1
|
Morisaki A, Nakano M, Nishiya K, Inno G, Kawase T, Takahashi Y, Shibata T. Use of the Bottleneck-Plug Technique for Large False Lumen Occlusion to Treat Type B Dissecting Aortic Aneurysm. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2025:15569845251339442. [PMID: 40356320 DOI: 10.1177/15569845251339442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2025]
Affiliation(s)
- Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Mariko Nakano
- Department of Diagnostic and Interventional Radiology, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Kenta Nishiya
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Goki Inno
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Takumi Kawase
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
| |
Collapse
|
2
|
D'Oria M, Budtz-Lilly J, Mani K, Legeza P, Piffaretti G, Bashir M, Jubouri M, Tinelli G, Scali S. Critical Review of Guidelines for Type B Aortic Dissection. Ann Vasc Surg 2025; 114:380-390. [PMID: 39855382 DOI: 10.1016/j.avsg.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/04/2025] [Accepted: 01/05/2025] [Indexed: 01/27/2025]
Abstract
The management of type B aortic dissection is one of the most challenging and debated topics in contemporary cardiovascular surgery practice. Patients with acute or chronic dissection-related complications face high morbidity and mortality if not treated promptly. For most patients requiring intervention, thoracic endovascular aortic repair (TEVAR) is considered the gold standard. However, both early and late TEVAR-related complications make decision-making complex, even for experienced clinicians. In many cases, optimal medical management with longitudinal imaging surveillance may be preferred. In response to these challenges, several societal guidelines have recently been published to provide evidence-based or expert consensus "best practice" recommendations. Although these guidelines share many commonalities, they also highlight key unresolved clinical questions. For example, debates persist over the appropriate use of TEVAR for "uncomplicated" TBAD, defining "high-risk" criteria for uncomplicated presentations, and management of the false lumen, among other topics. Despite recent updates, a critical evaluation of the nuanced differences between these guidelines is lacking. Therefore, the purpose of this review is to compare current clinical practice guidelines, highlight their similarities and differences, and offer a comprehensive evaluation of the evidence surrounding management of TBAD. Moreover, this analysis will provide recommendations to address important knowledge gaps.
Collapse
Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sala, Sweden
| | - Peter Legeza
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sala, Sweden
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, Vascular Surgery, Varese University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Mohamad Bashir
- Division of Vascular & Endovascular Surgery, Velindre University NHS Trust, Health & Education Improvement Wales (HEIW), Cardiff, UK
| | - Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| |
Collapse
|
3
|
Guo W, Ge YY, Rong D, Zhang HP, Xiong J, Jia X, Ma XH, Wang LJ, Le Xu Y, Zhang MH, Liu F. Complete Endovascular Repair of Entire Aorta for Extensive Pathologies - A Set of China Strategies. Ann Vasc Surg 2025; 116:120-136. [PMID: 40157451 DOI: 10.1016/j.avsg.2025.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Revised: 01/19/2025] [Accepted: 03/18/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND Endovascular aortic repair was introduced in China in 1997, with domestically produced devices emerging post-2000. Despite progress, treatment of complex aortic pathologies remains limited, necessitating innovative endovascular solutions. METHODS Our center developed 8 off-the-shelf endovascular innovations, including 3 inner branch stent graft systems for aortic arch reconstruction, 2 branched/fenestrated stent grafts for thoracoabdominal and juxtarenal aortic aneurysms, 1 iliac branch device for internal iliac artery preservation, and 2 novel devices-EndoPatch and EndoSeal (Endonom Medtech)-designed to seal distal tears and occlude false lumen in aortic dissections. These advancements integrate technologies such as steerable delivery systems, preloaded navigation aids, and mixed or inner branch configurations to accommodate anatomical variations. RESULTS Preliminary clinical applications demonstrated promising technical success rates and acceptable complication profiles. Two devices have been approved by China's National Medical Products Administration for clinical use, while others remain under investigation. Key challenges include anatomical variability, branch vessel patency concerns, and the absence of long-term outcomes for most devices. CONCLUSION These innovations establish a comprehensive endovascular strategy for extensive aortic pathologies, addressing critical gaps in China's device landscape. Early outcomes demonstrate the feasibility of standardized off-the-shelf solutions for complex anatomies, though multicenter trials and long-term follow-up remain essential to confirm safety and efficacy.
Collapse
Affiliation(s)
- Wei Guo
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Yang Yang Ge
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dan Rong
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hong Peng Zhang
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Jia
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao Hui Ma
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Li Jun Wang
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yong Le Xu
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Min Hong Zhang
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Feng Liu
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
4
|
Halloum N, Meyer AS, Wenkel M, Dohle DS, Youssef M, Dorweiler B, Treede H, El Beyrouti H. Aortic Remodeling After False Lumen Embolization in Aortic Dissection. J Clin Med 2025; 14:763. [PMID: 39941435 PMCID: PMC11818290 DOI: 10.3390/jcm14030763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 01/21/2025] [Accepted: 01/23/2025] [Indexed: 02/16/2025] Open
Abstract
Background/Objectives: Retrograde false lumen perfusion after thoracic endovascular aortic repair (TEVAR) can compromise positive remodeling and clinical outcomes. The aim of this study is to describe the feasibility and outcomes of a false lumen thrombosis technique. Methods: A single-center, retrospective analysis of patients between January 2017 and January 2022 who underwent TEVAR in conjunction with false lumen embolization. Results: Twelve patients (83% type A, 17% type B; 33% with frank rupture; mean age 65 years; eleven men) underwent 13 false lumen embolization procedures with a 92% technical success rate and a 100% clinical success rate. Positive aortic remodeling was observed in all the patients. The maximum thoracic aortic diameter remained stable (p = 0.526) but the true lumen increased from 22 to 33 mm (p = 0.009) and the false lumen decreased from 41 to 20 mm (p = 0.076) after a median follow-up of 31 months. Conclusions: False lumen embolization using the candy-plug is safe and promotes positive aortic remodeling.
Collapse
Affiliation(s)
- Nancy Halloum
- Department of Cardiac and Vascular Surgery, University Medical Centre Mainz, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Anna-Sophie Meyer
- Department of Cardiac and Vascular Surgery, University Medical Centre Mainz, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Martin Wenkel
- Department of Cardiac and Vascular Surgery, University Medical Centre Mainz, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Daniel-Sebastian Dohle
- Department of Cardiac and Vascular Surgery, University Medical Centre Mainz, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Marwan Youssef
- Department for Vascular Surgery, Asklepios Nord Clinic, 22417 Hamburg, Germany
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Medical Centre Mainz, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Hazem El Beyrouti
- Department of Cardiac and Vascular Surgery, University Medical Centre Mainz, Johannes Gutenberg University, 55131 Mainz, Germany
| |
Collapse
|
5
|
Karaolanis GI, Kotelis D, Jungi S, D'Amico R, Mujagic E, Makaloski V. False Lumen Patency After Occlusion With Physician-Modified Candy-Plug in Aortic Dissections: A 2-Center Experience. J Endovasc Ther 2024:15266028241300424. [PMID: 39601041 DOI: 10.1177/15266028241300424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
OBJECTIVE To evaluate the early and mid-term results of physician-modified candy-plug (pmCP) in patients with type-B or residual type-A aortic dissection (TBRAD). METHODS All patients with TBRAD who received false lumen (FL) occlusion with pmCP between September 2018 and May 2024 were analyzed. Primary outcomes were technical and clinical success, and overall mortality. Secondary outcomes were postoperative aortic remodeling and aortic reintervention. RESULTS Seventeen patients (88% male; mean age 69±12 years) underwent FL occlusion with a pmCP. Nine patients (53%) were emergently treated. The technical and clinical successes were 100% and 82%, respectively. One patient (6%) died postoperatively. Early complete FL occlusion was observed in 82% of the patients. One patient (6%) required an early pmCP-related reintervention. During a mean follow-up of 15±5 months, 75% of the patients had complete thoracic FL thrombosis while 13% of them aortic remodeling in the last computed tomography (CT) scan. Aneurysm size remained stable in 69% of the cases. There were no aortic-related re-interventions during follow-up. CONCLUSIONS The pmCP technique is a feasible and promising alternative technique, with high primary technical and clinical success rate. Stable aortic diameters can be expected during follow-up, thus reducing the need for further aortic reintervention. CLINICAL IMPACT Persistence of false lumen (FL) patency after thoracic endovascular aortic repair (TEVAR) for thoracic aortic dissection (TBAD) remains a significant challenge for physicians. Various strategies have been developed to address retrograde FL patency, including the candy-plug technique. This technique involves modifying thoracic stent grafts and placing an additional plug to occlude the reduced stent graft waist.Since its introduction, three generations of custom-made candy-plug devices (Cook Medical, Bloomington, IN, USA) have been developed. However, delivery times vary across countries and vascular surgery services, complicating procedural planning, particularly in symptomatic patients or cases of rapid FL diameter progression.In this study, we provide a step-by-step description of the physician-modified candy-plug technique and present our preliminary results.
