INTRAVASCULAR ULTRASOUND-GUIDED PERCUTANEOUS FENESTRATION OF THE INTIMAL FLAP IN THE DISSECTED AORTA

Background Aortic dissection with branch obstruction is associated wit h high morbidity and mortality. Fenestration of the dissection flap to relieve distal vessel ischemia is at present largely performed surgic ally. The surgical mortality and morbidity are high: because most pati ents are poor candidates for anesthesia or surgery. Methods and Result s Nine percutaneous fenestrations (one with additional stenting of the infrarenal true aortic lumen) were performed under local anesthesia i n seven patients with aortic dissection. The presenting symptoms were abdominal angina or claudication. By the transfemoral approach, the in timal flap was initially punctured with a needle-catheter combination through which a guidewire was placed across the dissection flap. The f enestration was carried out with a balloon catheter introduced over th e guidewire. The procedure was performed under on-line guidance with i ntravascular ultrasound imaging. The procedure was performed successfu lly and without complications in all patients. After intervention, sym ptoms resolved in all seven patients. Conclusions Intravascular ultras ound-guided percutaneous fenestration of the intimal flap in symptomat ic aortic dissections with distal vessel involvement is a technically feasible and safe procedure that can effectively relieve the patient's symptoms.