Aortic dissection with acute malperfusion syndrome: Endovascular fenestration via the funnel technique.
OBJECTIVE
To analyze the short- and long-term results of an original aortic fenestration method using the funnel technique during aortic dissection complicated by malperfusion syndrome.


METHODS
The funnel technique consists of deployment of an uncovered aortic stent graft placed from the false to the right lumen through an intimal flap aortic fenestration made by balloon angioplasty. Twenty-eight patients presenting with an aortic dissection (type A, n = 19; type B, n = 9) were treated for malperfusion syndrome owing to dynamic compression (16 renal, 17 bowel, and 13 lower limb ischemia) using the aforementioned technique, and had follow-up evaluation at short term (30 days) and long term (mean: 55 ± 40 months). Eight patients had severe ischemia on arrival (6 bowel, 7 renal, 3 lower limb).


RESULTS
Technical success was achieved in 27 of 28 patients (96%), and ischemic symptoms had disappeared in 25 of 28 patients (89%) at short-term follow up. Five patients presented postprocedure complications: 4 minor and 1 major with arterial thrombosis which caused technical failure (3.6%). The 30-day mortality rate was 7% (n = 2), related to bowel ischemia complications. At long-term follow up, 21 patients had a stable thoracic aortic diameter (91%).


CONCLUSIONS
The funnel technique, in cases of malperfusion syndrome after aortic dissection, safely improves short- and long-term clinical outcome, and could represent an interesting alternative in the management of patients. The hemodynamic efficiency of this technique may account for a lower mortality in our series.
Clinique Universitaire de Radiologie et d'Imagerie Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. Electronic address: AVendrell@chu-grenoble.fr.
Anne
A
Vendrell
Clinique Universitaire de Radiologie et d'Imagerie Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Julien
J
Frandon
Clinique Universitaire de Radiologie et d'Imagerie Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Mathieu
M
Rodiere
Clinique Universitaire de Chirurgie Cardio-Thoracique, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Olivier
O
Chavanon
Service de Cardiologie, Clinique des Eaux Claires, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France.
Jean-Philippe
JP
Baguet
Clinique Universitaire de Radiologie et d'Imagerie Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Ivan
I
Bricault
Université Joseph Fourier, Laboratoire de Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Bastien
B
Boussat
Clinique Universitaire de Radiologie et d'Imagerie Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Gilbert Raymond
GR
Ferretti
Clinique Universitaire de Radiologie et d'Imagerie Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Frédéric
F
Thony
D000208:Acute Disease; D001018:Aortic Diseases / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013577:Syndrome
aortic dissection; aortic fenestration; malperfusion; stent