Impact of Endovascular False Lumen Embolization on Thoracic Aortic Remodeling in Chronic Dissection

BackgroundRetrograde false lumen (FL) perfusion after thoracic endovascular aortic repair (TEVAR) for chronic dissection is a mode of treatment failure. Thrombosis the FL associated with favorable reverse remodeling. Objectives are to describe embolization (FLE) strategy and assess remodeling survival.MethodsFrom January 2009 December 2017, 51 patients underwent FLE, most previous TEVAR. Devices included combination iliac plug (29 patients), coils (19 or nitinol (3 patients). Computed tomography was performed before discharge, at 3 months, annually (median follow-up 2 years [range, 1 month 7 years]).ResultsAfter mean maximum diameter decreased (64.2 ± 12 mm 61.0 13 mm; P = .03), true increased (24.7 10 33.7 8 < .001), (36.7 25.6 15 mm, .001). For remodeling, thrombosis ≥10% decrease in increase achieved 20 (39.2%; 16 primarily, 4 secondarily). Nine progressed first FLE: persistent flow repeat FLE complete (n 4) open thoracoabdominal completion 5). A total 26 had indeterminate response (FL without change diameter), none have required reoperation. Six obliteration entire FL. At last follow-up, 42 (82%) were alive. Three deaths related pathology.ConclusionsFLE an important adjunct TEVAR promoting select retrograde perfusion. Retrograde survival. From years]). After pathology.