Custom Made Candy Plug for Distal False Lumen Occlusion in Aortic Dissection: International Experience

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • University of Hamburg
  • Mansoura University
  • Centre Chirurgical Marie Lannelongue
  • Vita-Salute San Raffaele University
  • Brescia Civil Hospital
  • University of Toronto
  • Lund University
  • Ludwig Maximilian University of Munich

Abstract

Objective: To evaluate early and midterm outcomes of the Candy Plug (CP) technique for distal false lumen (FL) occlusion in thoracic endovascular aortic repair for aortic dissection (AD) in a more real world cohort of patients from an international multicentre registry. Methods: A multicentre retrospective study was conducted of all consecutive patients from the contributing centres with subacute and chronic AD treated with the CP technique from October 2013 to April 2020 at 18 centres. Results: A custom made CP was used in 155 patients (92 males, mean age 62 ± 11 years). Fourteen (9%) presented with ruptured false lumen aneurysms. Technical success was achieved in all patients (100%). Clinical success was achieved in 138 patients (89%). The median hospital stay was 7 days (1 – 77). The 30 day mortality rate was 3% (n = 5). Stroke occurred in four patients (3%). Spinal cord ischaemia occurred in three patients (2%). The 30 day computed tomography angiogram (CTA) confirmed successful CP placement at the intended level in all patients. Early complete FL occlusion was achieved in 120 patients (77%). Early (30 day) CP related re-intervention was required in four patients (3%). The early (30 day) stent graft related re-intervention rate was 8% (n = 12). Follow up CTA was available in 142 patients (92%), with a median follow up of 23 months (6 – 87). Aneurysmal regression was achieved in 68 of 142 patients (47%); the aneurysm diameter remained stable in 69 of 142 patients (49%) and increased in five of 142 patients (4%). A higher rate of early FL occlusion was detected in the largest volume centre patients (50 [88%] vs. 70 [71%] from other centres; p = .019). No other differences in outcome were identified regarding volume of cases or learning curve. Conclusion: This international CP technique experience confirmed its feasibility and low mortality and morbidity rates. Aortic remodelling and false lumen thrombosis rates were high and support the concept of distal FL occlusion in AD using the CP technique.

Details

Original languageEnglish
Pages (from-to)50-56
Number of pages7
JournalEuropean journal of vascular and endovascular surgery
Volume66
Issue number1
Early online date22 Mar 2023
Publication statusPublished - Jul 2023
Peer-reviewedYes

External IDs

PubMed 36958480

Keywords

Keywords

  • Aneurysm, Aortic dissection, Aortic remodelling, Endovascular repair, False lumen occlusion, Thoracic endovascular aortic repair

Library keywords