Parachute-Plug Technique for Treatment of Chronic Type B Dissecting Aneurysm With False Lumen Rupture

Abstract

Purpose: False lumen rupture in type B aortic dissection is a life-threatening and difficult-to-treat disease. Recently, case reports showcased endovascular therapy for false lumen rupture with the candy-plug technique, but residual retrograde flow was a problem. Therefore, we created a new false lumen occluder, the parachute-plug, with improved sealing and fixation, and reported the experience of using this technique. Case Report: Our patient was a 43-year-old man diagnosed with false lumen rupture of type B aortic dissection. After recovery from profound shock, he underwent axilla-axilla crossover bypass and thoracic endovascular aortic repair landing from aortic arch zone II to the proximal celiac trunk. Aortography confirmed entry sealing but revealed persistent retrograde flow through the reentry tear into the false lumen. The parachute-plug, with long sealing and little gutter formation, was deployed into the false lumen adjacent to the distal landing zone of the thoracic stent graft. Final aortography revealed no residual antegrade or retrograde blood flow. The patient was discharged 28 days after surgery. At the 2-year follow-up, computed tomography angiography showed complete thrombosis of the false lumen and shrinkage of the aneurysm. Conclusion: The parachute-plug may be useful for treating false lumen rupture in type B aortic dissection. Clinical Impact The advantages of the parachute plug are longer sealing, better fixation, less gutter and easy preparation. Therefore, we believe it will allow us to treat chronic type B dissecting aortic aneurysms with rupture more safely and reliably than ever before, effectively reducing false lumen-related bleeding and improving survival rate.