title: A novel fenestration technique for abdominal aortic dissection membranes using a combination of a needle re-entry catheter and the "cheese-wire" technique.
abstract: OBJECTIVE
  This study was designed to demonstrate the applicability of a combined needle-based re-entry catheter and "cheese-wire" technique for fenestration of abdominal aortic dissection membranes.
  
  
  METHODS
  Four male patients (mean age: 65 years) with acute complicated aortic type B dissections were treated at our institution by fenestrating the abdominal aortic dissection membrane using a hybrid technique. This technique combined an initial membrane puncture with a needle-based re-entry catheter using a transfemoral approach. A guidewire was passed through the re-entry catheter and across the membrane. Using a contralateral transfemoral access, this guidewire was then snared, creating a through-and-through wire access. The membrane was then fenestrated using the cheese-wire maneuver.
  
  
  RESULTS
  We successfully performed: (a) membrane puncture; (b) guidewire passage; (c) guidewire snaring; and (d) cheese-wire maneuver in all four cases. After this maneuver, decompression of the false lumen and acceptable arterial inflow into the true lumen was observed in all cases. The dependent visceral arteries were reperfused. In one case, portions of the fenestrated membrane occluded the common iliac artery, which was immediately and successfully stented. In another case, long-standing intestinal hypoperfusion before the fenestration resulted in reperfusion-related shock and intraoperative death of the patient.
  
  
  CONCLUSIONS
  The described hybrid approach for fenestration of dissection membranes is technically feasible and may be established as a therapeutic method in cases with a complicated type B dissection.
authors.affiliation: Division of Interventional Radiology, Institute of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. skos@gmx.de
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kos
authors.forename: Lorenz
authors.initials: L
authors.lastname: Gürke
authors.forename: Augustinus L
authors.initials: AL
authors.lastname: Jacob
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D005263:Femoral Artery; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011677:Punctures; D014057:Tomography, X-Ray Computed