incredible tricks to occlude the false lumencacvsarchives.org/archivesite/2015/pdf/... · courtesy...
TRANSCRIPT
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Tilo Kölbel, MD, PhD
University Heart Center Hamburg
University Hospital Eppendorf
Incredible Tricks to Occlude the False Lumen
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Disclosures
Research-grants, travelling, proctoring
speaking-fees, IP with Cook.
Research-grant, travelling, speaking-fees
with Cordis
Research-grant, proctoring with Atrium
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Critical Issue:
„Why Does the Aorta Fail to
Remodel in Chronic Dissection?“
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Failure to Remodel in
Chronic Dissection
Perfusion and pressure
unchanged in false lumen
Presence of Intercostals
originating from false lumen
False lumen back flow to
Intercostals
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False Lumen Perfusion
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fEVAR in Chronic Type B
2010-2011
n=6, 9 months FU
Post TEVAR for type B: n=4
Post OR for type A: n=2
4 Type II EL; 1 type 1b EL
1 renal artery lost
Verhoeven et al. 2012; JEVT 19:343-49
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fEVAR in Chronic Type B
Courtesy of Stephan Haulon, Lille
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False Lumen Embolisation
2 Cases
1. FL-TAA-occlusion with:
2 Greenfield filters
6 detachable balloons
5ml thrombin
2. FL-TAA-occlusion with:
24mm Talent occluder
Loubert et al. 2003; J Endovasc Ther 10: 244-8
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Knickerbocker-Technique
Kölbel et al. 2014; J Endovasc Ther 21: 117-22
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Knickerbocker-Technique
Kölbel et al. 2014; J Endovasc Ther 21: 117-22
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Knickerbocker-Technique
Kölbel et al. 2014; J Endovasc Ther 21: 117-22
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Knickerbocker-Technique
Kölbel et al. 2014; J Endovasc Ther 21: 117-22
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Knickerbocker-Technique
Kölbel et al. 2014; J Endovasc Ther 21: 117-22
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Knickerbocker-Technique
Kölbel et al. 2014; J Endovasc Ther 21: 117-22
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Knickerbocker-Technique
Investigational technique
Diameter reducing ties
One sided bulge
Gold-markers
N=8
Technical success 8/8
2 requiring additional coils and cyanoacrylate
FL-thrombosis all patients
Kölbel et al. 2014; J Endovasc Ther 21: 117-22
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Direct False Lumen Occlusion
Seperates aortic FL-compartments!
Does not restrict further distal
techniques like fenestrated EVAR
Bulkhead
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False Lumen Embolisation
Idrees et al. 2014; J Vasc Surg 60:1507-13
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Candy-Plug
46
22mm Amplatzer plug II
Kölbel et al. 2013; J Endovasc Ther 20: 484-9
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Candy-Plug
Investigational
technique
Max. 46mm diameter
22mm Amplatzer II
N=6
Technical success 6/6
FL-thrombosis all
patients
Kölbel et al. 2013; J Endovasc Ther 20: 484-9
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Proximal False Lumen Embolisation
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Iliac False Lumen Embolisation
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Iliac False Lumen Embolisation
Ballon-occlusion to prevent plug-embolisation
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Iliac False Lumen Embolisation
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Spot-Stentgrafting
Bel et al. 2013; Ann Vasc Surg 27:671 e1-6
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Spot-Stentgrafting
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Spot-Stentgrafting
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Candy-Plug and Spot-Stentgrafting
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Candy-Plug and Spot-Stentgrafting
Entry at renal artery stent: Faring-technique
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Candy-Plug and Spot-Stentgrafting
Infrarenal entry External iliac artery entry
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Candy-Plug and Spot-Stentgrafting
16 months postop
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Post Type A, Branched Arch
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Post Type A, Branched Arch
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Post Type A, Branched Arch
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Post Type A, Branched Arch
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Conclusion
Tubular stent-graft sufficient in majority cases of TBAD.
False lumen backflow limiting treatment success in
chronic TBAD.
Landing Stent-grafts in dissected vessel may require
false-lumen occlusion techniques:
Knickerbocker-technique
Candy-plug
Coils, plugs, glue…….
Spot-stentgrafting
Fenestrated stent-grafts
Early results promising, but future role to be defined.