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Case Reports
. 2020 Feb 20;6(1):110-117.
doi: 10.1016/j.jvscit.2019.12.004. eCollection 2020 Mar.

False lumen embolization as a rescue technique in the setting of acute and chronic dissecting aneurysms as adjunct to thoracic endovascular aortic repair

Stephanie Rakestraw  1 , Anthony Feghali  1 , Kevin Nguyen  1 , Dawn Salvatore  1 , Paul DiMuzio  1 , Babak Abai  1
Affiliations
Case Reports

False lumen embolization as a rescue technique in the setting of acute and chronic dissecting aneurysms as adjunct to thoracic endovascular aortic repair

Stephanie Rakestraw et al. J Vasc Surg Cases Innov Tech. .

Abstract

Complicated type B aortic dissection (TBAD) is a life-threatening condition requiring surgical intervention. One such complication in the acute or chronic setting is aneurysmal degeneration. The dissected aortic wall is weakened, and the pressures in the false lumen are often high. In the past decade, thoracic endovascular aortic repair (TEVAR) has become the treatment of choice for TBAD. TEVAR can be complicated by lack of false lumen thrombosis, increasing the risk of death. We present three cases of TBAD with patent false lumens after TEVAR that were treated by false lumen coil embolization.

Keywords: Aortic dissection; Coil embolization; Dissecting aortic aneurysm; Endovascular; False lumen; TEVAR.

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Figures

Fig 1
Fig 1
A, Computed tomography (CT) angiography showing a complex type B aortic dissection, with two false lumens and one true lumen. The superior mesenteric artery (SMA) is shown with perfusion through the true lumen. The celiac artery (CA) was perfused through the false lumen. The patient also had an abdominal aortic aneurysm (AAA) measuring up to 4.7 cm. B, Status post thoracic endovascular aortic repair (TEVAR) with persistent filling of the false lumen. The SMA maintained true lumen perfusion; the CA is still perfused through the false lumen.
Fig 2
Fig 2
A, Persistent retrograde flow into the false lumen. B, Status post embolization, no flow seen.
Fig 3
Fig 3
A, One-year status post thoracic endovascular aortic repair (TEVAR) and coil embolization and false lumen thrombosis. B, No flow is seen in the false lumen (arrow). Coil artifact can be seen.
Fig 4
Fig 4
Computed tomography (CT) angiography showing 8.7-cm dissecting aortic pseudoaneurysm and dissection. The partially thrombosed false lumen can be seen.
Fig 5
Fig 5
A, Arch aortogram showing pseudoaneurysm distal to the left subclavian artery (LSA). B, Status post thoracic endovascular aortic repair (TEVAR), LSA flow was maintained. C, Status post TEVAR, large pseudoaneurysm remained. D, Status post false lumen embolization, decreased flow in false lumen and pseudoaneurysm.
Fig 6
Fig 6
One-month status post thoracic endovascular aortic repair (TEVAR) and false lumen coil embolization. Thrombosis within the false lumen has increased.
Fig 7
Fig 7
Computed tomography (CT) angiography showing a 7.5-cm dissecting aortic aneurysm with large false lumen.
Fig 8
Fig 8
A, Arch aortogram showing dissecting aortic aneurysm. B, Status post thoracic endovascular aortic repair (TEVAR). C, Status post TEVAR, type IB endoleak remained. D, Status post coil embolization, no flow seen into the false lumen.
Fig 9
Fig 9
One-month status post thoracic endovascular aortic repair (TEVAR) and coil embolization, no flow seen into false lumen.
See this image and copyright information in PMC

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