Collapse
Affiliation(s)
- Georgios I Karaolanis
- Department of Vascular Surgery, Swiss Aortic Center Bern, University Hospital of Bern, Bern, Switzerland
- Vascular Unit, Department of Surgery, Faculty of Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Drosos Kotelis
- Department of Vascular Surgery, Swiss Aortic Center Bern, University Hospital of Bern, Bern, Switzerland
| | - Silvan Jungi
- Department of Vascular Surgery, Swiss Aortic Center Bern, University Hospital of Bern, Bern, Switzerland
| | - Rosalinda D'Amico
- Department of Vascular Surgery, University Hospital of Basel, University of Basel, Switzerland
| | - Edin Mujagic
- Department of Vascular Surgery, University Hospital of Basel, University of Basel, Switzerland
| | - Vladimir Makaloski
- Department of Vascular Surgery, Swiss Aortic Center Bern, University Hospital of Bern, Bern, Switzerland
| |
Collapse
|
6
|
Spath P, Gouveia E Melo R. Aortic Risk Scoring Gets a PATENTed Solution: Debate on Remodelling after Aortic Dissection. Eur J Vasc Endovasc Surg 2024; 68:588-589. [PMID: 39067505 DOI: 10.1016/j.ejvs.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Paolo Spath
- Vascular Surgery, University of Bologna, DIMEC, Bologna, Italy; Vascular Surgery Unit, Hospital Infermi, AUSL Romagna, Rimini, Italy.
| | - Ryan Gouveia E Melo
- Vascular Surgery Department, Centro Hospitalar Universitário Lisboa Norte (CHULN); Faculdade de Medicina da Universidade de Lisboa (FMUL); Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Lisbon, Portugal
| |
Collapse
|
7
|
Eleshra A, Kölbel T, Haulon S, Bertoglio L, Rohlffs F, Dias N, Panuccio G, Tsilimparis N. Urgent Candy-Plug technique for distal false lumen occlusion in chronic aortic dissection. J Vasc Surg 2024; 80:1418-1424.e1. [PMID: 39029810 DOI: 10.1016/j.jvs.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE This study aimed to assess the impact of urgency on early and midterm outcomes of the Candy-Plug (CP) technique for distal false lumen (FL) occlusion in thoracic endovascular aortic repair for aortic dissection. METHODS The CP registry was reviewed, and patients were categorized into elective and urgent/emergent groups for analysis. End points included technical success, clinical success, early (30-day) computed tomography angiography findings, early (30-day) mortality, adverse events, and aortic remodeling in patients with available computed tomography angiography follow-up and reintervention. RESULTS A total of 155 patients received a custom-made CP, of whom 32 patients (44% male, mean age 61 ± 9 years) were treated urgently and 123 patients (63% male, mean age 62 ± 11 years) electively. The primary CP rate was higher in the urgent group (28/32, 88%, in the urgent group vs 96/123, 78%, in the elective group, P = .051). The mean contrast volume was higher in the urgent group (157 ± 56 mL in the urgent group vs 130 ± 71 mL in the elective group, P = .017). Technical success was achieved in all patients in both groups. Clinical success was achieved in 25 of 32 (78%) patients in the urgent group vs 113 and 123 (92%) in the elective group (P = .159). The early mortality rate was 13% (4 of 32 patients) in the urgent group vs 1% (1 of 123 patients) in the elective group (P = .120). There was no statistically significant difference regarding the early adverse events between the urgent and elective CP groups. Early aortic-related reinterventions were required in 6 of 32 (19%) patients in the urgent group vs 6 of 123 (5%) in the elective group (P = .094). Thoracic aortic aneurysm sac regression was lower in the urgent group (5/28, 18%, in the urgent group vs 63/114, 55%, in the elective group, P = .001). Stable thoracic aortic aneurysm sac was higher in the urgent group (22/28, 79%, in the urgent group vs 47/114, 41%, in the elective group, P = .000). An increase in thoracic aortic aneurysm sac occurred in 1 of 28 (4%) patients in the urgent group vs 4 of 114 (4%) patients in the elective group (P = .096). CONCLUSIONS The urgent use of the CP technique for distal FL occlusion in aortic dissection was feasible and effective. The decrease in aortic FL sac diameter may be affected by the urgent use of CP due to limited sizing availability. However, it achieved a high rate of aortic remodeling.
