A narrative review on endovascular false lumen management options in chronic aortic dissection

Abstract

Objective

Data on false lumen (FL) evolution after endovascular repair for aortic dissection showed discouraging findings in terms of complete FL thrombosis. Persistent flow from collateral arteries and distal entry points may prevent FL exclusion. This review aims to present the current techniques and available evidence on endovascular FL management in patients treated for chronic aortic dissection.

Methods

A review of the English literature was undertaken using the MEDLINE and Embase databases from January 2000 to February 2023. Studies reporting on technical and clinical findings of the available endovascular techniques for FL exclusion were considered eligible. Only descriptive data are presented, and no comparison was attempted.

Results

The available techniques dedicated to preventing FL retrograde flow are (1) the “Cork in the Bottle technique,” (2) physician-modified aortic occluders, (3) the Knickerbocker technique, and (4) FL endografts (FLEs; the Candy-Plug technique). The “Cork in the Bottle technique” has been related to a 24-month follow-up positive aortic remodeling rate at 80%. The Knickerbocker technique showed technical success at 94% but with a secondary reintervention rate at 31%. Follow-up imaging confirmed aortic diameter regression in 75% of patients. Physician-modified and custom-made FLEs (the Candy-Plug technique) have been used for FL backflow interruption. Published experience on the use of custom-made generation I to III FLEs showed a 94% technical success rate and an 80% complete FL thrombosis. During the midterm follow-up, positive aortic remodeling was detected in up to 90% of patients.

Conclusions

Exclusion of FL’s backflow is mandatory in patients managed for chronic aortic dissections and can be achieved with various techniques. All options are associated with high technical success in experienced hands; however, further advancements and long-term follow-up data are needed.