Jahanzaib Idrees1, Eric E Roselli2, Susan Shafii1, Joshua Reside1, Bruce W Lytle1. 1. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 2. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: roselle@ccf.org.
Abstract
OBJECTIVE: Persistent retrograde false lumen perfusion is a common mode of failure after thoracic endovascular aortic repair (TEVAR) for chronic dissection. Objectives were to describe a novel endovascular approach for false lumen occlusion and assess outcomes. METHODS: From 2009 to 2013, 21 patients (mean age, 64 ± 11 years) with chronic thoracoabdominal dissection underwent adjunctive false lumen embolization using covered stent devices for persistent retrograde perfusion. Eight patients had type B dissection, 13 had residual dissection after prior type A repair, and all were deemed high risk for open operation. False lumen embolization in 17 patients was an adjunct at the initial TEVAR or extension, including two as elephant trunk completion. In the other four, this was done as an isolated procedure, and three had previously undergone TEVAR sparing the celiac artery. Covered stent devices included iliac plugs in 18, nitinol embolization plugs in two, and occluded stent graft in one. More than one device was used in 15 patients. RESULTS: There was one hospital death due to left subclavian artery aneurysm rupture but no patient had stroke, paraplegia, myocardial infarction, or renal failure. Mean follow-up was 25 ± 19 months. During surveillance computed tomography imaging, false lumen thrombosis was noted in all patients, but four required further embolization because the thrombosis was incomplete. Mean maximum aortic diameter decreased from 64 ± 14 to 59 ± 15 mm. There was one late death from intracranial hemorrhage and no aortic ruptures. CONCLUSIONS: Adjunctive false lumen embolization with a covered stent device promotes thrombosis and remodeling after stent grafting the true lumen for chronic dissection. Further study of this strategy is warranted.
OBJECTIVE: Persistent retrograde false lumen perfusion is a common mode of failure after thoracic endovascular aortic repair (TEVAR) for chronic dissection. Objectives were to describe a novel endovascular approach for false lumen occlusion and assess outcomes. METHODS: From 2009 to 2013, 21 patients (mean age, 64 ± 11 years) with chronic thoracoabdominal dissection underwent adjunctive false lumen embolization using covered stent devices for persistent retrograde perfusion. Eight patients had type B dissection, 13 had residual dissection after prior type A repair, and all were deemed high risk for open operation. False lumen embolization in 17 patients was an adjunct at the initial TEVAR or extension, including two as elephant trunk completion. In the other four, this was done as an isolated procedure, and three had previously undergone TEVAR sparing the celiac artery. Covered stent devices included iliac plugs in 18, nitinol embolization plugs in two, and occluded stent graft in one. More than one device was used in 15 patients. RESULTS: There was one hospital death due to left subclavian artery aneurysm rupture but no patient had stroke, paraplegia, myocardial infarction, or renal failure. Mean follow-up was 25 ± 19 months. During surveillance computed tomography imaging, false lumen thrombosis was noted in all patients, but four required further embolization because the thrombosis was incomplete. Mean maximum aortic diameter decreased from 64 ± 14 to 59 ± 15 mm. There was one late death from intracranial hemorrhage and no aortic ruptures. CONCLUSIONS: Adjunctive false lumen embolization with a covered stent device promotes thrombosis and remodeling after stent grafting the true lumen for chronic dissection. Further study of this strategy is warranted.