The abdominal aortic fenestration procedure in acute thoraco-abdominal aortic dissection with aortic branch artery ischemia.
OBJECTIVE
Diagnostic work-up and treatment strategies have improved the prognosis of acute thoraco-abdominal aortic dissection. Little attention to aortic branch artery ischemia or even failed restoration following prosthetic repair of thoraco-abdominal dissection still merit a problem with high morbidity and mortality.


METHODS
Department of Vascular Surgery, Technische Universität München, Germany.


OBJECTIVE
Reflecting on visceral and neurological ischemic complications in acute thoraco-abdominal aortic dissection indications and limitations of the abdominal-aortic-fenestration procedure are discussed with a review on our own clinical experience and the results reported in the literature.


CONCLUSIONS
The abdominal-aortic-fenestration procedure is accomplished with minimal deterioration of the critically ill patient. In new onset or relief of aortic branch ischemia, following initial prosthetic repair of either type A or B dissection aortic fenestration is found to be an effective and secure adjunctive procedure to restore the blood flow of compromised organs. Primary abdominal aortic fenestration is recommended instead of prosthetic repair in cases of acute type B dissection. It is the treatment of choice because of branch artery ischemia becoming the focal point of deterioration.
Department of Vascular Surgery, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
J
J
Harms
U
U
Hess
A
A
Cavallaro
M
M
Naundorf
P C
PC
Maurer
D000208:Acute Disease; D000784:Aortic Dissection / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome