A novel off-the-shelf solution for the treatment of retrograde false lumen flow causing hemothorax after thoracic endovascular aortic repair for aortic dissection and rupture

Figures

• 

  Fig 1. Computed tomography angiography (CTA) on presentation. A coronal image demonstrating a large intramural hematoma in the descending thoracic aorta associated with a left hemothorax.

• 

  Fig 2. Computed tomography angiography (CTA) following thoracic endovascular aortic repair (TEVAR). A coronal image demonstrating endovascular graft in situ post repair with persistent retrograde flow within the false lumen (FL) and a large left-sided hemothorax. The blue arrow indicates the tapering segment of the FL, which was targeted for deployment of the occlusion device.

• 

  Fig 3. (A) Three-dimensional reconstruction of aorta post false lumen (FL) exclusion procedure demonstrating Cook converter graft and Amplatzer plugs within FL. (B) Schematic diagram of FL exclusion device mechanism.

• 

  Fig 4. (A) Intraoperative angiogram demonstrating persistent retrograde contrast filling of false lumen (FL) adjacent to the aortic graft. (B) Intraoperative angiogram demonstrating completion runs post FL exclusion procedure with Cook converter graft and Amplatzer plugs preventing contrast filling of FL. TL, True lumen.

• 

  Fig 5. Flow diagram demonstrating procedural steps of modified candy plug (CP) false lumen (FL) exclusion procedure.

• 

  Fig 6. Timeline of events diagram. A diagram of events during admission, referencing day 0 as day of admission and demonstrating hemoglobin trends and drain output prior to false lumen (FL) exclusion procedure. TEVAR, Thoracic endovascular aortic repair; VATS, video-assisted thoracoscopic surgery.

• 

  Fig 7. Follow-up computed tomography angiography (CTA) 7 weeks post false lumen (FL) exclusion procedure. A sagittal image demonstrating Cook converter graft and Amplatzer plugs within FL, which has completely thrombosed. The hemothorax has resolved.