Collapse
Affiliation(s)
- Ahmed Eleshra
- Department of Vascular Surgery, German Aortic Center, University Heart & Vascular Center, University Medical Center Eppendorf, Hamburg, Germany; Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Tilo Kölbel
- Department of Vascular Surgery, German Aortic Center, University Heart & Vascular Center, University Medical Center Eppendorf, Hamburg, Germany
| | - Stephan Haulon
- Department of Vascular Surgery, Hospital Marie Lannelongue, Paris, France
| | - Luca Bertoglio
- Division of Vascular Surgery, Department of Sperimental and Clinical Sciences (DSCS), University and ASST Spedali Civili Hospital of Brescia, Brescia, Italy
| | - Fiona Rohlffs
- Department of Vascular Surgery, German Aortic Center, University Heart & Vascular Center, University Medical Center Eppendorf, Hamburg, Germany
| | - Nuno Dias
- Department of Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Giuseppe Panuccio
- Department of Vascular Surgery, German Aortic Center, University Heart & Vascular Center, University Medical Center Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, German Aortic Center, University Heart & Vascular Center, University Medical Center Eppendorf, Hamburg, Germany; Department of Vascular Surgery, University Hospital, LMU, Munich, Germany
| |
Collapse
|
8
|
Torri L, Nana P, Panuccio G, Torrealba JI, Yousef El Sarhan D, Kölbel T. Physician-modified funnel-shaped covered stent for selective false lumen exclusion in chronic type B aortic dissection. Vascular 2024:17085381241289811. [PMID: 39364914 DOI: 10.1177/17085381241289811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
PURPOSE To describe the technique of off-centering a balloon-expandable covered stent for selective occlusion of a distal entry tear (ET) in a patient, conservatively treated for chronic type B aortic dissection (cTBAD), presenting FL expansion. TECHNIQUE A 63-year-old male, with conservatively managed cTBAD, presented at follow-up with FL partial thrombosis and expansion (thoracic aorta FL from 21 mm to 27 mm and abdominal aorta FL from 11 mm to 15 mm in 6 months). No proximal ET was identifiable. Distal FL perfusion was caused by an ET in the abdominal aorta feeding a 2 mm accessory renal artery (ARA). As the aortic diameter was below the threshold for endovascular repair, a selective occlusion of the distal ET and ARA was planned. A balloon-expandable covered stent was modified by off-centering the covered stent proximally and resulting in a funnel-shape occluder after deployment across the ET into the ARA. To prevent type Ic endoleak due to possible FL expansion caused by an intra-operatively detected phrenic artery (PA), coils were deployed into the lumen of the modified stent and the ARA. The pre-discharge computed tomography angiography showed exclusion of both the ARA and ET and a type 2 endoleak from the PA. CONCLUSION A balloon-expandable covered stent can be modified by off-centering the covered stent resulting in a funnel shape to adapt to different diameter requirements.
Collapse
Affiliation(s)
- Lorenzo Torri
- German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Petroula Nana
- German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - José Ignacio Torrealba
- German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Daour Yousef El Sarhan
- German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| |
Collapse
|
9
|
Gorgatti F, Nana P, Panuccio G, Rohlffs F, Torrealba JI, Kölbel T. Post-dissection Thoraco-abdominal Aortic Aneurysm Managed by Fenestrated or Branched Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2024; 68:325-334. [PMID: 38697255 DOI: 10.1016/j.ejvs.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/27/2024] [Accepted: 04/28/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE Fenestrated or branched endovascular aortic repair (F/B-EVAR) is a valuable treatment in patients with chronic post-dissection thoraco-abdominal aneurysm (PD-TAAA). This study aimed to analyse early and follow up outcomes of F/B-EVAR in these patients. METHODS Thirty day and follow up outcomes of consecutive patients with PD-TAAA treated with F/B-EVAR in a tertiary centre over eight years were analysed retrospectively. All patients presenting with PD-TAAA and managed with F/B-EVAR were eligible. A modified Crawford's classification system was used. Thirty day mortality and major adverse event (MAE) rates were analysed. Time to event data were estimated with Kaplan-Meier survival analysis. RESULTS Fifty five patients (80% men, mean age 63.7 ± 7.7 years) were included: 12 (22%) were managed urgently; 25 (46%) for chronic type B aortic dissection; and the remainder for residual type A aortic dissection. Of these patients, 88% had undergone previous thoracic endovascular aortic repair. Prophylactic cerebrospinal fluid drainage (CSFD) was used in 91%. Fifteen (27%) patients were treated with F-EVAR, nine (16%) with fenestrations and branches, and 31 (56%) with B-EVAR. False lumen adjunctive procedures were used in 56%. Technical success was achieved in 96% of patients. The thirty day mortality rate was 7% and MAE rate was 20%. Spinal cord injury (SCI) grades 1 - 3 and grade 3 rates were 13% and 2%, respectively. Mean follow up was 33.0 ± 18.4 months. Survival and freedom from unscheduled re-intervention were 86% (standard error [SE] 5%) and 55% (SE 8%) at 24 months, respectively. Freedom from target vessel stenosis and occlusion was higher in F-EVAR at the 12 month follow up (p = .006) compared with B-EVAR. CONCLUSION Fenestrated or branched endovascular repairs in patients with PD-TAAA showed high technical success, with acceptable early mortality and MAE rates. The SCI rate was > 10%, despite CSFD use and staged procedures. Almost a half of patients needed an unscheduled re-intervention within 24 months after F/B-EVAR.
