Key result
Endovascular false lumen management achieves ~80% complete thrombosis in chronic aortic dissection.
Why the study?
Data on false lumen evolution after endovascular repair for aortic dissection showed discouraging complete thrombosis, as persistent flow from collateral arteries and distal entry points may prevent exclusion.
What are the outcomes of various endovascular false lumen management techniques in patients with chronic aortic dissection?
What are the outcomes of various endovascular false lumen management techniques in patients with chronic aortic dissection?
Various endovascular techniques for false lumen management in chronic aortic dissection demonstrate high technical success and promote positive aortic remodeling, though long-term outcomes remain to be established.
Answers are grounded in this paper and cite their sources.
May warrant caution in expecting complete FL exclusion after endovascular repair; leaves open optimal adjunctive techniques for chronic aortic dissection.
Objective Data on false lumen (FL) evolution after endovascular repair for aortic dissection showed discouraging findings in terms of complete FL thrombosis. Persistent flow from collateral arteries and distal entry points may prevent FL exclusion. This review aims to present the current techniques and available evidence on endovascular false lumen management in patients treated for chronic aortic dissection . Methods A review of the English literature was undertaken using MEDLINE and EMBASE databases from January 2000 to February 2023. Studies reporting on technical and clinical findings of the available endovascular techniques for FL exclusion were considered eligible. Only descriptive data are presented, and no comparison was attempted. Results The available techniques dedicated to preventing FL retrograde flow are: a. The "Cork in the Bottle technique", b. Physician-modified aortic occluders, c. The Knickerbocker technique and d. False lumen endografts (FLE; the Candy-Plug technique). The "Cork in the Bottle technique" has been related to a 24-month follow-up positive aortic remodeling rate at 80%. The Knickerbocker technique showed technical success at 94% but with a secondary reintervention rate at 31%. Follow-up imaging confirmed aortic diameter regression in 75% of patients. Physician-modified and custom-made false lumen endografts (FLEs; the Candy Plug technique) have been used for FL backflow interruption. Published experience on the use of custom-made Generation I to III FLE showed 94% technical success rate and an 80% complete FL thrombosis. During the mid-term follow-up, positive aortic remodeling was detected in up to 90% of patients. Conclusions Exclusion of FL's backflow is mandatory in patients managed for chronic aortic dissections and can be achieved with various techniques. All options are associated with high technical success in experienced hands; however, further advancements and long-term follow-up data are needed.
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Nana et al. (2024) conducted a review in chronic aortic dissection. Endovascular false lumen management techniques was evaluated on Technical success, complete false lumen thrombosis, and positive aortic remodeling. Endovascular false lumen management techniques in chronic aortic dissection, such as the Candy Plug, achieved technical success rates up to 94% and complete false lumen thrombosis in 80% of cases.
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