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

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

doi:10.1055/s-0041-1730007

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.

Highlights

Aortic dissection is a painful and dangerous condition leading to urgent medical and surgical treatment
Candy plug technique has been recently introduced as an ancillary operation during thoracic endovascular aortic repair (TEVAR) for Type B aortic dissection.[1,2]
Ten days after cervical bypass, a semiconservative open conversion was performed through a left thoracoabdominal incision in the eighth intercostal space; the progressive shrinkage of the thoracic false lumen allowed treating the patient as a Type-IV thoracoabdominal aortic aneurysm (TAAA)

Summary

Case Report

Complex Regional Pain Syndrome with Aortic Distress after Thoracic Endovascular Aortic Repair and False Lumen Exclusion with “Candy Plug” Technique. MD PhD1 Andrea Kahlberg, MD2 Luca Bertoglio, MD2 Santi Trimarchi, MD PhD3,4 Riccardo Miloro, MD1 Renato Casana, MD5,6 Roberto Chiesa, MD2. Milan, Italy 2 Department of Vascular Surgery, Vita-Salute San Raffaele University, Milan, Italy 3 Department of Vascular Surgery, Fondazione Ca’ Granda Ospedale. Maggiore Policlinico, Milan, Italy 4 Department of Clinical and Community Sciences, University of. Milan, Italy 5 Laboratory of Vascular Research, Istituto Auxologico Italiano, Milan, Italy 6 Department of Surgery, Istituto Auxologico Italiano, Milan, Italy

Introduction

Case Presentation

Discussion