Simultaneous fenestration with stent implantation for acute limb ischemia due to type B acute aortic dissection complicated with both static and dynamic obstructions.
Stanford type B acute aortic dissection is sometimes complicated with compressed true lumen of the descending aorta (Dynamic obstruction) and stenosis of a major aortic branch (Static obstruction), which cause organ malperfusion. In such a case, medical therapy alone is usually not effective and endovascular treatments are required including stent implantation and balloon fenestration. However, it is difficult to determine which strategy should be selected, that is, only stent implantation at dissected branch or simultaneous fenestration with stent implantation. We report a case of a 54-year-old man with lower leg ischemia due to type B aortic dissection, who was successfully treated with stent implantation plus balloon fenestration. This case suggests that balloon fenestration plus stent implantation should be considered when static obstruction in the aortic branches is accompanied by dynamic obstruction in the descending aorta.
Division of Intensive and Cardiac Care Unit, Nippon Medical School Hospital, Tokyo, Japan.
Kosuke
K
Narita
Koichi
K
Akutsu
Takeshi
T
Yamamoto
Naoki
N
Sato
Satoru
S
Murata
Kyoichi
K
Mizuno
Keiji
K
Tanaka
D000208:Acute Disease; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001027:Aortography / Q000379:methods; D057510:Endovascular Procedures / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012039:Regional Blood Flow; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome