Aortic dissection: Percutaneous management of ischemic complications with endovascular stents and balloon fenestration Suzanne M. Slonim, MD, Ulf Nyman,

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Presentation transcript:

Aortic dissection: Percutaneous management of ischemic complications with endovascular stents and balloon fenestration Suzanne M. Slonim, MD, Ulf Nyman, MD, Charles P. Semba, MD, D.Craig Miller, MD, R.Scott Mitchell, MD, Michael D. Dake, MD Journal of Vascular Surgery Volume 23, Issue 2, Pages 241-253 (February 1996) DOI: 10.1016/S0741-5214(96)70268-9 Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Arteriogram demonstrates no flow into left common iliac artery in this patient with chronic type A dissection (case 10). B, Fluoroscopic image depicts 8F intravascular ultrasonography (IVUS) probe extending up true lumen of right external iliac artery, across reentry tear at level of internal iliac artery, into false lumen in aorta. A 7F Rosch-Uchida cannula loaded with small needle is in true lumen of left iliac artery. C, Needle is passed through intimal flap into opposite lumen under IVUS guidance. D, A 5F angiographic catheter is advanced over needle into opposite lumen. Needle is withdrawn, and guidewire is advanced into opposite lumen. E, Balloon catheter is advance over guidewire to dilate fenestration in intimal flap. F, Arteriogram demonstrates flow in left iliac artery after stenting of chronic dissection. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Arteriogram demonstrates no flow into left common iliac artery in this patient with chronic type A dissection (case 10). B, Fluoroscopic image depicts 8F intravascular ultrasonography (IVUS) probe extending up true lumen of right external iliac artery, across reentry tear at level of internal iliac artery, into false lumen in aorta. A 7F Rosch-Uchida cannula loaded with small needle is in true lumen of left iliac artery. C, Needle is passed through intimal flap into opposite lumen under IVUS guidance. D, A 5F angiographic catheter is advanced over needle into opposite lumen. Needle is withdrawn, and guidewire is advanced into opposite lumen. E, Balloon catheter is advance over guidewire to dilate fenestration in intimal flap. F, Arteriogram demonstrates flow in left iliac artery after stenting of chronic dissection. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Arteriogram demonstrates no flow into left common iliac artery in this patient with chronic type A dissection (case 10). B, Fluoroscopic image depicts 8F intravascular ultrasonography (IVUS) probe extending up true lumen of right external iliac artery, across reentry tear at level of internal iliac artery, into false lumen in aorta. A 7F Rosch-Uchida cannula loaded with small needle is in true lumen of left iliac artery. C, Needle is passed through intimal flap into opposite lumen under IVUS guidance. D, A 5F angiographic catheter is advanced over needle into opposite lumen. Needle is withdrawn, and guidewire is advanced into opposite lumen. E, Balloon catheter is advance over guidewire to dilate fenestration in intimal flap. F, Arteriogram demonstrates flow in left iliac artery after stenting of chronic dissection. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Arteriogram demonstrates no flow into left common iliac artery in this patient with chronic type A dissection (case 10). B, Fluoroscopic image depicts 8F intravascular ultrasonography (IVUS) probe extending up true lumen of right external iliac artery, across reentry tear at level of internal iliac artery, into false lumen in aorta. A 7F Rosch-Uchida cannula loaded with small needle is in true lumen of left iliac artery. C, Needle is passed through intimal flap into opposite lumen under IVUS guidance. D, A 5F angiographic catheter is advanced over needle into opposite lumen. Needle is withdrawn, and guidewire is advanced into opposite lumen. E, Balloon catheter is advance over guidewire to dilate fenestration in intimal flap. F, Arteriogram demonstrates flow in left iliac artery after stenting of chronic dissection. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Arteriogram demonstrates no flow into left common iliac artery in this patient with chronic type A dissection (case 10). B, Fluoroscopic image depicts 8F intravascular ultrasonography (IVUS) probe extending up true lumen of right external iliac artery, across reentry tear at level of internal iliac artery, into false lumen in aorta. A 7F Rosch-Uchida cannula loaded with small needle is in true lumen of left iliac artery. C, Needle is passed through intimal flap into opposite lumen under IVUS guidance. D, A 5F angiographic catheter is advanced over needle into opposite lumen. Needle is withdrawn, and guidewire is advanced into opposite lumen. E, Balloon catheter is advance over guidewire to dilate fenestration in intimal flap. F, Arteriogram demonstrates flow in left iliac artery after stenting of chronic dissection. