Intentional targeted false lumen occlusion after aortic dissection: a systematic review of the literature.

Intentional targeted false lumen occlusion after aortic dissection: a systematic review of the literature.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Spanos K, Kölbel T, Rohlffs F, Heidemann F, Giannoukas AD, Debus SE, Tsilimparis N

Abstract
BACKGROUND: Residual patent false lumen (FL) after chronic type B (cTBAD) or type A aortic dissection (TAAD) treatment is independently associated with poor long-term outcome. The aim of our study was to present endovascular techniques and the existing experience of targeted false lumen (FL) thrombosis after cTBAD or type A TAAD treatment.
MATERIAL AND METHODS: A systematic review was performed (PRISMA) searching in MEDLINE, CENTRAL, and Cochrane databases including studies reporting on targeted FL occlusion after cTBAD or TAAD.
RESULTS: One hundred-one patients either after open repair of a TAAD (n=40; 3 case reports and 3 retrospective studies) or after cTBAD (n=61; 13 case reports and 6 retrospective studies) underwent an endovascular procedure for intentional FL occlusion (2 studies reported on both procedures). In TAAD patients, 27/40 (68%) had previous open repair, while 48/61 (79%) with cTBAD had previously endovascular repair. Thirty-one (78%) with TAAD and fifty-one (83%) with cTBAD were treated electively. Four main techniques were used: the Candy-Plug (19/101), the Knickerbocker (3/91), the "cork in the bottle neck" technique (2/101) and false lumen embolization with combined use of coils, onyx, plugs and glue (77/101). The technical success rate was 100% with 30- day mortality rate of 2.5% (1/40) in TAAD and 0% in cTBAD patients. During follow up (ranging: 2 to 63 months) the mortality rate was 0% (0/31) and 7.1% (4/61) in TAAD and cTBAD patients, respectively. The FL remained completely thrombosed in 78% (31/40) of TAAD and 62% (38/61) of cTBAD patients, while it was partially thrombosed in 3 and 2, respectively (no report for 22 patients).
CONCLUSION: Intentional FL occlusion seems to be a feasible less invasive approach after cTBAD or type A TAAD treatment which is not broadly used. Future, larger studies with longer follow up may demonstrate the apparent benefit in terms of aortic remodeling or stabilization of the disease progression.

PMID: 30496905 [PubMed - as supplied by publisher]

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