Collapse
Affiliation(s)
- Filippo Gorgatti
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany
| | - Petroula Nana
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany.
| | - Giuseppe Panuccio
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany
| | - José I Torrealba
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany
| |
Collapse
|
10
|
Takagi H. Air aortogram. J Vasc Surg 2024; 80:911-912. [PMID: 37952780 DOI: 10.1016/j.jvs.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
| |
Collapse
|
11
|
Grandi A, D'Oria M, Panuccio G, Rohlffs F, Eleshra A, Torrealba J, Nana P, Lepidi S, Melloni A, Bertoglio L, Kölbel T. Design, evolution, and experience with the candy plug device for endovascular false lumen occlusion of chronic aortic dissections. Expert Rev Med Devices 2024:1-4. [PMID: 38803133 DOI: 10.1080/17434440.2024.2360987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION The management of the false lumen (FL) when dealing with aortic dissection is a crucial aspect since inducing its thrombosis is necessary in order to achieve aortic remodeling. One of the pitfalls of endovascular treatment of aortic dissection (AD) is retrograde distal FL perfusion and pressurization, which prevents FL thrombosis and thus aortic remodeling, while being associated with aneurysmal degeneration of the FL and poor long-term outcomes. AREAS COVERED Currently, there is no CE/FDA approved device for FL closure, however different techniques and devices have been proposed to overcome this challenge, the most known of which is the Candy Plug (CP). This review aims to describe the CP device, its implantation technique, and the available data in the literature (PubMed, Cochrane, and EMBASE databases; last queried, December 31, 2023). EXPERT OPINIONS While the treatment of AD remains technically challenging, the use of the CP technique to close any distal FL reperfusion proved to be feasible and safe with excellent rates of both technical and clinical success. Furthermore, recent studies have shown a quick learning curve with this technique.
Collapse
Affiliation(s)
- Alessandro Grandi
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
- Division of Vascular Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Ahmed Eleshra
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Jose Torrealba
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Petroula Nana
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Melloni
- Division of Vascular Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Luca Bertoglio
- Division of Vascular Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| |
Collapse
|
12
|
Melloni A, D’Oria M, Dioni P, Ongaro D, Badalamenti G, Lepidi S, Bonardelli S, Bertoglio L. Plug-Based Embolization Techniques of Aortic Side Branches during Standard and Complex Endovascular Aortic Repair. J Clin Med 2024; 13:2084. [PMID: 38610847 PMCID: PMC11012954 DOI: 10.3390/jcm13072084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Vascular plugs are an evolving family of vessel occluders providing a single-device embolization system for large, high-flow arteries. Nitinol mesh plugs and polytetrafluoroethylene membrane plugs are available in different configurations and sizes to occlude arteries from 3 to 20 mm in diameter. Possible applications during complex endovascular aortic procedures are aortic branch embolization to prevent endoleak or to gain an adequate landing zone, directional branch occlusion, and false lumen embolization in aortic dissection. Plugs are delivered through catheters or introducers, and their technical and clinical results are comparable to those of coil embolization. Plugs are more accurate than coils as repositionable devices, less prone to migration, and have fewer blooming artifacts on postoperative computed tomography imaging. Their main drawback is the need for larger delivery systems. This narrative review describes up-to-date techniques and technology for plug embolization in complex aortic repair.
Collapse
Affiliation(s)
- Andrea Melloni
- Division of Vascular Surgery, Department of Clinical and Experimental Sciences, University and ASST Spedali Civili Hospital of Brescia, 25123 Brescia, Italy; (P.D.); (D.O.); (S.B.); (L.B.)
| | - Mario D’Oria
- Division of Vascular and Endovascular Surgery, Cardiothoracovascular Department, University Hospital of Trieste ASUGI, 34139 Trieste, Italy; (M.D.); (G.B.); (S.L.)
| | - Pietro Dioni
- Division of Vascular Surgery, Department of Clinical and Experimental Sciences, University and ASST Spedali Civili Hospital of Brescia, 25123 Brescia, Italy; (P.D.); (D.O.); (S.B.); (L.B.)
| | - Deborah Ongaro
- Division of Vascular Surgery, Department of Clinical and Experimental Sciences, University and ASST Spedali Civili Hospital of Brescia, 25123 Brescia, Italy; (P.D.); (D.O.); (S.B.); (L.B.)
| | - Giovanni Badalamenti
- Division of Vascular and Endovascular Surgery, Cardiothoracovascular Department, University Hospital of Trieste ASUGI, 34139 Trieste, Italy; (M.D.); (G.B.); (S.L.)
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiothoracovascular Department, University Hospital of Trieste ASUGI, 34139 Trieste, Italy; (M.D.); (G.B.); (S.L.)
| | - Stefano Bonardelli
- Division of Vascular Surgery, Department of Clinical and Experimental Sciences, University and ASST Spedali Civili Hospital of Brescia, 25123 Brescia, Italy; (P.D.); (D.O.); (S.B.); (L.B.)
| | - Luca Bertoglio
- Division of Vascular Surgery, Department of Clinical and Experimental Sciences, University and ASST Spedali Civili Hospital of Brescia, 25123 Brescia, Italy; (P.D.); (D.O.); (S.B.); (L.B.)
| |
Collapse
|
13
|
Baghbani-Oskouei A, Savadi S, Mesnard T, Sulzer T, Mirza AK, Baig S, Timaran CH, Oderich GS. Transcatheter electrosurgical septotomy technique for chronic postdissection aortic aneurysms. J Vasc Surg Cases Innov Tech 2024; 10:101402. [PMID: 38304296 PMCID: PMC10830870 DOI: 10.1016/j.jvscit.2023.101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Aortic dissection often results in chronic aneurysmal degeneration due to progressive false lumen expansion. Thoracic endovascular aortic repair and other techniques of vessel incorporation such as fenestrated-branched or parallel grafts have been increasingly used to treat chronic postdissection aneurysms. True lumen compression or a vessel origin from the false lumen can present considerable technical challenges. In these cases, the limited true lumen space can result in inadequate stent graft expansion or restrict the ability to reposition the device or manipulate catheters. Reentrance techniques can be used selectively to assist with target vessel catheterization. Transcatheter electrosurgical septotomy is a novel technique that has evolved from the cardiology experience with transseptal or transcatheter aortic valve procedures. This technique has been applied in select patients with chronic dissection to create a proximal or distal landing zone, disrupt the septum in patients with an excessively compressed true lumen, or connect the true and false lumen in patients with vessels that have separate origins. In the present report, we summarize the indications and technical pitfalls of transcatheter electrosurgical septotomy in patients treated by endovascular repair for chronic postdissection aortic aneurysms.
Collapse
Affiliation(s)
- Aidin Baghbani-Oskouei
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Safa Savadi
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Thomas Mesnard
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Titia Sulzer
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Aleem K. Mirza
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H. Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gustavo S. Oderich
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| |
Collapse
|
14
|
Bastianon M, Di Gregorio S, Melani C, Mena Vera JM, Mozzetta G, Grimaldi F, Pallini C, Pratesi G. Visceral Aorta Electrocautery Septotomy to Allow Branched Endovascular Aortic Repair in Ruptured Chronic Post-Dissection Thoraco-Abdominal Aneurysm. J Endovasc Ther 2024:15266028241240900. [PMID: 38533777 DOI: 10.1177/15266028241240900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE Endovascular repair of chronic post-dissection thoraco-abdominal aortic aneurysms (PD-TAAA) presents specific technical challenges due to the presence of chronic septum. Small true lumen diameter and false lumen visceral vessel origin can make branched endograft prohibitive. Septotomy may allow to overcome these challenges in cases of high complex anatomy. TECHNIQUE We describe the application of electrocautery septotomy to the visceral aorta segment to deploy an off-the-shelf branched endograft in a chronic PD-TAAA rupture with true lumen collapse. CONCLUSIONS Electrocautery septotomy can be an effective adjunctive technique to facilitate branched endograft, overcoming technical challenges associated with the endovascular treatment of chronic PD-TAAA. CLINICAL IMPACT Electrocautery septotomy is an adjunctive technique that can facilitate endovascular treatment of post-dissection thoraco-abdominal aneurysm. By creating a common lumen, this technique might reduce the number of re-interventions associated with PD-TAAA endovascular exclusion.
