title: Fenestration of an iatrogenic aortic dissection after endovascular aneurysm repair.
abstract: OBJECTIVE
  To present a case of percutaneous fenestration of a type B aortic dissection after endovascular aneurysm repair (EVAR).
  
  
  METHODS
  An 82-year-old patient with an earlier conventionally inserted aortobi-iliac prosthesis presented with a proximal anastomotic pseudoaneurysm, which was excluded successfully by EVAR. Standard follow-up computed tomographic angiography (CTA) 48 hours after the procedure, however, revealed a type B aortic dissection. Despite conservative antihypertensive therapy, the patient developed abdominal and back pain, and intervention was indicated. Endovascular balloon fenestration of the intimal flap was performed, resulting in relief of pain even though the false lumen remained patent. At 8 months after the procedure, the patient was symptom free, and CTA showed no progression of the persistent type B dissection.
  
  
  CONCLUSIONS
  Percutaneous fenestration can be used as a therapy of first choice in patients with an acute aortic dissection post EVAR.
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Jip L
authors.initials: JL
authors.lastname: Tolenaar
authors.forename: Jasper W
authors.initials: JW
authors.lastname: van Keulen
authors.forename: Evert-Jan
authors.initials: EJ
authors.lastname: Vonken
authors.forename: Joost A
authors.initials: JA
authors.lastname: van Herwaarden
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.forename: Gert J
authors.initials: GJ
authors.lastname: de Borst
mesh_terms: D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D011474:Prosthesis Design; D012086:Reoperation; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome