Impact of Endovascular False Lumen Embolization on Thoracic Aortic Remodeling in Chronic Dissection

Kyle G. Miletic, Bogdan A. Kindzelski, Kevin E. Hodges, Jocelyn Beach, Michael Z. Tong, Faisal Bakaeen, Douglas R. Johnston, Milind Desai, Sean Lyden, Eric E. Roselli*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Background: Retrograde false lumen (FL) perfusion after thoracic endovascular aortic repair (TEVAR) for chronic dissection is a mode of treatment failure. Thrombosis of the FL is associated with favorable reverse remodeling. Objectives are to describe FL embolization (FLE) strategy and assess aortic remodeling and survival. Methods: From January 2009 to December 2017, 51 patients with chronic dissection underwent FLE, most after previous TEVAR. Devices included a combination of iliac plug (29 patients), coils (19 patients), or nitinol plug (3 patients). Computed tomography was performed before discharge, at 3 months, and annually (median follow-up 2 years [range, 1 month to 7 years]). Results: After FLE, mean maximum aortic diameter decreased (64.2 ± 12 mm to 61.0 ± 13 mm; P =. 03), true lumen diameter increased (24.7 ± 10 mm to 33.7 ± 8 mm; P <. 001), and FL diameter decreased (36.7 ± 12 mm to 25.6 ± 15 mm, P <. 001). For reverse remodeling, FL thrombosis with ≥10% decrease in diameter and ≥10% increase in true lumen diameter was achieved in 20 (39.2%; 16 primarily, 4 secondarily). Nine patients progressed after the first FLE: persistent FL flow with increase in aortic diameter and underwent repeat FLE with complete thrombosis (n = 4) or open thoracoabdominal completion (n = 5). A total of 26 patients had indeterminate response (FL thrombosis without change in maximum diameter), and none have required reoperation. Six patients had complete obliteration of the entire FL. At last follow-up, 42 (82%) patients were alive. Three deaths were related to aortic pathology. Conclusions: FLE is an important endovascular adjunct to TEVAR promoting reverse aortic remodeling in select patients with chronic aortic dissection and persistent retrograde FL perfusion.

Original languageEnglish (US)
Pages (from-to)495-501
Number of pages7
JournalAnnals of Thoracic Surgery
Volume111
Issue number2
DOIs
StatePublished - Feb 2021

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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