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Arteriogram demonstrates no flow into left common iliac artery in this patient with chronic type A dissection (case 10). B, Fluoroscopic image depicts 8F intravascular ultrasonography (IVUS) probe extending up true lumen of right external iliac artery, across reentry tear at level of internal iliac artery, into false lumen in aorta. A 7F Rosch-Uchida cannula loaded with small needle is in true lumen of left iliac artery. C, Needle is passed through intimal flap into opposite lumen under IVUS guidance. D, A 5F angiographic catheter is advanced over needle into opposite lumen. Needle is withdrawn, and guidewire is advanced into opposite lumen. E, Balloon catheter is advance over guidewire to dilate fenestration in intimal flap. F, Arteriogram demonstrates flow in left iliac artery after stenting of chronic dissection. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Selective left renal arteriogram (case 12) demonstrates irregular intimal contour at orifice of renal artery (arrow). B, Image from IVUS study of left renal artery demonstrates dissection flap (straight arrow), with true lumen (curved arrow) compressed by false lumen. C, Palmaz stent is deployed in proximal renal artery with angioplasty balloon. D, Arteriogram performed after deployment of stent reveals widely patent left renal artery. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Selective left renal arteriogram (case 12) demonstrates irregular intimal contour at orifice of renal artery (arrow). B, Image from IVUS study of left renal artery demonstrates dissection flap (straight arrow), with true lumen (curved arrow) compressed by false lumen. C, Palmaz stent is deployed in proximal renal artery with angioplasty balloon. D, Arteriogram performed after deployment of stent reveals widely patent left renal artery. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Selective left renal arteriogram (case 12) demonstrates irregular intimal contour at orifice of renal artery (arrow). B, Image from IVUS study of left renal artery demonstrates dissection flap (straight arrow), with true lumen (curved arrow) compressed by false lumen. C, Palmaz stent is deployed in proximal renal artery with angioplasty balloon. D, Arteriogram performed after deployment of stent reveals widely patent left renal artery. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Selective left renal arteriogram (case 12) demonstrates irregular intimal contour at orifice of renal artery (arrow). B, Image from IVUS study of left renal artery demonstrates dissection flap (straight arrow), with true lumen (curved arrow) compressed by false lumen. C, Palmaz stent is deployed in proximal renal artery with angioplasty balloon. D, Arteriogram performed after deployment of stent reveals widely patent left renal artery. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Arteriogram with injection of contrast media into true lumen of abdominal aorta demonstrates it to be severely compressed (case 17). Celiac axis, superior mesenteric artery (curved arrow), two left renal arteries (straight arrows), and both iliac arteries are supplied by true lumen. Flow to iliac arteries is significantly compromised. B, After deployment of aortic Palmaz stents, flow to right iliac artery remains impaired. C, Restoration of normal flow is seen after additional stents are deployed in iliac arteries. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Arteriogram with injection of contrast media into true lumen of abdominal aorta demonstrates it to be severely compressed (case 17). Celiac axis, superior mesenteric artery (curved arrow), two left renal arteries (straight arrows), and both iliac arteries are supplied by true lumen. Flow to iliac arteries is significantly compromised. B, After deployment of aortic Palmaz stents, flow to right iliac artery remains impaired. C, Restoration of normal flow is seen after additional stents are deployed in iliac arteries. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Arteriogram with injection of contrast media into true lumen of abdominal aorta demonstrates it to be severely compressed (case 17). Celiac axis, superior mesenteric artery (curved arrow), two left renal arteries (straight arrows), and both iliac arteries are supplied by true lumen. Flow to iliac arteries is significantly compromised. B, After deployment of aortic Palmaz stents, flow to right iliac artery remains impaired. C, Restoration of normal flow is seen after additional stents are deployed in iliac arteries. Journal of Vascular Surgery 1996 23, 241-253DOI: (10.1016/S0741-5214(96)70268-9) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions