title: "Cheese wire" fenestration of a chronic aortic dissection flap for endovascular repair of a contained aneurysm rupture.
abstract: A 70-year-old man presented with a contained aortic rupture above the aortic bifurcation in the setting of a chronic type B aortic dissection. The celiac and right iliac arteries were supplied by the false lumen, and the superior mesenteric, left iliac, and bilateral renal arteries were supplied by the true lumen. An open repair was not possible due to right-sided heart failure. The "cheese wire" maneuver is a technique used to fenestrate an intimal flap, alleviating malperfusion in aortic dissection. In our modification, a Glidewire (Terumo Medical, Somerset, NJ) was passed across the intimal flap using a Ross Modified Colapinto needle (Cook Medical, Bloomington, Ind) and pulled downward to shear through the membrane to the aortic bifurcation. The fenestration was followed by a unibody endograft stent repair across the contained rupture.
authors.affiliation: DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Jun
authors.initials: J
authors.lastname: Tashiro
authors.affiliation: DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Atif
authors.initials: A
authors.lastname: Baqai
authors.affiliation: DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Lee J
authors.initials: LJ
authors.lastname: Goldstein
authors.affiliation: Vascular and Interventional Radiology Section, University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Salsamendi
authors.affiliation: DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Michele
authors.initials: M
authors.lastname: Taubman
authors.affiliation: DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla. Electronic address: jrey@med.miami.edu.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rey
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome