The use of Amplatzer Vascular Plug II for left subclavian artery embolization during TEVAR with debranching successfully prevented type II endoleak in a high-risk patient with acute type B aortic dissection and rupture.
May support plug embolization in select debranching TEVAR; hypothesis-generating and requires prospective validation before practice change.
An 88-year-old man with severe chest pain and syncope was admitted to our hospital. Contrast-enhanced computed tomography (CT) revealed acute type B aortic dissection with rupture. Considering age and operative risk, we performed emergency thoracic aortic endovascular repair with two-debranching of the left common carotid and left subclavian arteries. To prevent type II endoleak, we used Amplatzer Vascular Plug (AVP) II for left subclavian artery embolization. Postoperative contrast-enhanced CT showed no type II endoleak and rupture site exclusion. As postoperative persistent blood flow to the primary entry or rupture site causes re-rupture, AVP II was crucial in preventing type II endoleak.
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Iida et al. (2015) studied this question.
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