Complex Regional Pain Syndrome with Aortic Distress after Thoracic Endovascular Aortic Repair and False Lumen Exclusion with “Candy Plug” Technique

Valerio S. Tolva; Andrea Kahlberg; Luca Bertoglio; Santi Trimarchi; Riccardo Miloro; Renato Casana; Roberto Chiesa

doi:10.1055/s-0041-1730007

AORTA, Inhaltsverzeichnis

CC BY 4.0 · Aorta (Stamford) 2021; 09(03): 113-115
DOI: 10.1055/s-0041-1730007

Case Report

Complex Regional Pain Syndrome with Aortic Distress after Thoracic Endovascular Aortic Repair and False Lumen Exclusion with “Candy Plug” Technique

Valerio S. Tolva

¹Department of Vascular Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy

,

Andrea Kahlberg

²Department of Vascular Surgery, Vita-Salute San Raffaele University, Milan, Italy

,

Luca Bertoglio

²Department of Vascular Surgery, Vita-Salute San Raffaele University, Milan, Italy

,

Santi Trimarchi

³Department of Vascular Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

⁴Department of Clinical and Community Sciences, University of Milan, Milan, Italy

,

Riccardo Miloro

¹Department of Vascular Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy

,

Renato Casana

⁵Laboratory of Vascular Research, Istituto Auxologico Italiano, Milan, Italy

⁶Department of Surgery, Istituto Auxologico Italiano, Milan, Italy

,

Roberto Chiesa

²Department of Vascular Surgery, Vita-Salute San Raffaele University, Milan, Italy

› Institutsangaben

Abstract

A 41-year-old male presented for pain treated with oxycodone. A zone-2 thoracic endovascular aortic repair with distal PETTICOAT (provisional extension to induce complete attachment) for complicated Type-IIIB aortic dissection was performed 18 months before. Repeated hospitalizations did not show any issues to justify the recurrent pain. The aortic nature of the pain was suspected considering the plug as a pain trigger. Through a left thoracoabdominal incision in the eighth intercostal space, the candy plug was removed. Pain diminished after thoracoabdominal surgery steadily.

Keywords

aortic dissection - TEVAR - aortic pain - acute aortic syndrome - candy plug - spinal cord protection - visceral perfusion

Volltext

Referenzen

References
1 Rohlffs F, Tsilimparis N, Fiorucci B, Heidemann F, Debus ES, Kölbel T. The candy-plug technique: technical aspects and early results of a new endovascular method for false lumen occlusion in chronic aortic dissection. J Endovasc Ther 2017; 24 (04) 549-555
2 Nathan DP, Brinster CJ, Woo EY, Carpenter JP, Fairman RM, Jackson BM. Predictors of early and late mortality following open extent IV thoracoabdominal aortic aneurysm repair in a large contemporary single-center experience. J Vasc Surg 2011; 53 (02) 299-306
3 Bhamidipati CM, Coselli JS, LeMaire SA. Perfusion techniques for renal protection during thoracoabdominal aortic surgery. J Extra Corpor Technol 2012; 44 (01) 31-37
4 Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med 2007; 8 (04) 326-331
5 Jänig W, Baron R. Complex regional pain syndrome: mystery explained?. Lancet Neurol 2003; 2 (11) 687-697
6 Spanos K, Kölbel T, Rohlffs F. et al. Intentional targeted false lumen occlusion after aortic dissection: a systematic review of the literature. Ann Vasc Surg 2019; 56: 317-329
7 Gierthmühlen J, Binder A, Baron R. Mechanism-based treatment in complex regional pain syndromes. Nat Rev Neurol 2014; 10 (09) 518-528
8 Straube S, Derry S, Moore RA, Cole P. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome. Cochrane Database Syst Rev 2013; 2013 (09) CD002918