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Controlled Balloon False Lumen Obliteration for the Endovascular Management of Chronic Dissection in the Descending Thoracic Aorta

Open AccessPublished:January 23, 2023DOI:https://doi.org/10.1016/j.xjtc.2023.01.010
Controlled Balloon False Lumen Obliteration for the Endovascular Management of Chronic Dissection in the Descending Thoracic Aorta
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      Abstract:

      Objective

      Retrograde false lumen perfusion has limited the utility of aortic stent-grafting for chronic aortic dissection. It is unknown balloon septal rupture, can improve outcomes for endovascular management of chronic aortic dissection.

      Methods

      Included patients underwent false lumen obliteration and creation of a single-lumen aortic landing zone using balloon aortoplasty during thoracic endovascular aortic repair (TEVAR). The distal thoracic stent-graft was sized to the total aortic lumen diameter, and septal rupture was performed within the stent-graft with a compliant balloon in the region 5cm proximal to the distal fabric edge. Clinical and radiographic outcomes are reported.

      Results

      Forty patients, average age of 56 years old, underwent TEVAR with septal rupture. Seventeen (43%) were chronic type B dissections, 17/40(43%) were residual type A dissections and 6/40 (15%) were acute type B dissections. Nine cases were emergent, complicated by rupture or malperfusion. Perioperative complications included 1 death (2.5%) due to rupture of the descending thoracic aorta and 2 (5%) instances each of stroke (neither permanent) and spinal cord ischemia (1 permanent). Two (5%) stent-graft induced new injuries were seen. Average postoperative CT follow up was 1.4 years. Thirteen (33%) patients saw a decrease in aortic size, 25/39 (64%) were stable, and 1/39 (2.6%) grew. Partial and complete false lumen thrombosis was achieved in 10/39 (26%) and 29/39 (74%), respectively. Mid-term aortic related survival was 97.5% at an average of 1.6 years.

      Conclusion

      Controlled balloon septal rupture offers an effective endovascular method to treat aortic dissection in the distal thoracic aorta.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Keywords

      Glossary of Abbreviations:

      TEVAR (Thoracic endovascular aortic repair), TBAD (Type B Aortic Dissection), cTBAD (Chronic type B aortic dissection), FL (False lumen), CTA (Computed tomography angiogram), CSF (Cerebral spinal fluid), CVA (Cerebral vascular accident), SCI (Spinal cord ischemia), SINE (Stent graft induced new aortic injury)

      Article info

      Publication history

      Accepted: January 17, 2023
      Received: May 18, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Disclosures: Watkins- Consultant for WL Gore, Aortic Advisory Board for Artivion

      The remaining authors have nothing to disclose.

      No funding was used for this study.

      Oral Presentation on demand at the 2022 AATS Aortic Symposium, Boston, MA.

      This study was last approved by the Institution Review Board (#25673) on 7/19/22.

      Central Picture: Pre-operative CTA imaging of a chronic type B dissection with aneurysm.

      Central message:

      Balloon induced rupture of the aortic dissection membrane following endograft placement for chronic dissection prevents retrograde false lumen perfusion. Further research should consider this technique.

      Perspective Statement:

      Endovascular management of aortic dissection has evolved significantly since 1999. Results for chronic dissection have been limited by retrograde false lumen perfusion. False lumen closure techniques have demonstrated improved outcomes. This study reports promising peri-operative and mid-term outcomes of balloon septal rupture during TEVAR.

      Identification

      DOI: https://doi.org/10.1016/j.xjtc.2023.01.010

      Copyright

      © 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery

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