Endovascular Closure of Chronic Dissection Entries in the Aortic Arch Using the Amplatzer Vascular Plug II as a Sealing Button

Abstract

Endovascular closure of small proximal dissection entries in the aortic arch with an AVP II used as a sealing button is feasible and may be an alternative to open surgical arch reconstruction in selected patients with chronic aortic dissection and secondary aneurysm expansion.

Amplatzer Vascular Plug for Complicated Residual DeBakey Type 1 Aortic Dissection in the Aortic Arch

“…One case eventually required a total arch replacement at 5 months due to persistent flow into the false lumen. 5 In our case, the location of the primary entry tear was in the proximal aortic arch. Open repair for this pathology requires an aortic arch replacement; however, considering the patient's age of 79, we thought endovascular repair was safer than open repair.…”

“…Finally, a total of 5 articles including 7 patients were found (Table 1). [4][5][6][7][8] In all of the 8 cases, including our case, ascending aorta replacement or hemiarch replacement was previously performed for type A aortic dissection, and later the proximal descending aorta dilated with the residual tears in the aortic arch or the proximal descending aorta. The median age was 57 (range: 44 to 79).…”

Endovascular entry closure using Amplatzer vascular plug for the aortic dissection in sub-acute phase

“…When deploying the Amplazter vascular plug 2 in the entry, the stability of the tissue around the entry site is critical. A previous report conducted in the chronic phase revealed the 2year reliability of this procedure in terms of management for aortic dissection [3]. In this case, we conducted the same A simultaneous angiographic image from the true and false lumens in a 60-degree right anterior oblique projection (A) revealed the location of the entry site.…”

“…However, repeat operation carries a high risk of perioperative complications. Endovascular management for entry closure with a vascular plug in the chronic phase has been reported previously [3]. We conducted the same procedure in the sub-acute phase and achieved favorable aortic remodeling, subsequently preventing vessel rupture.…”

Commentary: Buttoning Up the Proximal Tear

“…In this issue of the JEVT , Falkenberg and colleagues 1 describe an alternative approach to achieve false lumen thrombosis in 4 patients with chronic aortic dissection by selectively closing proximal entry tears using the Amplatzer Vascular Plug (AVP) II as a “sealing button.” The authors state that the alternative treatment option to the chosen technique would have been open surgical arch replacement with the elephant trunk technique in all patients.…”