Following an edited case demonstrating use of the candy plug technique for false lumen occlusion, presented by Fiona Rohlffs (Hamburg, Germany), an 80% majority of CX Aortic Vienna 2021 (5–7 October, broadcast) attendees stated that they too would deploy this technique in chronic aortic dissection patients.
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Rohlffs began by providing an overview of the patient—an 85-year-old male with chronic type B aortic dissection and a false lumen aneurysm greater than 7cm in size. She went on to detail the procedure, in which one candy-shaped stent graft was placed in the false lumen via catheterisation, with a second then being placed in complete alignment with the true lumen stent graft.
In response to a question from moderator Martin Grabenwöger (Vienna, Austria) on her use of two candy plug devices, she noted that this is necessary to completely occlude the section above the celiac trunk in larger aortic diameters. Rohlffs added that this is not the standard approach but was done to suit the unique anatomy of the patient in question—with a longer ceiling zone also being selected.
She also claimed that the use of computed tomography is “crucial” in this procedure, as it helps the operator ensure there is enough space to accommodate the stiff wire initially. A postoperative angiogram was also used to confirm adequate seal and prevention of false lumen backflow provided by the candy plug, Rohlffs added.
She also pointed to recently published data on 57 patients with chronic aortic dissection who were treated with the candy plug technique—which demonstrated “good technical success” in all patients and a “favourable” remodelling rate during follow-up.
Grabenwöger stated that this is a “very important approach” for closing off retrograde flow from the false lumen, particularly in the case of larger false lumens, before Tilo Kölbel, another of the session’s moderators, added to this by quipping that “we often say it is not worth doing this treatment at all if you do not close the back door”.
Registrants can view Rohlff’s edited case on demand here.
