False Lumen Obliteration as Adjunct in Management of Descending Aortic Dissections

Jeanette H. Man; Adeola Odugbesi; Crystal Rodriguez; Sarah Burger; Mel J. Sharafuddin

doi:10.1016/j.jvs.2021.06.162

Objective Although reported sporadically, a paucity of clinical experience has been reported with false lumen (FL) obliteration in chronic type B aortic dissections (TBADs). We report our increasing experience with FL obliteration (FLO) as a management adjunct. Methods We performed a retrospective review of patients with TBAD treated by our group from June 2016 through December 2020. We identified 16 patients (age, 67 ± 11 years; 13 men) who had undergone 18 FLO procedures. The 18 indications included 1 acute TBAD and 17 chronic descending aortic dissections, which had presented with aneurysmal degeneration (n = 15) or malperfusion (n = 2). Results Large Amplatzer plugs were used in 15 procedures (mean, 1.75; range, 1-3), other occlusive material was used in 3. FLO was used as a preemptive adjunct during complex endovascular thoracoabdominal aortic repair (fenestrated/branched endografts) in nine procedures. The prerequisite access into FL was straightforward in most cases. Transseptal access from the true lumen was also used. Distal landing zone optimization via wide-based septal fenestration was performed in 11 procedures. Two repeat interventions involving FLO were performed, in conjunction with extended aortic coverage into the visceral aorta using fenestrated endograft. Follow-up, including computed tomography angiograms, was available for all patients (mean duration, 16.8 ± 14 months). No periprocedural or aneurysm-related deaths occurred. Two patients had died of malignancy and trauma. No specific complications developed as a result of FLO. At the latest follow-up, the proportion of FL filling had decreased from 85% ± 8% to 15% ± 13% (P < .001). The aortic diameter had decreased from 68.0 ± 12.6 mm to 61.4 ± 8.0 mm (P = .06). The outcome of FLO (FLO, aneurysmal collapse, and/or resolution of malperfusion) was subjectively qualified as successful for 11 and partially successful for 7 procedures. Conclusions In addition to true lumen-based aortic interventions to treat complicated chronic descending aortic dissection, FLO is a safe and surprisingly effective adjunct, providing an additional safeguard in the comprehensive management of these challenging conditions. FLO can be used preemptively or as a secondary tool for patients with persistent FL filling after a primary intervention. Additional comparative evaluation of this modality is required to further ascertain its indications.

False Lumen Obliteration as Adjunct in Management of Descending Aortic Dissections

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