Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection.
OBJECTIVE
Acute aortic dissection frequently causes life-threatening ischemia of end-organs, historically associated with mortality exceeding 60%. Reperfusion with the use of interventional radiologic methods has evolved as a promising treatment. We report results of our initial 6 years of experience with percutaneous balloon fenestration of the intimal flap and endovascular stenting.


METHODS
Forty patients (32 male and 8 female) with a median age of 53 years (range 16-86 years) underwent percutaneous treatment for peripheral ischemic complications of 10 type A and 30 type B acute aortic dissections since 1991. Twenty patients had ischemia of multiple organ systems. Thirty patients had renal, 22 had leg, 18 had mesenteric, and 1 had arm ischemia.


RESULTS
Fourteen patients were treated with stenting of either the true or false lumen combined with balloon fenestration of the intimal flap, 24 with stenting alone, and 2 with fenestration alone. Successful revascularization was achieved in 93% +/- 4% (+/-70% confidence levels) of patients (37/40). Nine patients had procedure-related complications. The 30-day mortality rate was 25% +/- 7% (10/40), often related to irreversible ischemia of intra-abdominal organs that was present before the procedure. Of the remaining 30 patients, 5 have died and the remaining 25 continue to have relief of ischemic symptoms at a mean follow-up of 29 months.


CONCLUSIONS
Percutaneous balloon fenestration of the intimal flap and endovascular stenting is an effective treatment for life-threatening ischemic complications of acute aortic dissection.
Slonim
S M
SM
Division of Cardiovascular Radiology, Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Miller
D C
DC
Mitchell
R S
RS
Semba
C P
CP
Razavi
M K
MK
Dake
M D
MD
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications*; D000792:Angiography; D001014:Aortic Aneurysm / Q000150:complications*; D001132:Arm / Q000098:blood supply; D002404:Catheterization; D003106:Colon / Q000098:blood supply; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D007668:Kidney / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011677:Punctures; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015607:Stents