(s):

Francesco Setacci ◽

Pasqualino Sirignano ◽

Gianmarco de Donato ◽

Giuseppe Galzerano ◽

Carlo Setacci

Keyword(s):

Emergency Department ◽

Abdominal Aortic Aneurysm ◽

Aortic Wall ◽

Clinical Success ◽

Type I ◽

Ruptured Abdominal Aortic Aneurysm ◽

Technical Success ◽

Abdominal Aortic ◽

Good Clinical Condition

We report a clinical evolution of a 85-years old male admitted to our Emergency Department for ruptured abdominal aortic aneurysm (rAAA). One month later a huge type I proximal endoleak was detected and corrected by proximal aortic extension. We decided to fix the stent-graft to the aortic wall using EndoAnchors. However, an asymptomatic type III endoleak due to controlateral limb disconnection was detected at the followed schedulated CT angio and corrected by a relining of the endograft. The patient is now in good clinical condition with no evidence of endoleaks at 1-year follow-up.

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Totally Percutaneous Fenestration via the “Cheese-Wire” Technique to Facilitate Endovascular Aneurysm Repair in Chronic Aortic Dissection

Vascular and Endovascular Surgery ◽

10.1177/1538574417753006 ◽

2018 ◽

Vol 52 (3) ◽

pp. 218-221 ◽

Cited By ~ 1

Author(s):

Jordan R. Stern ◽

Danielle E. Cafasso ◽

Darren B. Schneider ◽

Andrew J. Meltzer

Keyword(s):

Aortic Dissection ◽

Endovascular Aneurysm Repair ◽

False Lumen ◽

Contralateral Side ◽

Percutaneous Technique ◽

Infrarenal Aorta ◽

Chronic Aortic Dissection ◽

History Of ◽

Aneurysm Repair

Here, we describe a totally percutaneous technique for longitudinal fenestration of a chronic dissection flap in the setting of endovascular aneurysm repair (EVAR), where the septum would otherwise preclude proper endograft sealing. This technique is demonstrated in a 65-year-old man with a history of open surgical repair of a Stanford type A aortic dissection, with a type B component that was managed nonoperatively. The patient developed aneurysmal degeneration of the infrarenal aorta during follow-up, and his anatomy was well suited for EVAR with the exception of a chronic dissection flap dividing the proximal seal zone. Using bilateral percutaneous access, a wire was passed through an existing fenestration in the septum from true to false lumen and snared from the contralateral side. Downward traction on this through-wire was then used as a “cheese-wire” to divide the septum longitudinally and clear it from the proximal fixation site. Removal of the septum provided an adequate proximal seal zone for the endograft, and standard infrarenal EVAR was then performed with a good technical result. Longitudinal fenestration using this technique is a useful adjunctive maneuver to facilitate EVAR in the setting of chronic aortic dissection and is safely achievable via a totally percutaneous approach.

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Similar Midterm Clinical Outcomes and Aortic Remodeling in Bifurcated and Straight Aortic Stent Grafts Used to Treat Isolated Abdominal Aortic Dissection

Journal of Endovascular Therapy ◽

10.1177/15266028211061267 ◽

2021 ◽

pp. 152660282110612

Author(s):

Tun Wang ◽

Chang Shu ◽

Quan-ming Li ◽

Ming Li ◽

Xin Li ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Type I ◽

Stent Grafts ◽

Type A Aortic Dissection ◽

Abdominal Aortic ◽

Abdominal Aortic Dissection ◽

Aortic Remodeling ◽

Bifurcated Graft

Purpose: The optimal treatment for isolated abdominal aortic dissection (IAAD) is currently unknown. We compared the effects of straight and bifurcated aortic stent grafts on postoperative aortic remodeling in patients with IAAD. Materials and Methods: From February 2012 to December 2019, 57 patients with IAAD were treated using endovascular methods, including either a bifurcated or a straight aortic stent graft. The clinical features, risk factors, computed tomography angiograms, midterm follow-up results, and aortic remodeling of these patients were reviewed and analyzed. Results: In total, 44 (77%) patients were treated with a bifurcated graft and 13 (23%) patients were treated with a straight graft. Patients treated with straight grafts had fewer common iliac arteries involved (38% vs 73%, p=0.023), the dissection length was shorter (76.3 ± 40.0 vs 116.2 ± 56.7 mm, p=0.011), and the preoperative aortic diameter (26.0 ± 5.6 vs 35.2 ± 12.1 mm) and the false lumen diameter (13.1 ± 5.2 vs 21.2 ± 11.3 mm) were smaller. During the procedure, there were 3 (5.3%) type I endoleaks, 1 (1.8%) surgical conversion and 1 (1.8%) partial renal artery coverage without perioperative mortality. Patients with straight grafts had shorter operative time (96.5 ± 24.4 vs 144.2 ± 49.0 minutes, p<0.0001). The median follow-up duration was 37.6 ± 21.0 (range = 3–89) months with 1 (1.8%) aortic-related death. Type A aortic dissection occurred in 1 (1.8%) patient. New descending aortic dissection occurred in 3 (5.3%) patients, and 1 patient advanced to type A aortic dissection 3 months later. Two (3.5%) patients had limb occlusion. There was no significant difference in aortic remodeling, survival, and freedom from all adverse events between the 2 treatment strategies. Conclusions: Endovascular treatment provides a safe, minimally invasive treatment for IAAD in midterm follow-up. Compression of the true lumen at the aortic bifurcation is the main concern after treatment with a bifurcated graft. Straight grafts are an excellent alternative for some patients, with the benefit of reduced procedural time, effective aortic remodeling, and excellent clinical prognosis. More experience is needed to offer clear recommendations for making treatment decisions as well as determine long-term effectiveness and durability.

