False Lumen Occlusion Using GORE TAG of Large Thoracic Aneurysm in Chronic Aortic Dissection
Khalil Qato, Allan Conway, Gary Giangola, Alfio Carroccio.
Lenox Hill Hospital, NY, NY, USA.
Objective(s): To describe a case of an expanding thoracic false lumen aneurysm in a patient with chronic aortic dissection treated by false lumen occlusion, "candy-plug technique" using a GORE Tag endograft.
Methods: A 54 yo M with a past medical history of hypertension, pulmonary hypertension, end-stage renal disease on hemodialysis (due to polycystic kidney disease), presents with an enlarging thoracoabdominal aneurysm from a chronic dissection. In 2015, the patient was treated for an acute aortic dissection (Debakey Class I) which was complicated by paraplegia, treated with bilateral aorto-iliac bare metal kissing stents. At the time, a 38 mm thoracoabdominal aneurysm was noted. One year later, he presented for follow-up with growth of his thoracoabdominal aneurysm to 56mm, with resolution of his paraplegia. In consideration of his recently resolved paraplegia, polycystic kidney disease, and bilateral 7 mm iliac kissing stents, a staged, hybrid approach for repair was taken.
First, he underwent thoracic stent grafting of the descending thoracic aorta. Second, a debranching of his superior mesenteric artery and celiac artery was performed with retrograd bypass from the left common iliac artery. Lastly, he was taken to the operating room and a Gore TAG endograft was extended to the level of the Renal arteries, in the hopes of maintaining perfusion to the kidneys to prevent infarct and possible infection from the polycystic kidney disease. Subsequently, the false lumen was canalized via a re-entry tear in the infra-renal aorta. A modified Gore TAG 38mm endograft was deployed with a 22mm Amplatzer plug (Figures 1).
Results: Completion angiogram showed successful occlusion of the thoracic aortic aneurysm, and a follow-up CT scan demonstrated no flow into the aneurysm sac (Figure 2).
Conclusions: 'Candy-plug' technique using a Gore TAG endograft may be utilized successfully for embolization of a large false lumen aneurysm from chronic aortic dissection.
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