False lumen occlusion for chronic dissection

摘要

Currently, the primary treatment for distal aortic dissection is medical using anti-impulse therapy. Surgical intervention has been reserved for patients who develop complications, and increasingly this has been in the form of thoracic endovascular aortic repair (TEVAR). Results of TEVAR for acute complicated dissection have been excellent as compared to open surgical or medical therapy, but the results after TEVAR for chronic complicated dissection are mixed. This is especially true for patients with dissections that extend into the abdominal aorta (the most common presentation). When these patients are treated with simple TEVAR of the true lumen across the primary entry tear, they are still prone to have retrograde false lumen flow and pressuriza-tion from distal re-entry tears in the visceral segment of the aorta or iliac arteries. This is true even when the stent-graft is extended throughout the thoracic aorta to the level of the celiac artery. The backflow into the false lumen can lead to persistent risk of rupture even if it is slow flow not detectable during arterial phase computed tomography. Delayed venous phase imaging is critical in these patients to detect the slower retrograde flow that can contribute to excessive pressur-ization of the aneurysmal false lumen. Aortic dissection disease requires particularly complex treatment, and the currently available endovascular systems fall short during the chronic phase.