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IFT11. Candy Plug Generation II for False Lumen Occlusion in Chronic Aortic Dissection: Feasibility and Early Results

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.04.070 ◽

2019 ◽

Vol 69 (6) ◽

pp. e80-e81

Author(s):

Ahmed Eleshra ◽

Tilo Kolbel ◽

Nikolaos Tsilimparis ◽

Giuseppe Panuccio ◽

Martin Scheerbaum ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Chronic Aortic Dissection ◽

Early Results

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Long stent graft for frozen elephant trunk repair in acute type A aortic dissection

10.22541/au.161901765.59965551/v1 ◽

2021 ◽

Author(s):

Chaojie Wang ◽

Wenqian Zhang ◽

Jihai Peng ◽

Jie He ◽

Wenliu Xu ◽

...

Keyword(s):

Aortic Dissection ◽

Thoracic Aorta ◽

False Lumen ◽

Type A ◽

Acute Type ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Type A Aortic Dissection ◽

Aortic Remodeling

OBJECTIVES: The frozen elephant trunk (FET) technique has become an important tool in the treatment of acute type A aortic dissection. The aim of this study was to evaluate the effect of long FET on spinal cord injury (SCI) and distal aortic remodeling after acute type A aortic dissection based on clinical and radiological outcomes. METHODS: From January 2018 to November 2019, 158 patients [mean age 51.8 years (range 32 - 78 years), 88.6% male] with acute type A aortic dissection were treated by FET with 100 mm (n=113) or 150 mm (n=45) open hybrid stent graft prosthesis. Patients were divided into two groups according to the length of FET. The clinical and radiological outcomes of the patients were reviewed retrospectively. RESULTS: Postoperative outcomes did not differ significantly: in-hospital mortality (9.7% vs 6.7%, P=0.758) and SCI (5.3% vs 2.2%, P=0.674). Aortic remodeling, which was evaluated by aortic diameter, true lumen diameter, false lumen diameter and the rate of false lumen complete thrombosis, was more positive in long FET group in the descending thoracic aorta during the follow-up period. At the abdominal level, there was no statistically significant difference between the two groups. CONCLUSIONS: The long version of FET does not increase the risk of SCI in patients with acute type A aortic dissection. The application of long FET can achieve better results in terms of remodeling of the thoracic aorta in the short- and medium-term follow-up.

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Endovascular treatment of obstructive iliac artery dissections

Acta Radiologica ◽

10.1080/02841850510021166 ◽

2005 ◽

Vol 46 (4) ◽

pp. 359-365 ◽

Cited By ~ 11

Author(s):

B. Önal ◽

E. T. Ilgit ◽

S. Akpek ◽

G. Erbas ◽

A. Akkaya

Keyword(s):

Endovascular Treatment ◽

Iliac Artery ◽

Clinical Success ◽

Symptom Relief ◽

False Lumen ◽

Complete Relief ◽

Technical Success ◽

Technical Success Rate ◽

Presenting Symptoms

Purpose: To report our results from a study of the endovascular treatment of flow restricting chronic atherosclerotic or catheter‐induced segmental iliac artery dissections with bare stents. Material and Methods: Thirty symptomatic patients with 32 lesions, including chronic atherosclerotic ( n = 21) and catheter‐induced ( n = 11) segmental arterial dissections, were treated with primary stenting. The common iliac artery was involved in 19 lesions and the external iliac artery in the remaining 13. Two patients had two lesions in the same vessel. Technical success was defined as restoration of the smooth contoured luminal patency with no more than 20% residual stenosis in diameter in atherosclerotic dissections associated with plaque formation or total obliteration of the false lumen in catheter‐induced dissections. Complete relief of, or marked improvements in, presenting symptoms, or at least single category improvement, was assessed for clinical success. Results: Technical success rate was 100%. No procedure‐related complications such as distal emboli or early occlusions were observed. Complete symptom relief was achieved in all patients with catheter‐induced dissection and in all but three cases with chronic spontaneous atherosclerotic dissection. In two cases, occlusion of the stents occurred during the follow‐up period. Clinical and radiological mean follow‐up for 24 months (range 3–55) revealed patency of all other stented segments. Cumulative primary patency rate was 97% over 12 months and 90% over 24 months. Conclusion: Endovascular treatment of chronic atherosclerotic and catheter‐induced short obstructive iliac arterial dissections with bare stents is safe and effective. Patency of the diseased arterial segment with a smooth lumen can be sustained for an extensive period.

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