Intravascular ultrasound-guided creation of re-entry sites to improve intermittent claudication in patients with aortic dissection.
OBJECTIVE
To report percutaneous fenestration of aortic dissection flaps to relieve distal ischemia using a novel intravascular ultrasound (IVUS)-guided fenestration device.


METHODS
Two men (47 and 62 years of age) with aortic dissection and intermittent claudication had percutaneous ultrasound-guided fenestration performed under local anesthesia. Using an ipsilateral transfemoral approach, the intimal flap was punctured under real-time IVUS guidance using a needle-catheter combination through which a guidewire was placed across the dissection flap into the false lumen. The fenestration was achieved using balloon catheters of increasing diameter introduced over the guidewire. Stenting of the re-entry was performed in 1 patient to equalize pressure across the dissection membrane in both lumens. The procedures were performed successfully and without complications. In both patients, ankle-brachial indexes improved from 0.76 to 1.07 and from 0.8 to 1.1, respectively. Both patients were without claudication at the 3- and 6-month follow-up examination.


CONCLUSIONS
Percutaneous intravascular ultrasound-guided fenestration and stenting at the level of the iliac artery in aortic dissection patients with claudication is a technically feasible and safe procedure and relieves symptoms.
Husmann
Marc J
MJ
Department of Cardiovascular Department, Division of Angiology, University Hospital (Inselspital), Bern, Switzerland. marc.husmann@insel.ch
Kickuth
Ralf
R
Ludwig
Karin
K
Schmidli
Jürg
J
Baumgartner
Iris
I
Triller
Jürgen
J
Do
Dai-Do
DD
D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000628:therapy*; D000800:Angioplasty, Balloon; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional