False Lumen Backflow In Chronic Aortic Dissections: What Is Its Role and How Can It Be Treated?
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1 University Heart Center Hamburg GERMAN AORTIC CENTER False Lumen Backflow In Chronic Aortic Dissections: What Is Its Role and How Can It Be Treated? Tilo Kölbel, Nikos Tsilimparis, Sabine Wipper, Sebastian Debus University Heart Center Hamburg University Hospital Eppendorf
2 Disclosure Speaker name: Tilo Kölbel, MD I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company X Other: Proctoring, travel, research-grants, patents with Cook Medical I do not have any potential conflict of interest
3 Critical Issue: Why Does the Aorta Fail to Remodel in Chronic Dissection?
4 Failure to Remodel in Chronic Dissection! Perfusion and pressure unchanged in false lumen! Presence of Intercostals originating from false lumen! False lumen back flow to Intercostals
5 TEVAR in Chronic Type B! ! n=80, 26 months FU! TEVAR for type B and residual AD False Lumen Patency in:! LSA-coverage 75%, 24% debranching! Median 16 (1-74) months.! 35% FL-expansion during FU (!) Scali et al. 2013; J Vasc Surg. 58:10-7
6 TEVAR in Chronic Type B! ! N=58, 38 months FU! TEVAR for chronic type B (>14days)! Perioperative mortality 5.2%! 3 year mortality 36% Mani et al. 2012; Eur J Vasc Endovasc Surg 43:
7 TEVAR in Chronic Type B Mani et al. 2012; Eur J Vasc Endovasc Surg 43:
8 TEVAR in Chronic Type B False Lumen Perfusion No Aortic Remodelling Death Mani et al. 2012; Eur J Vasc Endovasc Surg 43:
9 False Lumen Perfusion
10 fevar in Chronic Type A/B University Heart Center Hamburg! ! N=31, 17 months FU! 6 Type II EL; 6 type 1b EL! 30d-mortality: 9.6%! Technical success: 93.5%! FL-thrombosis: 88% Oikonomou et al. 2014; J Vasc Endovasc Surg 48: 641-8
11 fevar in Chronic Type B Courtesy of Stephan Haulon, Lille
12 Direct False Lumen Occlusion! Seperate aortic FL-compartments.! Further distal techniques like fenestrated EVAR not restricted. Bulkhead
13 Knickerbocker-Technique
14 Kölbel et al. 2014; J Endovasc Ther 21: Knickerbocker-Technique
15 Kölbel et al. 2014; J Endovasc Ther 21: Knickerbocker-Technique
16 Kölbel et al. 2014; J Endovasc Ther 21: Knickerbocker-Technique
17 Kölbel et al. 2014; J Endovasc Ther 21: Knickerbocker-Technique
18 Kölbel et al. 2014; J Endovasc Ther 21: Knickerbocker-Technique
19 Kölbel et al. 2014; J Endovasc Ther 21: Knickerbocker-Technique! Investigational technique! Diameter reducing ties! One sided bulge! Gold-markers! N=8! Technical success 8/8! 2 requiring additional coils and cyanoacrylate! FL-thrombosis all patients
20 Cork in the Bottleneck! 2 Cases 1. FL-TAA-occlusion with:! 2 Greenfield filters! 6 detachable balloons! 5ml thrombin 2. FL-TAA-occlusion with:! 24mm Talent occluder Loubert et al. 2003; J Endovasc Ther 10: 244-8
21 False Lumen Embolisation Idrees et al. 2014; J Vasc Surg 60:
22 Candy-Plug 46 22mm Amplatzer plug II Kölbel et al. 2013; J Endovasc Ther 20: 484-9
23 Candy-Plug
24 Candy-Plug! Investigational technique! Max. 46mm diameter! 22mm Amplatzer II! N=6! Technical success 6/6! FL-thrombosis all patients Kölbel et al. 2013; J Endovasc Ther 20: 484-9
25 Iliac False Lumen Embolisation
26 Iliac False Lumen Embolisation University Heart Center Hamburg Ballon-occlusion to prevent plug-embolisation
27 Iliac False Lumen Embolisation
28 Conclusion! Tubular stent-graft sufficient in majority cases of TBAD.! False lumen backflow limiting treatment success in chronic TBAD.! 2 new techniques to occlude false lumen backflow! Knickerbocker-technique! Candy-plug! Early results promising, but future role to be defined.
29 University Heart Center Hamburg GERMAN AORTIC CENTER False Lumen Backflow In Chronic Aortic Dissections: What Is Its Role and How Can It Be Treated? Tilo Kölbel, Nikos Tsilimparis, Sabine Wipper, Sebastian Debus University Heart Center Hamburg University Hospital Eppendorf
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