Endovascular Fenestration in Aortic Dissection With Acute Malperfusion Syndrome: Immediate and Late Follow-Up

Study Questions:

What are the immediate and long-term results of fenestration in aortic dissection with acute malperfusion syndrome?

Methods:

Between 1999 and 2007, 35 patients (31 men; ages 57 ± 11 years) with aortic dissection (19 with type A and 16 with type B) were treated by fenestration for malperfusion syndrome (27 renal, 27 bowel, and 14 lower limb) due to dynamic compression. Fenestration was performed with two rigid guidewires inserted in one 8F sheath (45 cm long). The mean interval between aortic dissection and fenestration was 5 days (28 patients within 3 days and 7 patients between 9 and 41 days).

Results:

Fenestration (100% technical success rate) with an additional endovascular procedure (29 peripheral stents and 1 thoracic stent graft) resulted in angiographic success in 97% of the patients. Bowel surgery was performed in 7 patients. Mortality within the first month (12/35) was related to bowel ischemia (n = 5), neurologic complications (n = 3), type A surgery (n = 2), and late treatment (n = 2). At a mean follow-up of 48 ± 30 months, 4 of the remaining 23 patients had died, and 2 had withdrawn from the study. The diameter of the aorta, as measured using computed tomography/magnetic resonance imaging, remained stable in 12 of the remaining 17 patients, and had increased in 5 patients (1 with Marfan syndrome and 4 with multiple arterial ectasia).

Conclusions:

The authors concluded that fenestration saved 69% of the patients with acute malperfusion syndrome in complicated aortic dissection.

Perspective:

This study reports that endovascular fenestration is safe and effective in the treatment of dynamic compression at the origin of visceral or peripheral malperfusion in the presence of complicated aortic dissection. Furthermore, it appears that after fenestration, the diameter of the aorta does not enlarge in the long-term. The results of this uncontrolled single-center study are promising, but need further validation in other centers and in multicenter registries.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Aortic Surgery, Cardiac Surgery and CHD & Pediatrics, Congenital Heart Disease, CHD & Pediatrics and Imaging, CHD & Pediatrics and Interventions, CHD & Pediatrics and Quality Improvement, Interventions and Imaging, Interventions and Structural Heart Disease, Computed Tomography, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: Endovascular Procedures, Follow-Up Studies, Tomography, X-Ray Computed, Dilatation, Pathologic, Marfan Syndrome, Lower Extremity, Magnetic Resonance Imaging, Stents


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