Aortic dissection: percutaneous management of ischemic complications with endovascular stents and balloon fenestration.
OBJECTIVE
The purpose of this study was to evaluate endovascular stenting (EVS) and balloon fenestration (BF) of intimal flaps for the management of lower extremity, renal, and visceral ischemia in acute or chronic aortic dissection.


METHODS
Twenty-two patients (16 male, 6 female) with a median age of 53 years (range 35 to 77 years) underwent percutaneous treatment for peripheral ischemic complications of 12 type A (five acute, seven chronic) and 10 type B (nine acute, one chronic) aortic dissections.


RESULTS
Ten patients had leg ischemia, 13 had renal ischemia, and 6 had visceral ischemia. Sixteen patients were treated with EVS including 11 with renal, 6 with lower extremity, 2 with superior mesenteric artery, and 2 with aortic stents. Three patients had BF of the intimal flap, and three had BF in combination with EVS. Revascularization with clinical success was achieved in all 22 patients. Two patients died 3 days and 13.4 months after the procedure was performed, respectively. Of the remaining 20 patients, 1 is lost to follow-up, and 19 have persistent relief of clinical symptoms. Mean follow-up time is 13.7 months (range 1.1 to 46.5 months). One case was complicated by guidewire-induced perinephric hematoma.


CONCLUSIONS
EVS and BF provide a safe and effective percutaneous method for managing peripheral ischemic complications of aortic dissection.
Slonim
S M
SM
Department of Cardiovascular and Interventional Radiology, Stanford University Hospital, CA 94305, USA.
Nyman
U
U
Semba
C P
CP
Miller
D C
DC
Mitchell
R S
RS
Dake
M D
MD
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000628:therapy*; D007668:Kidney / Q000098:blood supply*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008638:Mesenteric Arteries / Q000473:pathology*; D017538:Mesenteric Artery, Superior / Q000473:pathology; D008641:Mesenteric Vascular Occlusion / Q000628:therapy; D008875:Middle Aged; D015607:Stents; D015996:Survival Rate