Cargando…

Initial experience with a modified “candy-plug” technique for false lumen embolization in chronic type B aortic dissection

BACKGROUND: Persistent distal false lumen (FL) perfusion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) can lead to aneurysmal degeneration and an increased risk of rupture. We have presented our initial experience using a modified “candy-plug” (CP) technique f...

Descripción completa

Detalles Bibliográficos
Autores principales: Miles, Daniel, Arbabi, Cassra, McMackin, Katherine, Tjaden, Bruce, Schonefeld, Sally, Baril, Donald, Gupta, NavYash, Gewertz, Bruce, Azizzadeh, Ali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10154964/
https://www.ncbi.nlm.nih.gov/pubmed/37152918
http://dx.doi.org/10.1016/j.jvscit.2022.11.012
_version_ 1785036236217384960
author Miles, Daniel
Arbabi, Cassra
McMackin, Katherine
Tjaden, Bruce
Schonefeld, Sally
Baril, Donald
Gupta, NavYash
Gewertz, Bruce
Azizzadeh, Ali
author_facet Miles, Daniel
Arbabi, Cassra
McMackin, Katherine
Tjaden, Bruce
Schonefeld, Sally
Baril, Donald
Gupta, NavYash
Gewertz, Bruce
Azizzadeh, Ali
author_sort Miles, Daniel
collection PubMed
description BACKGROUND: Persistent distal false lumen (FL) perfusion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) can lead to aneurysmal degeneration and an increased risk of rupture. We have presented our initial experience using a modified “candy-plug” (CP) technique for FL embolization. METHODS: From February 2021 to July 2022, we treated six patients using the modified CP technique. All the patients had undergone prior or simultaneous TEVAR for chronic TBAD with persistent FL perfusion and aneurysm expansion. Bilateral common femoral artery access was obtained, and intravascular ultrasound was used to confirm wire access in the true lumen (TL) and FL. A conformable TAG device (W.L. Gore & Associates, Flagstaff, AZ) was used in four cases and an Excluder aortic cuff (W.L. Gore & Associates) in two cases. The device was modified by placing a constraining “napkin-ring” suture through the middle segment of the device. Femoral sheaths were placed in the TL and FL. A standard TL TEVAR extension was performed at the level of the celiac artery (zone 5). Next, the CP device was advanced and deployed in the FL, distally aligning it with the TL device. An appropriately sized Amplatzer II plug (Abbot Vascular, Santa Clara, CA) was then deployed in the constrained segment of the modified stent graft. Completion angiography was performed to confirm successful FL embolization. RESULTS: Technical success was defined as successful deployment of the CP device in the FL. The technical success rate was 100% (six of six patients). Clinical success was defined as the cessation of aneurysm growth on follow-up computed tomography angiography. No 30-day mortality, myocardial infarction, stroke, spinal cord ischemia, access site complications, or aortic-related reinterventions occurred. Surveillance imaging at a mean follow-up of 10 months confirmed clinical success (stable aneurysm size or shrinkage) for all five patients with follow-up data available. CONCLUSIONS: The modified CP embolization technique is a promising solution for persistent distal FL perfusion after TEVAR for TBAD. Further investigation is required to determine the long-term durability of this technique as an adjunct to TEVAR to promote aortic remodeling.
format Online
Article
Text
id pubmed-10154964
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-101549642023-05-04 Initial experience with a modified “candy-plug” technique for false lumen embolization in chronic type B aortic dissection Miles, Daniel Arbabi, Cassra McMackin, Katherine Tjaden, Bruce Schonefeld, Sally Baril, Donald Gupta, NavYash Gewertz, Bruce Azizzadeh, Ali J Vasc Surg Cases Innov Tech Innovative Techniques BACKGROUND: Persistent distal false lumen (FL) perfusion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) can lead to aneurysmal degeneration and an increased risk of rupture. We have presented our initial experience using a modified “candy-plug” (CP) technique for FL embolization. METHODS: From February 2021 to July 2022, we treated six patients using the modified CP technique. All the patients had undergone prior or simultaneous TEVAR for chronic TBAD with persistent