Aortic dissection with acute malperfusion syndrome: Endovascular fenestration via the funnel technique Anne Vendrell, MD, Julien Frandon, MD, Mathieu.

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Presentation transcript:

Aortic dissection with acute malperfusion syndrome: Endovascular fenestration via the funnel technique Anne Vendrell, MD, Julien Frandon, MD, Mathieu Rodiere, MD, Olivier Chavanon, MD, PhD, Jean-Philippe Baguet, MD, PhD, Ivan Bricault, MD, PhD, Bastien Boussat, MD, Gilbert Raymond Ferretti, MD, PhD, Frédéric Thony, MD The Journal of Thoracic and Cardiovascular Surgery Volume 150, Issue 1, Pages 108-115 (July 2015) DOI: 10.1016/j.jtcvs.2015.03.056 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A 71-year-old patient admitted for acute type B aortic dissection, with severe bowel ischemia (bowel tract bleeding and high lactate level) due to dynamic compression and dissection of the superior mesenteric artery. A and B, Angio CT scan on axial views, (C) sagittal and (D) coronal reformations, showing thoraco-abdominal type B AD, with a large primary entry tear located in the aortic arch (arrowhead); compression of the TL by the FL in the abdominal aorta, decreasing blood flow in the abdominal arteries. TL, True lumen; FL, false lumen. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 108-115DOI: (10.1016/j.jtcvs.2015.03.056) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Illustration of the funnel technique: A and B, shows the dynamic compression. The true lumen is collapsed by the large false lumen. C and D, Aortic fenestration with balloon angioplasty of the fenestration opening and deployment of the stent graft across the false and the true lumen. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 108-115DOI: (10.1016/j.jtcvs.2015.03.056) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Aortic fenestration using the funnel technique in the same patient. A, Angiogram showing a collapsed TL. The right renal artery and the intercostal arteries originate from the TL (arrowheads). B, Angiogram of the FL after insertion of a catheter through the intimal perforation, showing the celiac trunk, the left renal artery, and the superior and inferior mesenteric arteries (white arrows). Only the first part of the superior mesenteric artery is supplied by the FL. C, Final angiogram with injection in the FL. The blood flow in the TL has been restored by the stent graft (star) with good patency of both renal arteries (solid arrows), the celiac trunk (splenic and hepatic arteries), and the superior mesenteric artery (dashed arrows). TL, True lumen; FL, false lumen. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 108-115DOI: (10.1016/j.jtcvs.2015.03.056) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Follow-up CT at day 2 in the same patient in (A, B) axial views, (C) sagittal reformations, and (D) VRT reformations showing the stent graft (star) within the TL and the FL, and the good patency of the aortic branches. Another stent has been placed in the superior mesenteric artery in the same procedure because of static compression (arrowhead). Ischemic symptoms disappeared after the procedure, and the patient evolved favorably. TL, True lumen; FL, false lumen. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 108-115DOI: (10.1016/j.jtcvs.2015.03.056) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Survival rate after treatment by the funnel technique. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 108-115DOI: (10.1016/j.jtcvs.2015.03.056) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

The funnel technique: An uncovered aortic stent graft is used between the false and the true lumen. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 108-115DOI: (10.1016/j.jtcvs.2015.03.056) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions