Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection Suzanne M. Slonim,

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Presentation transcript:

Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection Suzanne M. Slonim, MD, D.Craig Miller, MD, R.Scott Mitchell, MD, Charles P. Semba, MD, Mahmood K. Razavi, MD, Michael D. Dake, MD The Journal of Thoracic and Cardiovascular Surgery Volume 117, Issue 6, Pages 1118-1127 (June 1999) DOI: 10.1016/S0022-5223(99)70248-5 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 Treatments of patients with acute aortic dissection from September 1992 through February 1998. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 1118-1127DOI: (10.1016/S0022-5223(99)70248-5) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 2 Endovascular stent placement used to treat a 51-year-old man with mesenteric and renal ischemia related to a type B dissection. Before percutaneous intervention the patient had resection of an ischemic right colon. A, Digital subtraction arteriogram with the catheter in the aortic true lumen demonstrates a severely collapsed true lumen that supplies the celiac axis. The origin of the superior mesenteric artery is occluded by an intimal flap. It fills through collateral vessels from the gastroduodenal artery (large arrows ) and then occludes a few centimeters beyond the origin of a replaced right hepatic artery (small arrow). B, Arteriogram with injection of the false lumen demonstrates supply to the right renal artery and both lower extremities. The left renal artery does not fill from either the true or false lumen. C, Spot image in a lateral view demonstrates stents in the aorta, the proximal superior mesenteric artery, and the left renal artery (arrow). D, Arteriogram in a lateral view with the catheter in the aortic true lumen demonstrates filling of the superior mesenteric and left renal arteries. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 1118-1127DOI: (10.1016/S0022-5223(99)70248-5) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 Balloon fenestration of the intimal flap used to treat an 80-year-old woman with left lower extremity ischemia immediately after surgical repair of a type A dissection. A, Arteriogram with injection in the aortic false lumen demonstrates flow to the right lower extremity but no flow to the left lower extremity. The true lumen was severely collapsed, with no flow below the renal vessels. B, A large angioplasty balloon catheter is inflated in the false lumen to use as a target. A curved metallic cannula is placed in the true lumen and pointed toward the inflated balloon in the opposite lumen. C, After a small needle is passed through the cannula into the opposite lumen, a 5F angiographic catheter is advanced over the needle, and the needle is exchanged for a guide wire. An angioplasty balloon is advanced over the guide wire and inflated to dilate the fenestration in the intimal flap. D, Arteriogram after creation of the fenestration demonstrates good flow from the false lumen through the fenestration to the left lower extremity. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 1118-1127DOI: (10.1016/S0022-5223(99)70248-5) Copyright © 1999 Mosby, Inc. Terms and Conditions