: To describe the clinical utility and technical aspects of the candy-plug technique using an Excluder aortic extender (Ex-cuff) for false lumen (FL) occlusion in chronic aortic dissection. : This is a retrospective study analyzing seven consecutive patients (mean age, 63 years; range, 44-78 years; 6 men) with aneurysmal dilatation or rupture in chronic aortic dissection. All patients had undergone thoracic endovascular aortic repair with FL occlusion using this technique. We assessed technical (deployment accuracy) and clinical (no FL backflow on the latest contrast-enhanced computed tomography) success. : Technical success was obtained in six patients (86%). Technical failure was caused by the malposition of the candy-plug. The mean follow-up period was 593 days (range, 222-1225 days). Clinical success was obtained in four (57%), and incomplete Amplatzer Vascular Plug (AVP) embolization was seen in two. There was no enlarged FL after the procedure, and all patients are alive during the follow-up periods. : The candy-plug technique using an Ex-cuff may be a feasible option; however, it takes time to achieve complete AVP embolization. Therefore, using additional embolic materials should be considered when we use it for the rupture case. (This is a translation of Jpn J Endovasc Interv 2018; 19: 29-35.).

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Article Synopsis
  • - The study evaluated the early and mid-term results of using a physician-modified candy-plug (pmCP) technique for occluding false lumen in patients with type-B aortic dissection, involving analysis of 17 patients treated between September 2018 and May 2024.
  • - Results showed a 100% technical success rate, an 82% clinical success rate, and a low postoperative mortality of 6%. Notably, 82% of patients achieved early complete false lumen occlusion.
  • - The pmCP technique demonstrated promising long-term outcomes with 75% of patients experiencing complete thoracic false lumen thrombosis and stable aneurysm sizes during follow-up, indicating reduced need for further aortic interventions. *
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This report details the successful endovascular repair of a ruptured thoracoabdominal aortic aneurysm in a patient with chronic type B aortic dissection. The procedure consisted of thoracic endovascular aortic repair, abdominal endovascular aortic repair, false lumen (FL) embolization with Candy-Plug, and FL stent-graft technique. The approach effectively regulated FL inflow, achieving complete FL closure.

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Urgent Candy-Plug technique for distal false lumen occlusion in chronic aortic dissection.

J Vasc Surg

November 2024

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.

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.

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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).

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Introduction: We sought to examine midterm results and remodeling effect of false-lumen occlusion treatment using AFX VELA in case of chronic dissection repair.

Material And Methods: From June 2019 to May 2022, we performed false lumen occlusion treatment using a modified Candy-Plug technique with AFX VELA on 8 chronic aortic dissection patients with a patent false lumen. We collected operative data, short-term clinical outcomes, mid-term clinical outcomes and imaging test results.

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