Techniques and outcomes of percutaneous aortic anastomosis leak closure after frozen elephant trunk procedure for aortic dissection.

BACKGROUND

The aim of our study was to provide a summary of applied percutaneous aortic anastomosis leak (AAL) closure techniques after frozen elephant trunk (FET) procedure for aortic dissection and describe the procedural and mid-term outcomes in a consecutive cohort of patients at our center.

METHODS

All patients who underwent percutaneous closure of AAL after FET between January 2018 and December 2020 were identified. Three different strategies were employed: (I) the retrograde technique; (II) the true-to-false lumen loop technique; and (III) the antegrade technique. Procedural and short-term results were assessed.

RESULTS

A total of 34 AAL closure procedures were performed in 32 patients. The mean age was 44.3±9.1 years, and 87.5% of patients were male. Successful device deployments were achieved in 36 leaks (100%). Immediate residual leaks were mild and moderate in 37.5% and 9.4% of patients, respectively. After a mean follow-up of 47.1±24.6 months, reduction in AAL to mild or less was accomplished in 90.6% of patients. Complete thrombosis and basically complete thrombosis of the FET's segment false lumen were achieved in 75.0% and 15.6% of patients, respectively. The maximal diameter of FET's segment false lumen significantly decreased by 13.6±8.7 mm (from 33.0±9.4 to 19.4±16.2 mm, P<0.001).

CONCLUSIONS

Percutaneous closure of AAL after FET procedure was associated with false lumen reduction of aortic dissection. The magnitude of benefit was greatest with AAL reduction to a grade of mild or less. Therefore, attempts should be made to reduce AAL as much as possible.