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

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.

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

2019 ◽  
Vol 26 (6) ◽  
pp. 782-786 ◽  
Author(s):  
Ahmed Eleshra ◽  
Tilo Kölbel ◽  
Nikolaos Tsilimparis ◽  
Giuseppe Panuccio ◽  
Martin Scheerbaum ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Success ◽  
False Lumen ◽  
The Other ◽  
Type I ◽  
Technical Success ◽  
Chronic Aortic Dissection ◽  
Early Results ◽  
Aortic Remodeling

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.

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

2019 ◽  
Vol 70 (3) ◽  
pp. 710-717 ◽  
Author(s):  
Quentin Pellenc ◽  
Arnaud Roussel ◽  
Romain De Blic ◽  
Antoine Girault ◽  
Pierre Cerceau ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Chronic Aortic Dissection ◽  
Aortic Remodeling

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

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.

scholarly journals Outcome after acute und subacute TEVAR in uncomplicated type B aortic dissection

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
S Jungi ◽  
S Mylonas ◽  
M Ante ◽  
W Ahmad ◽  
K Meisenbacher ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Aortic Diameter ◽  
Lumen Diameter ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Best Medical Therapy ◽  
One Year ◽  
Aortic Remodeling

Abstract Objective In the past years, a paradigm shift from best medical therapy to early thoracic endovascular aortic repair (TEVAR) has been observed in the treatment of uncomplicated type B aortic dissection (uTBAD). We aimed to analyze outcomes after TEVAR in the acute and subacute phase of uTBAD, focusing on aortic remodeling. Methods Retrospective analysis of consecutive patients who underwent TEVAR for acute or subacute uTBAD in two tertiary referral centers from 2008 – 2017. Two assessors per center reviewed computed tomography scans of each patient at presentation, at one year and at the last follow-up using post-processing software. Results Forty-nine patients were treated with TEVAR for uTBAD. The indication for TEVAR was the presence of multiple morphologic predictors of adverse aortic outcome. The most common predictors were a false lumen diameter of > = 22mm in 76% of patients, a primary entry tear of > = 10mm in 69% and a total aortic diameter of > = 40mm in 67%. There were no in-hospital deaths and no deaths at 1 year. The median follow-up was 40.6 months. Three-year cumulative survival was 94 % (46/49). Fourteen secondary interventions were performed in 10 patients (20 %) after a median of 4.2 months. TEVAR lead to remodeling of the descending thoracic aorta with a median reduction of the total aortic diameter of 4.5 mm within one year and stable diameters after three years. The median maximum false lumen diameter diminished from 26 mm to 15 mm in one year (at 3 years: 14.8 mm). Conclusion In this cohort of selected patients with uTBAD and multiple morphologic predictors of worse aortic outcome, elective acute or subacute TEVAR was associated with a low mortality and positive aortic remodeling in the mid-term follow-up.

scholarly journals Long Stent Graft for Frozen Elephant Trunk Repair in Acute Type A Aortic Dissection

2021 ◽  
Author(s):  
Chaojie Wang ◽  
Wenqian Zhang ◽  
Jihai Peng ◽  
Jie He ◽  
Guangtian Chen ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Thoracic Aorta ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Remodeling

Abstract Background: 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. In the long FET group, the level of complete false lumen thrombosis was more extensive during the follow-up period. 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.

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

2021 ◽  
pp. 152660282098527
Author(s):  
Jan Stana ◽  
Carlota Fernandes Prendes ◽  
Ramin Banafsche ◽  
Nikolaos Konstantinou ◽  
Barbara Rantner ◽  
...  
Keyword(s):  
False Lumen ◽  
Type A ◽  
Emergency Setting ◽  
Chronic Type ◽  
Type A Aortic Dissection ◽  
Custom Made ◽  
Descending Aortic Aneurysm ◽  
Type A Dissection ◽  
Open Surgical Approach

Purpose: To demonstrate the feasibility of urgent endovascular treatment of a chronic type A dissection and contained rupture of the false lumen using a noncustomized triple-branched arch endograft, which necessitated reassignment of the branches to the supra-aortic vessels. Case Report:: A 57-year-old patient with a contained rupture of the descending thoracic aorta, in the setting of a chronic type A dissection and a maximum aortic diameter of 85 mm, was converted to endovascular repair after failure of an open surgical approach. A custom-made triple-branched arch endograft designed for another patient was employed, with concomitant occlusion of the false lumen using a Candy Plug occluder. To adjust the graft’s configuration to the patient’s anatomy, the supra-aortic vessels were not assigned to the originally planned branches. The 12-month follow-up angiography demonstrated a satisfactory result. Conclusion: A noncustomized triple-branched arch endograft can be used in an emergency setting to treat chronic type A dissection, reassigning the branches to the supra-aortic vessels as needed.

