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. 2025 Jul 8;31(4):384-391.
doi: 10.4274/dir.2025.242986. Epub 2025 Mar 17.

Efficacy of endovascular circulating false lumen occlusion in chronic aneurysmal descending aortic dissections

Emeric Gremen  1   2 , Mathieu Finas  2 , Eliott Mathieu  2 , Frédéric Thony  2 , Mathieu Rodiere  2 , Julien Ghelfi  1   2
Affiliations

Efficacy of endovascular circulating false lumen occlusion in chronic aneurysmal descending aortic dissections

Emeric Gremen et al. Diagn Interv Radiol. .

Abstract

Purpose: To evaluate the efficacy of endovascular circulating false lumen occlusion (CFLO) in inducing positive aortic remodeling in chronic aneurysmal descending aortic dissection (AD).

Methods: This retrospective monocentric study included patients treated by CFLO between 2003 and 2022 in the context of chronic AD with progressive descending aneurysmal evolution and persistent circulating false lumen (FL). The procedure was achieved with coils, plugs, and/or glue at the entry tear or in the FL and/or with covered stenting in the supra-aortic trunk. The primary endpoint evaluated the positive aortic remodeling, defined as stabilization or a decrease in the aortic diameter on a computed tomography scan at the 1-year follow-up after the procedure. The FL circulating status, safety, and occurrence of aneurysm events during follow-up were also evaluated.

Results: Twenty patients [median age: 65.4 years, interquartile range (IQR): 58.4–69.9; 13 men] were included, with a median duration from an acute AD of 32.5 months (IQR: 8.8–76.5). Twelve patients (60%) achieved complete FL thrombosis after CFLO, whereas 8/20 patients (40.0%) experienced partial thrombosis. Additionally, positive aortic remodeling was observed in 13 patients (65%). Following the procedure, the aneurysmal aortic diameter decreased in 8/20 patients (40.0%) and remained stable in 5/20 patients (25.0%). Two patients (10%) had complications related to the procedure. Two patients (10%) had secondary aneurysm events during follow-up.

Conclusion: CFLO is a feasible and efficient method to induce FL thrombosis and reduce aneurysmal progression in chronic AD.

Clinical significance: The positive outcomes observed highlight the potential of this technique to improve patient management in complex aortic pathologies. This approach offers a valuable option in the management of chronic AD and emphasizes the importance of endovascular interventions in enhancing patient outcomes.

Keywords: Chronic aortic dissection; aortic aneurysm; circulating false aortic lumen; coils; embolization; endovascular occlusion; entry tear; false lumen; false lumen thrombosis; glue; plugs; stent; thoracic endovascular aortic repair; true lumen.

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Conflict of interest statement

The authors declared no conflicts of interest.

Figures

Figure 1
Figure 1
Study flowchart. CFLO, circulating false lumen occlusion; FL, false lumen; TEVAR, thoracic endovascular aortic repair; CT, computed tomography.
Figure 2
Figure 2
Treatment of a thoracic chronic dissecting aortic aneurysm after Bentall surgery in a 73-year-old patient with a history of chronic aortic dissection by coiling of the proximal portal of entry. The target entry tear (ET, black arrows) is located within segment 2, feeding the false lumen (FL, black stars). The coils (white arrows) indirectly occlude the ET, allowing thrombosis and regression of the FL (white arrowheads). Computed tomography scan with injection at arterial time before (a, c, e) and after (b, g) embolization. Serigraphy with injection and locating the ET by retrograde catheterization of the FL (d) and the true lumen (f).
Figure 3
Figure 3
Plug treatment of chronic aortic dissection with aneurysmal progression at the thoracic level in a patient after Bentall surgery. The entry tear (ET, black arrow) is located at the distal anastomosis (arrowheads) of the ascending aortic surgical prothesis. A type II plug (white arrow) is deployed through the ET. The proximal wing is in the true lumen (TL), and the body and distal wing are in the false lumen (FL). Axial computed tomography scan with injection at arterial time before (a) and after (b) embolization. Serigraphy with injection (c) identifying the ET. Maximum intensity projection reconstruction scans (d) after embolization. Three-dimensional reconstruction at arterial time before (e) and after (f) embolization. After treatment: regression of the FL, re-expansion of the TL, and decrease in the aortic diameter.
Figure 4
Figure 4
Treatment of a chronic aneurysmal dissection at the thoracic level using glue. Sagittal maximum intensity projection reconstruction scans before (a) and after (b) glue embolization (white arrows). Occlusion of the entry tear (black arrow) allows thrombosis of the false lumen (white star).
See this image and copyright information in PMC

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