Collapse
Affiliation(s)
- Martina Bastianon
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Sara Di Gregorio
- Clinic of Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Caterina Melani
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Jorge Miguel Mena Vera
- Clinic of Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Gaddiel Mozzetta
- Clinic of Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Grimaldi
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Cristina Pallini
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Giovanni Pratesi
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
- Clinic of Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| |
Collapse
|
15
|
Loschi D, Santoro A, Rinaldi E, Anselmi C, Grignani C, Chiesa R, Melissano G. Open and endovascular reinterventions after Candy Plug false lumen embolization of type B aortic dissection. J Vasc Surg 2023; 78:1409-1417. [PMID: 37572890 DOI: 10.1016/j.jvs.2023.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE In the majority of patients with chronic type B aortic dissection, there is persistent retrograde flow in the false lumen (FL) through distal re-entry tears. Among several endovascular techniques proposed for FL management, the "Candy Plug" (CP) technique has gained acceptance with good early results. The aim of this study is to report the types and outcomes of open and endovascular reinterventions and identify mechanisms of procedure failure as well as other causes for reinterventions. METHODS All patients with type B aortic dissection submitted to thoracic endovascular aneurysm repair and CP implantation for FL embolization from January 2016 to December 2022 at our institution were included in this study. The preoperative, intraoperative, and postoperative data of the primary intervention and secondary reinterventions, when performed, were prospectively collected and retrospectively analyzed. Preoperative and postoperative computed tomography angiography were also analyzed. RESULTS During the study period, 33 patients were submitted to thoracic endovascular aneurysm repair and CP implantation. Twenty-three patients (69.7%) showed thoracic FL complete thrombosis with aortic stability or positive remodeling at a mean follow-up of 45 ± 23.1 months. Ten patients (30.3%) underwent aortic reinterventions (male, n = 9; mean age, 60.5 ± 7.6 years). Of these 10 patients, in four patients, complete thrombosis of the FL was never achieved, leading to ongoing perfusion of the FL, defined as "primary failure." The other six patients underwent reinterventions for different causes: two patients, after initial sealing, showed a progressive enlargement of the abdominal FL leading to distal degeneration. One patient showed proximal degeneration, two patients showed a type II thoracoabdominal aortic aneurysm and CP implantation was used as a planned procedure to reduce the extent of the surgical procedure, and one patient had recurrent, intractable back pain despite complete thrombosis of the FL. Reinterventions were open in five cases and endovascular in five. One in-hospital death (postoperative day 27) after a type II thoracoabdominal aortic aneurysm open repair was recorded. In addition, two cases of delayed spinal cord ischemia after open reintervention were recorded: one resulting in permanent paraplegia and one transitory with complete recovery. CONCLUSIONS The CP technique was safe and effective; however, a significant rate of aortic-related reintervention was observed. Several mechanisms led to reinterventions either in terms of "primary failure" of the CP or subsequent aneurysmal degeneration. Complex reinterventions were often necessary, with a high rate of major complications in case of open repair. Life-long and closer surveillance might be required in these patients.