FL perfusion and aneurysm expansion. Bilateral common femoral artery access was obtained, and intravascular ultrasound was used to confirm wire access in the true lumen (TL) and FL. A conformable TAG device (W.L. Gore & Associates, Flagstaff, AZ) was used in four cases and an Excluder aortic cuff (W.L. Gore & Associates) in two cases. The device was modified by placing a constraining “napkin-ring” suture through the middle segment of the device. Femoral sheaths were placed in the TL and FL. A standard TL TEVAR extension was performed at the level of the celiac artery (zone 5). Next, the CP device was advanced and deployed in the FL, distally aligning it with the TL device. An appropriately sized Amplatzer II plug (Abbot Vascular, Santa Clara, CA) was then deployed in the constrained segment of the modified stent graft. Completion angiography was performed to confirm successful FL embolization. RESULTS: Technical success was defined as successful deployment of the CP device in the FL. The technical success rate was 100% (six of six patients). Clinical success was defined as the cessation of aneurysm growth on follow-up computed tomography angiography. No 30-day mortality, myocardial infarction, stroke, spinal cord ischemia, access site complications, or aortic-related reinterventions occurred. Surveillance imaging at a mean follow-up of 10 months confirmed clinical success (stable aneurysm size or shrinkage) for all five patients with follow-up data available. CONCLUSIONS: The modified CP embolization technique is a promising solution for persistent distal FL perfusion after TEVAR for TBAD. Further investigation is required to determine the long-term durability of this technique as an adjunct to TEVAR to promote aortic remodeling. Elsevier 2022-12-10 /pmc/articles/PMC10154964/ /pubmed/37152918 http://dx.doi.org/10.1016/j.jvscit.2022.11.012 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Innovative Techniques
Miles, Daniel
Arbabi, Cassra
McMackin, Katherine
Tjaden, Bruce
Schonefeld, Sally
Baril, Donald
Gupta, NavYash
Gewertz, Bruce
Azizzadeh, Ali
Initial experience with a modified “candy-plug” technique for false lumen embolization in chronic type B aortic dissection
title Initial experience with a modified “candy-plug” technique for false lumen embolization in chronic type B aortic dissection
title_full Initial experience with a modified “candy-plug” technique for false lumen embolization in chronic type B aortic dissection
title_fullStr Initial experience with a modified “candy-plug” technique for false lumen embolization in chronic type B aortic dissection
title_full_unstemmed Initial experience with a modified “candy-plug” technique for false lumen embolization in chronic type B aortic dissection
title_short Initial experience with a modified “candy-plug” technique for false lumen embolization in chronic type B aortic dissection
title_sort initial experience with a modified “candy-plug” technique for false lumen embolization in chronic type b aortic dissection
topic Innovative Techniques
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10154964/
https://www.ncbi.nlm.nih.gov/pubmed/37152918
http://dx.doi.org/10.1016/j.jvscit.2022.11.012
work_keys_str_mv AT milesdaniel initialexperiencewithamodifiedcandyplugtechniqueforfalselumenembolizationinchronictypebaorticdissection
AT arbabicassra initialexperiencewithamodifiedcandyplugtechniqueforfalselumenembolizationinchronictypebaorticdissection
AT mcmackinkatherine initialexperiencewithamodifiedcandyplugtechniqueforfalselumenembolizationinchronictypebaorticdissection
AT tjadenbruce initialexperiencewithamodifiedcandyplugtechniqueforfalselumenembolizationinchronictypebaorticdissection
AT schonefeldsally initialexperiencewithamodifiedcandyplugtechniqueforfalselumenembolizationinchronictypebaorticdissection
AT barildonald initialexperiencewithamodifiedcandyplugtechniqueforfalselumenembolizationinchronictypebaorticdissection
AT guptanavyash initialexperiencewithamodifiedcandyplugtechniqueforfalselumenembolizationinchronictypebaorticdissection
AT gewertzbruce initialexperiencewithamodifiedcandyplugtechniqueforfalselumenembolizationinchronictypebaorticdissection
AT azizzadehali initialexperiencewithamodifiedcandyplugtechniqueforfalselumenembolizationinchronictypebaorticdissection