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. 2020 Jun 25;6(3):433-437.
doi: 10.1016/j.jvscit.2020.05.012. eCollection 2020 Sep.

Intercostal artery embolization to induce false lumen thrombosis in type B aortic dissection

Gregory A Magee  1 , Jeniann A Yi  2 , David P Kuwayama  3
Affiliations

Intercostal artery embolization to induce false lumen thrombosis in type B aortic dissection

Gregory A Magee et al. J Vasc Surg Cases Innov Tech. .

Abstract

Persistent false lumen flow is common after thoracic endovascular aortic repair of type B aortic dissection and may contribute to continued aortic aneurysmal degeneration. We report an innovative technique of intercostal artery embolization within the false lumen for a patient who had incomplete false lumen thrombosis and progressive aortic enlargement after thoracic endovascular aortic repair of chronic type B aortic dissection. Technical success was facilitated by use of on-table cone beam computed tomography angiography, virtual vessel marking, and modern endovascular tools. The patient had no complications from the procedure. Postoperative imaging demonstrated complete thoracic false lumen thrombosis and favorable aortic remodeling with reduction in maximal aortic diameter.

Keywords: Embolization; False lumen; Intercostal artery; Type B aortic dissection.

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Figures

Fig 1
Fig 1
Maximal aortic diameter before (A) and 6 months after (B) thoracic endovascular aortic repair (TEVAR) and 2 months after coil embolization of false lumen intercostal arteries (C). Images are straightened multiplanar reconstructions of extracted aortic centerlines (Aquarius iNtuition 3D; TeraRecon, Foster City, Calif). Labels denote the widest aortic diameter on cross-sectional slices perpendicular to centerline.
Fig 2
Fig 2
Coronal reconstruction of computed tomography angiography (CTA) image after thoracic endovascular aortic repair (TEVAR) demonstrating partial false lumen thrombosis (FLT) in zone 5.
Fig 3
Fig 3
A, Three-dimensional polyline overlays used to demonstrate false lumen intercostal artery trajectory during endovascular intervention to aid in cannulation. B, Postoperative fluoroscopy imaging demonstrating successful coil embolization of false lumen intercostal arteries.
Fig 4
Fig 4
Three-dimensional reconstruction of computed tomography angiography (CTA) image before (A) and after (B) false lumen intercostal artery embolization demonstrating improved false lumen thrombosis (FLT) around the thoracic aorta and prior thoracic endovascular aortic repair (TEVAR).
See this image and copyright information in PMC

References

    1. Kang W.C., Greenberg R.K., Mastracci T.M., Eagleton M.J., Hernandez A.V., Pujara A.C. Endovascular repair of complicated chronic distal aortic dissections: intermediate outcomes and complications. J Thorac Cardiovasc Surg. 2011;142:1074–1083. - PubMed
    1. Lombardi J.V., Hughes G.C., Appoo J.J., Bavaria J.E., Beck A.W., Cambria R.P. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg. 2020;71:723–747. - PubMed
    1. Tsai T.T., Evangelista A., Nienaber C.A., Myrmel T., Meinhardt G., Cooper J.V. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007;357:349–359. - PubMed
    1. Kitagawa A., Greenberg R.K., Eagleton M.J., Mastracci T.M., Roselli E.E. Fenestrated and branched endovascular aortic repair for chronic type B aortic dissection with thoracoabdominal aneurysms. J Vasc Surg. 2013;58:625–634. - PubMed
    1. Liu F., Ge Y.Y., Guo W., Liu X.P., Jia X., Xiong J. Preoperative thoracic false lumen branches are predictors of aortic enlargement after stent grafting for DeBakey IIIb aortic dissection. J Thorac Cardiovasc Surg. 2018;155:21–29.e3. - PubMed

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