Clinical Utility of the Candy-Plug Technique Using an Excluder Aortic Extender

Figures

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  Fig. 1 Preparation of a candy plug using the Ex-cuff. The needle of the Ti-Cron suture was inserted through the Ex-cuff to secure the thread. Complete ligation was achieved with approximately 10 mm of clearance.

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  Fig. 2 Candy-plug sizing. TL stent graft≒crescent length (yellow line). Ex-cuff=mean FL diameter (white lines)+10%–20%.

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  Fig. 3 TEVAR using the candy-plug technique. (a) The candy plug is placed in the FL and positioned parallel to the distal end of the stent graft in the TL. (b) Completion aortography shows marked decreasing retrograde flow into the FL.

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  Fig. 4 Causes of residual FL flow. (a) CECT shows persistent retrograde flow though the AVP in the FL. (b) CECT shows persistent retrograde flow into the FL due to the migration of the candy plug.

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  Fig. 5 Complete FL thrombosis despite placement of an undersized candy plug. (a) The mean FL diameter was 45 mm with a massive mural thrombus. The flow lumen measured 30 mm. (b) The 36-mm candy plug achieved complete FL thrombosis.

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  Fig. 6 A man in his 70s with hemoptysis after type A aortic dissection treated by total arch and descending aorta replacement and TEVAR. (a) Preoperative CECT shows hematoma around the anastomosis. (b) Aortography shows minor extravasation (arrowhead) close to the anastomosis and multiple distal entry points. (c) Postoperative TEVAR with the candy-plug technique shows no residual FL flow above the candy plug (arrow) on completion aortography. (d) Postoperative CT 10 days later shows FL thrombosis above the candy plug with a reduction in hematoma volume.