A Case Report of Percutaneous Fenestration of the Intimal Flap for Limb Ischemia in the Aortic Dissection.
10.4070/kcj.2000.30.3.339
- Author:
Hyun Sook KIM
;
Jae Kwan SONG
;
Hoon Ki PARK
;
Goo Yeong CHO
;
Il Woo SUH
;
Cheol Whan LEE
;
Myeong Ki HONG
;
Seong Wook PARK
;
Seung Jung PARK
- Publication Type:Original Article
- Keywords:
aortic dissection;
fenestration;
intimal flap
- MeSH:
Angiography;
Aorta;
Aorta, Thoracic;
Catheters;
Extremities*;
Female;
Femoral Artery;
Follow-Up Studies;
Humans;
Hypesthesia;
Inflation, Economic;
Ischemia*;
Lower Extremity;
Magnetic Resonance Imaging;
Membranes;
Middle Aged;
Needles;
Perfusion;
Subclavian Artery;
Transcutaneous Electric Nerve Stimulation;
Ultrasonography
- From:Korean Circulation Journal
2000;30(3):339-345
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
The residual tense false lumen following surgical repair of aortic dissection remains one of the most difficult and challenging postsurgical problems. Percutaneous fenestration of the dissecting membrane under the guidance of intravascular ultrasound has been recently introduced to depressurize the tense false lumen. A 63-year-old woman who underwent repair of acute type I dissection was readmitted because of claudication and numbness of the left lower extremity. Angiography, computed tomography, and magnetic resonance imaging clearly showed a dissection flap starting from the thoracic aorta distal to the left subclavian artery. Compressed true lumen by the markedly enlarged tense false lumen was also noted in the double-channeled descending thoracoabdominal aorta. Under intravascular ultrasound guidance, the intimal flap was punctured with a Brockenbrough needle advanced to the true lumen through a femoral artery, and then, a balloon catheter was introduced over the guidewire which was placed across the dissection flap. Desired fenestration was obtained successfully by inflation of the balloon without complications. After procedure, symptoms resolved promptly and she is currently(clinical follow-up of 12 months postfenestration) ambulating without claudication. In conclusion, percutaneous fenestration of the intimal flap is a technically feasible and an effective alternative procedure to surgical repair for restoration of perfusion to an ischemic extremity in selected patients complicated with aortic dissection.
