False lumen embolization in chronic aortic dissection promotes thoracic aortic remodeling at midterm follow-up

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

“…Norberto et al 19 and Pellenc et al 20 showed that thrombosis of the false lumen after TEVAR for TBAD promotes aortic remodeling. Watanabe et al 21 showed that aortic remodeling after TEVAR decreases the risk of aortic adverse events.…”

“…14,15,17,18 Coil embolization of the false lumen has been used as another method of encouraging thrombosis, but fewer than 100 cases have been reported in the literature. 16,19,20 In patients with a larger false lumen relative to total aortic diameter, coil embolization may be preferred to the knickerbocker technique. Coils placed into the false lumen could provide less potential for stent graft injury than overexpanding a graft into a large false lumen.…”

Commentary: Should we use a “full metal jacket” after repair for chronic residual type I aortic dissection?

“…4 Strategies to force the FL thrombosis using coils or other embolization devices have been encouraging. 5 Huang and colleagues 1 suggest using the Petticoat technique to expand the thoracoabdominal TL and promote the FL thrombosis. Unfortunately, no significant advantage was observed in the thoracic aorta.…”

Commentary: Techniques for Treating Postdissection Thoracoabdominal Aortic Aneurysm: Can Parallel Stent-Grafts Challenge Fenestrated/Branched Technology for Total Endovascular Repair?

“…[7][8][9][10] Recently, several special strategies, for example, the candy-plug technique, the knickerbocker technique, and coil embolization of the FL, have been used to block retrograde FL flow from the distal tears, with encouraging results in selected patients. [11][12][13] But all of these techniques have their own specific shortcomings and scope of applications. Open repair of postdissection TAAA is a challenging task, presenting serious technical problems for surgeons and significant mortality risk for patients.…”

“…Similarly, the problem with knickerbocker technique 12 is that it cannot prevent further distal FL perfusion in the infrarenal segment of the aorta and has the risk of aortic rupture during balloon inflation and subsequent later dilatation. Embolization with coils or a vascular plug has a high FL thrombosis rate (60%) and low SCI rate (3.7%), 13,19 but the metallic coils will interfere with follow-up imaging using computed tomography. None of these techniques is suitable for all lesions, and it is better to choose the optimal one according to the particular patient.…”