title: Aortic Dissection: Accurate Subintimal Flap Fenestration by Using a Reentry Catheter with Fluoroscopic Guidance-Initial Single-Institution Experience.
abstract: OBJECTIVE
  To evaluate the feasibility, effectiveness, and safety of using a commercially available reentry catheter with fluoroscopic guidance to gain controlled target lumen reentry for fenestration in patients with aortic dissection.
  
  
  METHODS
  This retrospective study was approved by the local institutional review board; informed consent was waived. Between April 2009 and December 2013, 13 consecutive patients (10 men and three women; mean age, 51.2 years; range, 30.0-77.0 years; mean age of women, 47.0 years; range, 30.0-69.0 years; mean age of men, 52.4 years; range, 35.0-77.0 years) with aortic dissection and spinal (n = 4), renal (n = 7), mesenteric (n = 2), and/or iliofemoral (n = 9) malperfusion syndrome were included. All patients received target lumen reentry by means of balloon fenestration of the aortic dissection flap. A reentry catheter was used for fluoroscopically guided puncture of the target lumen. Technical success, clinical outcome, Stanford type of dissection, procedure time, number of fenestrations of the intimal flap per patient, necessity of additional aortic stent-graft implantation and/or placement of a bare metal stent, complications, and follow-up images were evaluated. Pre- and postinterventional systolic blood pressure gradients between the true lumen and the false lumen were compared (Wilcoxon signed-rank test). Safety of the reentry catheter maneuver was estimated with the Clopper-Pearson method.
  
  
  RESULTS
  Use of the reentry catheter was technically successful in all 13 (100%) patients and clinically successful in 10 of 13 (77%) patients. Four patients had type A and nine had type B dissection. The mean clinical follow-up period was 14.2 months. Median procedure time was 71 minutes. In four patients, fenestration of the intimal flap was performed twice. Three patients underwent additional aortic stent grafting, four patients underwent placement of an iliofemoral stent, and one patient underwent placement of a carotid artery stent. Blood pressure gradients between the true lumen and the false lumen were significantly reduced (P = .0313). One patient who had a combination of syndromes died of multiorgan failure.
  
  
  CONCLUSIONS
  The applied commercially available reentry catheter seems to be a reliable and safe tool that may be useful for gaining target lumen reentry with reasonably good clinical outcomes.
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.).
authors.forename: Franziska
authors.initials: F
authors.lastname: Wolfschmidt
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.).
authors.forename: Nicole
authors.initials: N
authors.lastname: Hassold
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.).
authors.forename: Jan Peter
authors.initials: JP
authors.lastname: Goltz
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.).
authors.forename: Rainer
authors.initials: R
authors.lastname: Leyh
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.).
authors.forename: Thorsten Alexander
authors.initials: TA
authors.lastname: Bley
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.).
authors.forename: Ralph
authors.initials: R
authors.lastname: Kickuth
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation*; D057785:Catheters; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D017539:Tunica Intima; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods