Modified “Candy-Plug” Technique for False Lumen Embolization in Chronic Type B Aortic Dissection
Daniel Miles, Sally Schonefeld, Cassra Arbabi, Donald Baril, NavYash Gupta, Bruce Gewertz, Ali Azizzadeh
Cedars-Sinai Medical Center, Los Angeles, CA
OBJECTIVES: Persistent distal false lumen (FL) perfusion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) can lead to aneurysmal degeneration and increased risk of rupture. We present a modified “candy-plug” technique for FL embolization.
METHODS: After placement of a spinal drain bilateral common femoral artery (CFA) access was obtained using ultrasound guidance. Intravascular ultrasound (IVUS) was used to confirm true lumen (TL) traverse from the left CFA and FL traverse from the right CFA after crossing a natural fenestration at the left renal artery. The existing TEVAR was extended to the level of the celiac artery. A GORE conformable thoracic aortic graft (c-TAG) was modified on the back table with constraining suture (Gore-Tex CV-4) to create a napkin-ring narrowing. This modified c-TAG was then deployed in the false lumen at the level of the TEVAR extension. A 14mm Amplatzer plug was deployed in the constrained portion of the modified c-TAG. Completion angiography confirmed successful FL exclusion and no endoleak.
RESULTS: The patient tolerated the procedure well and was admitted to the intensive care unit for close monitoring. He remained neurologically intact and his CSF drain was removed on post-operative day 1. His dual anti-platelet medication was resumed and he was discharged on post-operative day 2 in excellent condition.
CONCLUSIONS: The “candy-plug” embolization technique is a promising solution for persistent distal FL perfusion after TEVAR for TBAD. This minimally invasive technique can serve as an adjunct to standard TEVAR and promote aortic remodeling.
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