Modified ‘candy-plug’ technique for chronic type B aortic dissection with aneurysmal dilatation: a case report

Abstract

BackgroundThe original ‘candy-plug’ technique has been reported to be beneficial for the treatment of residual perfused false lumen in patients with aortic dissection. However, this technique is also associated with several problems, such as narrowing of the true lumen and damage to the flap or vessel wall. Therefore, we modified the procedure to overcome these problems. Here we report a case in which the patient was successfully treated using the modified procedure.Case presentationA 59-year-old man presented with chronic type B aortic dissection with aneurysmal dilatation. The patient had undergone prosthetic graft replacement of the ascending aorta for acute type A aortic dissection 3 years previously and replacement of the descending aorta for residual type B aortic dissection with aneurysmal dilatation 1 year previously. After these procedures, the residual false lumen aneurysm of the distal descending aorta expanded to 57-mm in diameter. Endovascular stent grafting was successfully performed using the modified ‘candy-plug’ technique with relining of the true lumen and occlusion of the false lumen. The patient was discharged 10 days after the procedure. Follow-up imaging at 1 year showed a completely thrombosed false lumen aneurysm.ConclusionThe modified ‘candy-plug’ technique is useful for treatment of residual type B aortic dissection with aneurysmal dilatation.

Candy-plug technique for ruptured chronic type B aortic dissection

“…3 However, Ogawa and colleagues 3 reported the risk of major problems including narrowing of the true lumen by compression of the candy-plug stent and flap and vessel wall injury by the stent. Therefore, Kotani and colleagues 4 described a modified candy-plug technique involving a stent-graft in the true lumen at the distal end of the occluder device in the false lumen. 4 We used this modified candy-plug technique for ruptured chronic type B aortic dissection in our patient, which provided good early results.…”

“…Therefore, Kotani and colleagues 4 described a modified candy-plug technique involving a stent-graft in the true lumen at the distal end of the occluder device in the false lumen. 4 We used this modified candy-plug technique for ruptured chronic type B aortic dissection in our patient, which provided good early results.…”

Homemade Candy Plug Using a Zenith Alpha Thoracic Stent-Graft for False Lumen Distal Occlusion in Acute-on-Chronic Type B Aortic Dissection

“…The candy-plug technique is a useful method of occluding a large distal false lumen in chronic aortic dissection. 2–7 Rohlffs et al 3 successfully deployed candy plugs in 18 patients with chronic thoracic aortic dissection; all but one had no persisting false lumen backflow. Others 5,7 have reported the successful use of the candy-plug technique in emergency treatment of false lumen rupture of chronic type B aortic dissection.…”

Distal Neo-Neck Formation for Chronic Type B Dissection: False Lumen Closure After TEVAR

“…Endovascular technology has progressed, and various methods to prevent type Ib endoleak have been developed, such as the Knickerbocker technique, candy-plug technique, and branched stent grafts. [8][9][10][11] However, false lumen flow cannot be suppressed in all cases due to stiffness of the aorta in the chronic phase.…”

“…Therefore, this method is inferior to open surgery in terms of curability. 2,3,[8][9][10][11] When only open surgery is performed for chronic dissection, extensive aortic replacement is usually required, making the procedure very invasive. 2,[12][13][14][15] Therefore, we have developed a new method for closing the false lumen after TEVAR and named it as distal neo-neck with true aortic aneurysm and including patients with postoperative aneurysm of type A dissection, at the Matsubara Tokushukai Hospital.…”