Collapse
Affiliation(s)
- Diletta Loschi
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy.
| | - Annarita Santoro
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Enrico Rinaldi
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Claudia Anselmi
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Camilla Grignani
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Roberto Chiesa
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Germano Melissano
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| |
Collapse
|
16
|
Wang Q, Wei H, He C, Liu Y. Atrial septal defect occluder combined with stent graft for the management of post-dissection aortic aneurysm previously treated with unsuccessful coils: a case report. CVIR Endovasc 2023; 6:58. [PMID: 38019332 PMCID: PMC10686903 DOI: 10.1186/s42155-023-00405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Although the candy-plug technique has been reported to be useful for the treatment of post-dissection aortic aneurysm, the stent graft needs be to customized to accommodate the size of vascular occluders. CASE PRESENTATION We present a case of a persistent false lumen successfully treated with endovascular stent-graft and atrial septal defect occluder in a patient with Stanford Type B dissection. A covered stent graft was implanted into the false cavity through a distal rupture, and an atrial septal defect occluder was inserted into the covered stent to seal of the false cavity. Decreased aneurysmal diameter and false lumen thrombosis were noted by CT scan at 6-month follow-up. CONCLUSIONS Our case showed that combined use of a stent graft and atrial septal defect occluder is safe, technically feasible and effective in sealing of the false lumen in post-dissection aortic aneurysm patients with previously failed false lumen thrombosis.
Collapse
Affiliation(s)
- Qiqi Wang
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haijun Wei
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chunshui He
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yang Liu
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| |
Collapse
|
17
|
Palmier M, Mougin J, Bendavid J, Fabre D, Kölbel T, Haulon S. Evaluation of false lumen occluders implanted in the abdominal aorta false lumen. J Vasc Surg 2023; 78:1146-1152. [PMID: 37406944 DOI: 10.1016/j.jvs.2023.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Management of postdissection thoracoabdominal aneurysms with a fenestrated and/or branched endograft (F/BEVAR) is associated with favorable outcomes. Treatment should include both true lumen endografting and false lumen occlusion (FLO). Favorable results have recently been reported for FLO in the false lumen of the thoracic aorta. The purpose of this study is to analyze the results of FLO of the abdominal aorta in patients treated for post dissection thoracoabdominal aneurysm. METHODS A multicenter retrospective analysis of prospective data of consecutive patients managed for post dissection thoracoabdominal aortic aneurysm from April 2019 to December 2022 with F/BEVAR associated with FLO in the abdominal false lumen was conducted. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) was followed. Baseline demographics, operative details, and early outcomes (mortality, length of stay) were recorded. Primary endpoints were technical and clinical success. FLO technical success was defined as complete occlusion of false lumen backflow above the FLO on completion angiogram. RESULTS During the 3-year study, 23 patients were treated for post dissection thoracoabdominal aneurysm with F/BEVAR and the use of abdominal FLO. Twenty-one patients (91.3%) had received prior endovascular treatment. The technical and clinical success was 95.7%. The abdominal FLO had a technical success rate of 78.3%. The median diameter of the FLO was 34 mm. No patient died during the perioperative period, and one patient had spinal cord ischemia (4.3%) with partial recovery. Six patients (26.1%) required early reintervention. The median duration of hospitalization in the intensive care unit and overall was 1 day (interquartile range, 0-3 days) and 7.5 days (interquartile range, 2-22 days), respectively. During the mean follow-up of 9.9 ± 9.0 months, no patient died. False lumen occlusion was complete or partial in nine (39.1%) and nine (39.1%) patients, respectively. No aortic rupture occurred during follow-up. Maximum aortic diameter decreased in 48% and remained stable in 39% of cases. CONCLUSIONS Abdominal aorta FLO during endovascular treatment of post dissection thoracic abdominal aortic aneurysm is associated with favorable outcomes. It offers an additional staging therapeutic option before extensive aorto-bi-iliac coverage, associated with low spinal cord ischemia rates. FLO also provides high rates of false lumen occlusion and false lumen remodeling during follow-up. Longer follow-up and larger cohorts are required to confirm these very promising early findings.
Collapse
Affiliation(s)
- Mickael Palmier
- Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Le Plessis Robinson, France
| | - Justine Mougin
- Service de Chirurgie Vasculaire, Hôpital G&R Laënnec, CHU Nantes, Nantes, France
| | - Jeremy Bendavid
- Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Le Plessis Robinson, France
| | - Dominique Fabre
- Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Le Plessis Robinson, France
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Medical Center Eppendorf, Hamburg, Germany
| | - Stéphan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Le Plessis Robinson, France.
| |
Collapse
|
18
|
Shehab M, Mani K. Trick or Treat with the Candy Plug. Eur J Vasc Endovasc Surg 2023; 66:57. [PMID: 37075923 DOI: 10.1016/j.ejvs.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Maysam Shehab
- Department of surgical sciences, Uppsala university, Uppsala, Sweden
| | - Kevin Mani
- Department of surgical sciences, Uppsala university, Uppsala, Sweden.
| |
Collapse
|