AORTIC DISSECTION - PERCUTANEOUS MANAGEMENT OF ISCHEMIC COMPLICATIONSWITH ENDOVASCULAR STENTS AND BALLOON FENESTRATION

Purpose: The purpose of this study was to evaluate endovascular stenti ng (EVS) and balloon fenestration (BF) of intimal flaps for the manage ment of lower extremity, renal, and visceral ischemia in acute or chro nic aortic dissection. Methods: Twenty-two patients (16 male, 6 female ) with a median age of 53 years (range 35 to 77 years) underwent percu taneous treatment for peripheral ischemic complications of 12 type A ( five acute, seven chronic) and 10 type B (nine acute, one chronic) aor tic dissections. Results: Ten patients had leg ischemia, 13 had renal ischemia, and 6 had visceral ischemia. Sixteen patients were treated w ith EVS including 11 with renal, 6 with lower extremity, 2 with superi or mesenteric artery, and 2 with aortic stents. Three patients had BF of the intimal flap, and three had BF in combination with EVS. Revascu larization with clinical success was achieved in all 22 patients. Two patients died 3 days and 13.4 months after the procedure was performed , respectively. Of the remaining 20 patients, 1 is lost to follow-up, and 19 have persistent relief of clinical symptoms. Mean follow-up tim e is 13.7 months (range 1.1 to 46.5 months). One case was complicated by guidewire-induced perinephric hematoma. Conclusion: EVS and BF prov ide a safe and effective percutaneous method for managing peripheral i schemic complications of aortic dissection.