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In recent years, significant advancements have been made in endovascular therapy for aortic dissection, resulting in the development of various treatment methods. Nevertheless, there is a contentious discussion regarding the suitability of different treatment methods for addressing the unique features of individual lesions. Specifically, the matter of whether the presence of small intimal tears or multiple distal tears requires extensive aortic coverage with graft stents, which may block the blood supply to important organs, intercostal arteries, or lumbar arteries, remains unresolved. Further research is necessary to determine the need for complex fenestrated or branched endovascular aortic repair (F/B-EVAR) in the management of chronic post-dissection aneurysms involving visceral arteries. Our report highlights the successful endovascular repair of three patients with aortic dissection, encompassing one Stanford A type and two Stanford B types. Utilizing the Amplatzer Vascular Plug (AVP) alone or in combination with the coil embolization technique, we achieved favorable clinical outcomes. This article aims to provide valuable insights and new perspectives on the tailored management of aortic dissection by conducting a comprehensive examination of the subtle differences in the treatment processes and techniques applied to these three patients.

Objective To promote embolization of spinal dural arteriovenous fistula (SDAVF) with a small long tortuous feeder that may impede successful application of an embolic agent. Methods An induced-wedge technique was developed in which blood flow was blocked by coiling at the proximal part of the microcatheter for secure injection of N -butyl cyanoacrylate. We used this technique in 11 patients with SDAVF (male/female ratio, 8:3): 7 thoracic, 2 lumbar, 1 sacral, and 1 cervical. Clinical outcome was evaluated by the Aminoff-Logue Disability Scale. Results Penetration of embolic agent through the fistula into the vein was complete ( n = 5), nearly complete (no penetration of embolic agent into the vein but no residual fistula on 3 adjacent selective angiograms; n = 4), or partial (embolization with a small residual filling of the draining vein; n = 2). All patients improved neurologically during follow-up (median, 18 months; range, 7–37 months) and achieved complete recovery. Of the 2 patients who obtained partial obliteration, one showed disappearance of the residual lesion on angiography 21 months later and the other achieved complete results after repeat embolization. Conclusions The induced-wedge technique can improve SDAVF embolization by providing better penetration of the liquid embolic agent to the fistula and vein. [ABSTRACT FROM AUTHOR]

Comparable failure rates of distal or proximal transcatheter arterial embolization (TAE) techniques for blunt splenic injuries have been reported. This study is to investigate the efficacy and complication of combining both TAE techniques. We included 26 patients of blunt splenic injuries for TAE therapy and randomized them into distal TAE and combined TAE groups. A prospective study was performed to compare their demographics, clinical parameters, hemograms, post-TAE splenic infarct volumes, splenic abscess and pancreatitis between the two groups. Of 26 patients, 17 received distal TAE, 9 received combined TAE. Their basic demographics, clinical parameters and hemograms did not differ. Mean systolic blood pressure of all patients was significantly elevated after TAE at 24 hours later. Three patients of distal TAE group had residual pseudoaneurysms in follow up. They were considered failures in distal TAE group as opposed to all successes in combined TAE group. The risk difference of failure of distal TAE was 17.6%. None developed post-TAE splenic abscess, massive splenic infarct or pancreatitis. The mean splenic infarct volume of distal TAE (10.9%) versus combined TAE groups (6.6%) was not significant ( p = 0.481). Combined TAE is effective and safe to decrease the failure rates of non-operative management for blunt splenic injuries., Competing Interests: CONFLICTS OF INTEREST The authors have no any financial or non-financial conflicts of interest for disclosure.