title: Simultaneous Surgical Treatment of Type B Dissection Complicated With Visceral Malperfusion and Abdominal Aortic Aneurysm: Role of Aortic Fenestration.
abstract: Aortic dissection occurs in about 5% of patients with coexistent abdominal aortic aneurysm (AAA); combined type B dissection complicated with visceral malperfusion and AAA is an uncommon aortic emergency and patients presenting with complications of thoracic aortic dissection have a dismal prognosis related to difficulties in treatment strategies. Despite tremendous improvement of endovascular techniques, surgical aortic fenestration represents a quick, safe, and effective procedure able to restore flow in an otherwise malperfused aorta. This procedure has to be kept in mind because subsets of patients cannot be treated conventionally due to either prohibitive risk of aortic replacement, anatomic contraindication, or limitations of percutaneous procedures. Herein we report a case of a patient presenting with type B aortic dissection complicated by visceral malperfusion and AAA which was successfully treated simultaneously by open AAA repair and surgical fenestration. We focus on the mechanism of malperfusion and on the role of surgical fenestration.
authors.affiliation: Division of Vascular and Endovascular Surgery, Palermo, Italy;
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Filippone
authors.affiliation: Division of Vascular and Endovascular Surgery, Palermo, Italy;
authors.forename: Gabriele
authors.initials: G
authors.lastname: Ferro
authors.affiliation: Section of Radiology, Ospedale Civico e Benfratelli, Palermo, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Duranti
authors.affiliation: Division of Vascular and Endovascular Surgery, Palermo, Italy;
authors.forename: Gaetano
authors.initials: G
authors.lastname: La Barbera
authors.affiliation: Division of Vascular and Endovascular Surgery, Palermo, Italy;
authors.forename: Francesco
authors.initials: F
authors.lastname: Talarico
keywords: Aortic dissection; Fenestration; Visceral malperfusion