• Hong Zhang, Yang Yang Ge, Kai Lu, Long Cao, Peng Liu, Xiao Ping Liu, Li Jun Wang, and Wei Guo.
• Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China.
• Ann Vasc Surg. 2019 May 1; 57: 60-68.

BackgroundThe natural history of the thoracic false lumen after coil embolization for type B aortic dissection (TBAD) treated by previous thoracic endovascular aortic repair (TEVAR) remains a matter of debate. The aim of this study is to assess the efficacy of coil embolization in promoting thoracic aortic remodeling of TBAD with persistent thoracic false lumen after TEVAR.MethodsBetween January 2015 and December 2016, 7 consecutive TBAD patients with persistent thoracic false lumen post-TEVAR underwent coil embolization, either isolated (3 with maximum thoracic aortic diameter <55 mm) or combined with adjunctive procedure(s) specifically for distal re-entry tears (4 with thoracic aneurysmal aortic dissection ≥55 mm in diameter). Pre- and postcoiling computer tomography angiography (CTA) images were used to evaluate aortic remodeling via false lumen thrombosis status and maximum thoracic aorta diameter.ResultsProcedures were performed successfully in all patients, without intraoperative complications or 30-day mortality. Two dissection-related deaths occurred after hospital discharge, yielding a 6-month mortality of 28.6%. Six patients had surveillance CTA images available for analyses at median 11.2 months (range 5.6-23.5) of follow-up. Thoracic aortic shrinkage and completely thrombosed thoracic false lumen were seen in 1 patient (16.7%); thoracic aortic stabilization albeit with persistent blood flow along the false lumen below or even more proximal to the embolization in 4 patients (66.7%); and continued thoracic aortic growth and aortoesophageal fistula proximal to the embolized false lumen in 1 patient.ConclusionsIn this retrospective single center experience, the efficacy of coil embolization in promoting thoracic aortic remodeling of TBAD with persistent thoracic false lumen post-TEVAR appears to be limited, especially in patients with thoracic aneurysmal aortic dissection. Further studies are warranted to inform the optimal treatment strategy.Copyright © 2019 Elsevier Inc. All rights reserved.

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