Management of the false lumen in chronic aortic dissection
False lumen (FL) thrombosis and aortic remodeling is a major predictor of survival in chronic aortic dissection (AD). Chronic AD (> 3 months) is associated with a non-compliant intimal flap, multiple fenestrations in the intimal flap and aortic branch artery communication with the FL. This makes FL thrombosis and subsequent aortic remodeling difficult to achieve with conventional thoracic EVAR devices. This presentation provides an overview of different methods to manage FL in chronic AD.
Nice presentation. There is a brief moment of terror as you push the syringe on the balloon and you meet resistance then bing -it’s out. You peek over at the A-line trace, smile. You then drop the balloon like you’re sneaking out of a party with the host’s silverware.
On a serious note, without sealing retrograde false lumen flow, the hemodynamics take on that of a long track pseudo aneurysm and the arch hump will grow. Sometimes an appropriately sized stent graft will bust out of the constraints of the true lumen, but from experience, the chronic flap can be as tough as adventitia.