Black candy-plug technique for a large false lumen in a patient with complicated type B aortic dissection

Figures

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  Fig 1. Contrast-enhanced computed tomography (CT) reveals progressive false lumen (FL) enlargement due to a type Ia endoleak after thoracic endovascular aortic repair (TEVAR) (A, arrow) and persistent retrograde flow (B) from multiple re-entries involving the celiacomesenteric trunk (C,arrow; D,arrowhead).

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  Fig 2. Aortography shows a proximal bird-beak configuration suggestive of a type Ia endoleak (A,arrowhead), and retrograde flow at the level of celiacomesenteric trunk (B,arrow), indicating distal false lumen (FL) reperfusion.

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  Fig 3. Under intravascular ultrasound (IVUS) guidance, the dissection flap was punctured from the true lumen into the false lumen (FL) approximately 2 cm distal to the caudal end of the thoracic stent graft, and a Radifocus guidewire was advanced into the FL (A). The fenestration was then dilated using an 8 mm × 4 cm balloon catheter (B). The modified Excluder aortic extender (Ex-cuff) was deployed at the distal level of the thoracic stent graft (C). Subsequently, a 16-mm Amplatzer Vascular Plug I, preloaded with a 2.2F microcatheter was deployed at the waist of the modified Ex-cuff (D). The microcatheter was then withdrawn into the plug, and four detachable coils were placed within the plug (E and F). Angiography revealed persistent perigraft leakage around the Ex-cuff (G). Therefore, 33% n-butyl-2-cyanoacrylate (NBCA) was slowly injected, achieving complete occlusion (H) (arrowhead, coil-in-plug; arrow, NBCA-Lipiodol). Completion angiography confirmed complete elimination of FL perfusion in the thoracic aortic segment (I).

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  Fig 4. Contrast-enhanced computed tomography (CT) obtained at 3 weeks shows no migration or displacement of the candy-plug (A) and complete thrombosis of the thoracic false lumen (FL) (B and C).