Outcomes of abdominal false lumen embolization for chronic aortic dissection after prior proximal repair with stent-graft

Q: How was endovascular abdominal false lumen embolization performed and assessed?

Between 2015 and 2019, 24 patients underwent endovascular abdominal false lumen embolization using vascular plugs, coils, or candy plugs as main or auxiliary procedures. Pre- and pre-reintervention CT images were compared to examine aortic remodeling.

Q: What were the key outcomes regarding thrombosis and aortic diameter changes?

Technical success was achieved without intraoperative complications, early morbidity, or mortality. Complete thrombosis in the abdominal false lumen occurred in 3 patients (12.5%), while the abdominal aortic diameter increased significantly; continuous follow-up was recommended.

Sep 29, 2026

Uploaded by Sophia Brooks

Persistent false lumen perfusion with aneurysmal formation is common after thoracic endovascular aortic repair for extended aortic dissection and leads to poor outcomes. Endovascular false lumen embolization has been used for postdissection aortic aneurysm, but prior reports largely focus on thoracic, not abdominal, treatment. This study evaluates abdominal false lumen embolization in patients with residual patent abdominal false lumen after prior stent-graft repair, using CT-based remodeling assessment.

LanguageEnglish

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Abstract

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J Chin MedAssoc Original article Outcomes of abdominal false lumen embolization for chronic aortic dissection after prior proximal repair with stent-graft Ching-Yuan Kuoa,b, Chun-Yang Huanga,b, Tai-Wei Chena,b, Hung-Lung Hsua,c, Chun-Che Shiha,d, Chiao-Po Hsua,b,e,* aSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; bDivision of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC; cDepartment of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC; dDivision of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC; eDepartment of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC Abstract Background: Persistent false lumen (FL) perfusion with aneurysmal formation is common after thoracic endovascular aortic repair (TEVAR) for typical extended aortic dissection and is associated with poor outcomes. Endovascular FL embolization (FLE) has recently been tried for treatment of postdissection aortic aneurysm (PDAA) . However, most reports address thoracic rather than abdominal FLE. In this study, we present the results of abdominal FLE in patients with residual patent abdominal FL following stent-graft repair for aortic dissection. Methods: Between 2015 and 2019, 24 patients (mean age: 56.7 ± 11.8 years, range: 40-84 years, 18 male) received endovascular abdominal FLE using vascular plugs, coils, or candy plugs as the main surgery (5 patients) or auxiliary procedure (19 patients) after earlier stent-graft repair for aortic dissection (Type A: 9, Type B: 15) . The medical records were reviewed and aortic remodeling was examined comparing the preembolization computed tomography (CT) and the most recent CT before reintervention. Results: Technical success was achieved without any intraoperative complications, early morbidity, or mortality. Median follow-up was 34.4 months (range: 12-71) . Regarding thoracic FL, 15 patients exhibited complete thrombosis before the procedure and did not change status thereafter except for 1 patient with distal stent-graft-induced new entry. In the other 9 patients, 6 exhibited increased thrombosis. With regard to the abdominal aorta, increased FL thrombosis only occurred in 8 patients with 3 (12 .5%) achieving complete thrombosis. The maximal thoracic aortic diameter did not change (1 .4 ± 5.6 mm) statistically, but the abdominal diameter increased significantly (4 .3 ± 3.7 mm, p < 0 .005) . Conclusion: From our results, abdominal FLE is a safe procedure. However, covering all the re-entry tears is complex and the possibility of complete FL thrombosis is low. The abdominal aortic diameter appears to become enlarged in these patients. Continuous follow-up is necessary after FLE. Keywords: Aortic dissection; Embolization; False lumen 1. INTRODUCTION Thoracic endovascular aortic repair (TEVAR) has become the primary treatment for complicated type B aortic dissections.1,2 The goal of TEVAR is to eliminate antegrade flow into the false lumen (FL) by covering the proximal aortic tear with stent-graft placed in the true lumen (TL) of the descending aorta. Closure of the primary tear also facilitates thrombosis and the subsequent regression of the FL and re-expansion of the TL, a late effect known as aortic remodeling.3 * Address correspondence. Dr. Chiao-Po Hsu, Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: chiaopo@ms39.hinet.net (C.-P. Hsu). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 633-640. Received April 16, 2022; accepted October 3, 2022. doi: 10. 1097/JCMA.0000000000000934. Copyright © 2023, the Chine

FAQs

What problem does the study address after thoracic endovascular aortic repair?

Persistent false lumen perfusion with aneurysmal formation is common after TEVAR and is associated with poor outcomes. The study focuses on residual patent abdominal false lumen after prior proximal stent-graft repair.

How was endovascular abdominal false lumen embolization performed and assessed?

Between 2015 and 2019, 24 patients underwent endovascular abdominal false lumen embolization using vascular plugs, coils, or candy plugs as main or auxiliary procedures. Pre- and pre-reintervention CT images were compared to examine aortic remodeling.

What were the key outcomes regarding thrombosis and aortic diameter changes?

Technical success was achieved without intraoperative complications, early morbidity, or mortality. Complete thrombosis in the abdominal false lumen occurred in 3 patients (12.5%), while the abdominal aortic diameter increased significantly; continuous follow-up was recommended.

Sep 29, 2026

Uploaded by Sophia Brooks