Custom Made Candy Plug for Distal False Lumen Occlusion in Aortic Dissection: International Experience

Objective: To evaluate early and midterm outcomes of the Candy Plug (CP) technique for distal false lumen (FL) occlusion in thoracic endovascular aortic repair for aortic dissection (AD) in a more real world cohort of patients from an international multicentre registry. Methods: A multicentre retrospective study was conducted of all consecutive patients from the contributing centres with subacute and chronic AD treated with the CP technique from October 2013 to April 2020 at 18 centres. Results: A custom made CP was used in 155 patients (92 males, mean age 62 ± 11 years). Fourteen (9%) presented with ruptured false lumen aneurysms. Technical success was achieved in all patients (100%). Clinical success was achieved in 138 patients (89%). The median hospital stay was 7 days (1 – 77). The 30 day mortality rate was 3% (n = 5). Stroke occurred in four patients (3%). Spinal cord ischaemia occurred in three patients (2%). The 30 day computed tomography angiogram (CTA) confirmed successful CP placement at the intended level in all patients. Early complete FL occlusion was achieved in 120 patients (77%). Early (30 day) CP related re-intervention was required in four patients (3%). The early (30 day) stent graft related re-intervention rate was 8% (n = 12). Follow up CTA was available in 142 patients (92%), with a median follow up of 23 months (6 – 87). Aneurysmal regression was achieved in 68 of 142 patients (47%); the aneurysm diameter remained stable in 69 of 142 patients (49%) and increased in five of 142 patients (4%). A higher rate of early FL occlusion was detected in the largest volume centre patients (50 [88%] vs. 70 [71%] from other centres; p = .019). No other differences in outcome were identified regarding volume of cases or learning curve. Conclusion: This international CP technique experience confirmed its feasibility and low mortality and morbidity rates. Aortic remodelling and false lumen thrombosis rates were high and support the concept of distal FL occlusion in AD using the CP technique

New insights in (acute) endovascular abdominal aneurysm repair:when fenestrated devices fall short

The suitability for endovascular aneurysm repair (EVAR) is determined primarily by abdominal aortic aneurysm (AAA) anatomy. For patients unsuitable for standard EVAR, due to proximal neck anatomy, fenestrated aortic stent-grafting (FEVAR) is a viable alternative to open repair surgery. Initially FEVAR stent-grafts were custom-made to fit the unique anatomical characteristics of each treated individual. This customization leads to production delays therefore excluding acute aneurysms from endovascular treatment. For patients in need for more urgent treatment, several alternatives have currently been developed. The aim of this review is to provide an overview on current developments and results in acute endovascular abdominal aortic aneurysm repair

New insights in (acute) endovascular abdominal aneurysm repair:when fenestrated devices fall short

The suitability for endovascular aneurysm repair (EVAR) is determined primarily by abdominal aortic aneurysm (AAA) anatomy. For patients unsuitable for standard EVAR, due to proximal neck anatomy, fenestrated aortic stent-grafting (FEVAR) is a viable alternative to open repair surgery. Initially FEVAR stent-grafts were custom-made to fit the unique anatomical characteristics of each treated individual. This customization leads to production delays therefore excluding acute aneurysms from endovascular treatment. For patients in need for more urgent treatment, several alternatives have currently been developed. The aim of this review is to provide an overview on current developments and results in acute endovascular abdominal aortic aneurysm repair.</p

Intra-arterial thrombolysis: Is ICU admission necessary?

Background: Intra-arterial thrombolysis is an effective and safe method for treating acute limb ischaemia. However, during thrombolysis, patients are at risk of life-threatening haemorrhagic complications. In the literature there is no consensus on how patients should be monitored during treatment. Patients in our hospital are admitted to an intensive care unit (ICU) during treatment even though ICU beds are scarce and ICU admission is a stressful event. This raises the question: is ICU admission necessary to prevent major bleeding complications? Methods: A retrospective study was conducted where all patients having received intra-arterial thrombolysis between January 2015 and February 2017 were included. Patients' files were reviewed for adverse events, laboratory results, information about transfusion of blood products and additional interventions. Results: In total 52 procedures were analysed. No major complications and no haemodynamic instability occurred; 11 minor complications occurred in nine individual patients (18.8%). No transfusions of fresh frozen plasma or packed red blood cells were given during thrombolysis. In three patients packed red blood cells were given within one week of thrombolysis. No other additional treatment was necessary. Conclusions: Treatment outside of the ICU during peripheral intra-arterial thrombolysis should be considered a safe option on the condition that continuous patient monitoring for local and systemic complications is carried out. A protocol for escalation of treatment in case a complication occurs is mandatory

Mesenteric ischemia after abdominal aortic aneurysm repair: a systemic review

Mesenteric ischemia after abdominal aneurysm repair is a devastating complication with mortality rates up to 70%. Incidence however is relatively low. The aim of this review was to provide an overview on current insights, diagnostic modalities and on mesenteric ischemia after abdominal aortic aneurysm repair