Fenestration of Aortic Dissection Using a Fluoroscopy-Based Needle Re-Entry Catheter System

Excerpt

Acute aortic dissection is a potentially fatal aortic emergency with reported mortality rates of up to 50% within 48 h [1, 2]. Aortic branch involvement may lead to malperfusion of visceral, renal, spinal, or iliacofemoral arteries. Most patients with type A dissection are managed surgically [3]. However, in some cases of type A dissection and type B dissection with malperfusion syndrome, initial treatment is medical or interventional [4]. One possible option of treatment is stent-grafting for proximal entry closure [5]. Another useful technique is stent implantation to support and widen the narrowed true lumen [6]. Aortic fenestration is a further important approach that allows outflow from the false lumen and enables quick reperfusion of ischemic side branches of the aorta by decompression of the false aortic lumen [7, 8]. Although adequate fenestration may be achieved using open surgical procedure [9], minimally invasive endovascular procedures have become more popular [10, 11]. In this context, a few devices that may be helpful to create a hole within the dissection flap have been described [12]. …