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

Aorta ◽  
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.

Non-Standard Management of Target Vessels With the Inner Branch Arch Endograft: A Single-Center Retrospective Study

2021 ◽  
pp. 152660282110586
Author(s):  
Jose I. Torrealba ◽  
Konstantinos Spanos ◽  
Giuseppe Panuccio ◽  
Fiona Rohlffs ◽  
Thomas Gandet ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
False Lumen ◽  
Aberrant Right Subclavian Artery ◽  
Left Vertebral Artery ◽  
Type I ◽  
Single Center ◽  
Standard Management

Purpose: The purpose of this study was to evaluate early and mid-term results of non-standard management of the supraaortic target vessels with the use of the inner branch arch endograft in a single high-volume center. Material and methods: A single-center retrospective study including all patients undergoing implantation of an inner branch arch endograft from December 2012 to March 2021, who presented a non-standard management of the supraaortic target vessels (any bypass other than a left carotid-subclavian or landing in a dissected target vessel). Technical success, mortality, reinterventions, endoleak (EL), and aortic remodeling at follow-up were analyzed. Results: Twenty-four patients were included. In 17 (71%) cases, the non-standard management was related to innominate artery (IA) compromise (12 with IA dissection, 2 with short IA, 2 with short proximal aortic landing zone that required occlusion of IA, 1 with occluded IA after open arch repair). Two (8%) cases were related to an aberrant right subclavian artery (RSA), 1 patient (4%) due to the concomitant presence of a left vertebral artery (LVA) arising from the arch and an occluded left subclavian artery (LSA), and another patient presented with an occluded LSA distal to a dominant vertebral artery. Three (13%) cases were exclusively related to management in patients with genetic aortic syndromes. Twenty (83%) patients had a previous type A aortic dissection. Ten (42%) patients presented a thoracic or thoracoabdominal aortic aneurysm and 8 (33%) patients an arch aneurysm, 6 of them associated to false lumen (FL) perfusion. There were 2 (8%) perioperative minor strokes, and 1 patient with perioperative mortality. Seven patients presented an early type I endoleak, all resolved at follow-up. Seven patients required reinterventions during follow-up (7 reinterventions related to continuous false lumen perfusion, 3 related to Type Ia endoleak, 2 related to surgical bypass). All patients who presented with FL perfusion had complete FL thrombosis at follow-up. No patient presented aneurysm growth at follow-up. Conclusions: The use of the inner branch arch endograft with a non-standard management of the supraaortic target vessels is a possible option. Despite a high reintervention rate, regression or stability of the aneurysmal diameter was achieved in all the patients with follow-up.

Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection

2020 ◽  
Vol 54 (8) ◽  
pp. 756-759
Author(s):  
Amer Harky ◽  
Robert K. Fisher ◽  
Mark L. Field
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
False Lumen ◽  
Acute Type ◽  
Type B ◽  
Frozen Elephant Trunk ◽  
Type B Aortic Dissection ◽  
Elephant Trunk ◽  
Thoracoabdominal Aorta

Purpose: To report a case who required a thoracic endovascular stenting (TEVAR) following the deployment of frozen elephant trunk due to false lumen expansion Case Report: A 47 years old male patient undergone emergency repair of acute type A aortic dissection in 2011 with bioprosthetic aortic root conduit. Seven years later he presented with moderate aortic valve disease and expanding chronic dissection of the aortic arch, therefore a redo operation with replacement of the prosthetic aortic valve, ascending aorta, total arch and deployment of frozen elephant trunk and he was discharged in good health. Several days post discharge he presented with new onset of chest pain and a new dissection involved the thoracoabdominal aorta was noted pressing on the true lumen and the frozen elephant trunk. Following a multi-disciplinary team meeting, TEVAR was deemed as a most appropriate approach and this was achieved successfully, and patient was discharged. At 1 year of follow up, he remains well and asymptomatic. Conclusion: Close imaging follow-up following deployment of a FET is mandatory. A new acute Type B aortic dissection distal to the FET, that causes false lumen propagation parallel to the stented portion, is a surgical emergency and further intervention mandated.

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