title: Endovascular Closure of Chronic Dissection Entries in the Aortic Arch Using the Amplatzer Vascular Plug II as a Sealing Button.
abstract: OBJECTIVE
  To present a new endovascular technique to avoid open surgical arch reconstruction in selected patients with aneurysmal dilatation due to small chronic dissection entries in the aortic arch.
  
  
  METHODS
  The true and the false lumen of the aortic arch are catheterized from the femoral arteries. An Amplatzer Vascular Plug II (AVP II) is advanced through the proximal entry from the false lumen side and deployed as a sealing button in the entry hole, with 1 disc in the true lumen and the remaining 2 discs in the false lumen. This technique was used in 4 patients with chronic dissection involving the aortic arch, three of whom had had previous surgery for acute type A aortic dissection. In 3 patients, the false lumen of the thoracic aorta was successfully obliterated, with thrombosis and aortic diameter reduction during follow-up. In 1 patient, false lumen flow persisted, and he was subsequently treated with a total arch reconstruction and frozen elephant trunk.
  
  
  CONCLUSIONS
  Endovascular closure of small proximal dissection entries in the aortic arch with an AVP II used as a sealing button is feasible and may be an alternative to open surgical arch reconstruction in selected patients with chronic aortic dissection and secondary aneurysm expansion.
authors.affiliation: Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden marten.falkenberg@vgregion.se.
authors.forename: Mårten
authors.initials: M
authors.lastname: Falkenberg
authors.affiliation: Department of Hybrid and Interventional Surgery, Unit of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Roos
authors.affiliation: Department of Thoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Lepore
authors.affiliation: Department of Thoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Svensson
authors.affiliation: Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Zachrisson
authors.affiliation: Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Henrikson
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000628:therapy*; D001027:Aortography; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D065506:Vascular Closure Devices
keywords: aneurysm; aortic arch; aortic dissection; entry site; false lumen; true lumen; vascular plug