title: Endovascular fenestration in aortic dissection with acute malperfusion syndrome: immediate and late follow-up.
abstract: OBJECTIVE
  To evaluate the immediate and long-term results of fenestration in aortic dissection with acute malperfusion syndrome.
  
  
  METHODS
  Between 1999 and 2007, 35 patients (31 men; age, 57 ± 11 years) with aortic dissection (19 with type A and 16 with type B) were treated by fenestration for malperfusion syndrome (27 renal, 27 bowel, and 14 lower limb) due to dynamic compression. Fenestration was performed with 2 rigid guidewires inserted in one 8F sheath (45 cm long). The mean interval between aortic dissection and fenestration was 5 days (28 patients within 3 days and 7 patients between 9 and 41 days).
  
  
  RESULTS
  Fenestration (100% technical success rate) with an additional endovascular procedure (29 peripheral stents and 1 thoracic stent graft) resulted in angiographic success in 97% of the patients. Bowel surgery was performed in 7 patients. Mortality within the first month (12/35) was related to bowel ischemia (n = 5), neurologic complications (n = 3), type A surgery (n = 2), and late treatment (n = 2). At a mean follow-up of 48 ± 30 months, 4 of the remaining 23 patients had died and 2 had withdrawn from the study. The diameter of the aorta, as measured using computed tomography/magnetic resonance imaging, remained stable in 12 of the remaining 17 patients and had increased in 5 (1 with Marfan syndrome and 4 with multiple arterial ectasia).
  
  
  CONCLUSIONS
  In emergencies, fenestration saved 69% of the patients with acute malperfusion syndrome in complicated aortic dissection. During the follow-up period, the aortic diameter remained stable in most of the surviving patients.
authors.affiliation: Department of CardioVascular Imaging and Intervention, Hôpital Cardiologique, CHRU de Lille, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Midulla
authors.forename: Armelle
authors.initials: A
authors.lastname: Renaud
authors.forename: Thomas
authors.initials: T
authors.lastname: Martinelli
authors.forename: Mohammad
authors.initials: M
authors.lastname: Koussa
authors.forename: Claire
authors.initials: C
authors.lastname: Mounier-Vehier
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Beregi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005602:France; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome