Treatment of postoperative distal anastomotic endoleak with the Amplatzer Vascular Plug II in chronic aortic arch dissection: A case report Iskander.

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Presentation transcript:

Treatment of postoperative distal anastomotic endoleak with the Amplatzer Vascular Plug II in chronic aortic arch dissection: A case report Iskander Bouassida, MD, Olivier Meyrignac, MD, Bertrand Marcheix, MD, PhD, Paul Revel-Mouroz, MD, Hervé Rousseau, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 155, Issue 1, Pages e7-e10 (January 2018) DOI: 10.1016/j.jtcvs.2017.07.081 Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A-D, Angiography before and after implantation of the Amplatzer Vascular Plug II (St Jude Medical, St Paul, Minn). A, Delayed antegrade false-lumen opacification (asterisk) originating from the dissected left subclavian artery with large reentry from the left subclavian artery (arrow). B, Correct placement in the left subclavian artery (arrow) of a 10 × 40-mm balloon-expandable covered stent (Atrium Medical Corp, Merrimack, NH). C, Persistent delayed antegrade false-lumen opacification (asterisk) despite correct stent placement (arrow). D, Angiography from the false lumen shows an entry tear (arrow) at the distal anastomosis of the Dacron polyester fabric tube. E, Implantation of a 14-mm Amplatzer Vascular Plug II through a false-lumen approach. One disk is placed in the true lumen (arrow), with the distal end remaining in the false lumen. F, Aortography after Amplatzer Vascular Plug II implantation (thick arrow) shows no residual false-lumen opacification. The Journal of Thoracic and Cardiovascular Surgery 2018 155, e7-e10DOI: (10.1016/j.jtcvs.2017.07.081) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A-D, Initial computed tomography (A and B) and follow-up computed tomography at 7 years after Amplatzer Vascular Plug II (St Jude Medical, St Paul, Minn) implantation (C and D). E-F, Three-dimensional volume rendering reconstructions of initial computed tomography (E) and computed tomography at 1-year follow-up (F). A, Circulating false lumen (asterisk) with aneurysmal evolution at the aortic arch level (48 × 45 mm). B, Ascending thoracic aorta at the Dacron polyester fabric tube distal end (30 mm; arrow), circulating false lumen, and aneurysmal evolution of the descending aorta (46 × 44 mm; asterisk). C, Thrombosed false lumen with aortic remodeling (aortic arch, 46 × 42 mm; asterisk). D, The Amplatzer Vascular Plug II is positioned without significant protrusion (arrow). Note descending thoracic aorta false lumen thrombosis and remodeling (42 × 40 mm; asterisk). E, Entry tear at the Dacron polyester fabric tube distal anastomosis (arrow). Asterisks indicate circulating false lumen. F, The Amplatzer Vascular Plug II positioned at the entry tear (arrow). Note the absence of circulating false lumen. The Journal of Thoracic and Cardiovascular Surgery 2018 155, e7-e10DOI: (10.1016/j.jtcvs.2017.07.081) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Amplatzer Vascular Plug II implantation for anastomotic endoleak in chronic aortic arch dissection. The Journal of Thoracic and Cardiovascular Surgery 2018 155, e7-e10DOI: (10.1016/j.jtcvs.2017.07.081) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Video 1 A 14-mm Amplatzer Vascular Plug II (St Jude Medical, St Paul, Minn) is delivered through a false-lumen approach: 1 disk is positioned in the true lumen and 2 disks are positioned in the false lumen to avoid major protrusion. Video available at: http://www.jtcvsonline.org/article/S0022-5223(17)31777-4/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2018 155, e7-e10DOI: (10.1016/j.jtcvs.2017.07.081) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions