Ischemic complications in aortic dissection - percutaneous treatment with balloon fenestration and stent implantation.

Purpose: To describe principles and results of percutaneous treatment of is chemic complications of aortic dissection. Materials and Methods: In five c ases (four patients) aortic dissection was clinically complicated by renal (n = 4), iliofemoral (n = 2) or mesenterial ischemia (n = 1). After evaluat ion by means of computed tomography, angiography, and manometry, treatment consisted of balloon fenestration of the intimal flap, stent placement or b oth. Results: Eleven of 25 vascular beds were classified as ischemic. Treat ment consisted of 11 balloon fenestration procedures in 3 patients, in one case supported by stent placement across the dissection membrane. Stents we re placed in five renal arteries, one stent was placed in the true lumen of the aorta. One iliac artery was treated with balloon dilatation. One renal artery dissection became symptomatic after balloon fenestration and was tr eated successfully by stent placement. In all cases ischemia was resolved b y endovascular treatment. All patients had persistent relief of symptoms. M ean follow-up time is 5.8 months. Conclusion: Ischemic complications of aor tic dissection can be effectively and safely treated with stent placement a nd balloon fenestration.