False Lumen Obliteration In The Management Of Chronic Descending Aortic Dissections

Monday, March 31, 2025

3:18 PM – 3:27 PM CT

Location: Music City Center, 205 BC

Presenting Author(s)

Brendan Carney, DO (he/him/his)

Resident
University of Iowa Hospitals and Clinics, United States

Author/Co-author(s)

Mel J. Sharafuddin, MD, FACS, FSIR

Clinical Professor of Surgery and Radiology
University of Iowa Healthcare, United States

Purpose: Standalone thoracic endovascular aortic repair (TEVAR) in chronic descending aortic dissections (CDAD) frequently leads to high failure rates, primarily due to persistent filling of the false lumen (FL). The purpose of this study is to evaluate the role of false lumen obliteration (FLO) as an adjunctive therapy in the management of CDAD, aimed at improving patient outcomes and promoting favorable aortic remodeling.

Materials and Methods: We conducted a retrospective review at a single center, including patients treated for CDAD with aneurysmal degeneration between June 2016 and September 2024. Sixteen patients (mean age 67 ± 11 years; 13 males) underwent 18 FLO procedures. Follow-up computed tomography angiography (CTA) was available for all patients, with a mean follow-up duration of 21.7 ± 50 months. FL and true lumen (TL) volumes were assessed using 3D workstation software, and outcomes were subjectively qualified.

Results:

FLO was a planned intervention in 8 procedures and a rescue adjunct in 10. Large Amplatzer plugs (18- or 22-mm diameter) were deployed in 15 procedures. Additional devices included converted aortic endografts (2), coils (1), and Gelfoam slurry (1). FLO was combined with extended coverage into the visceral aorta using F/BEVAR in 6 cases, aortic bifurcation relining with unibody endograft in 4 cases, iliac bifurcation reconstruction with iliac branch endografts (IBE) in 2 cases, and stent-graft incorporation of visceral branches in 3 cases.

Outcomes were classified as successful in 11 patients and partially successful in 7. The mean FL volume decreased significantly from 182.9 ± 114.5 mL preoperatively to 15.2 ± 20.4 mL postoperatively (p < 0.0001). The maximal aortic diameter also decreased from 64.8 ± 9.9 mm to 59.8 ± 7.0 mm (p < 0.005). Two patients with large type IB and II endoleaks who transitioned to palliative care were excluded from the final analysis.

Three patients experienced delayed failures characterized by resumption of FL filling and sac expansion. These were managed with IBE relining or seal-zone extension into the visceral segments using F/BEVAR. No periprocedural or aneurysm-related deaths occurred, and no FLO-related complications were reported.

Conclusion: In addition to TL-based interventions for CDAD, FLO serves as an important adjunct, promoting favorable aortic remodeling and reducing the risk of adverse outcomes.