-Case Reports-

Treatment of Visceral Malperfusion in Acute Type B Aortic Dissection by Percutaneous Endovascular Fenestration Using a Stent, with Additional Stenting of the True Lumen

Hideki Miyachi¹, Shiro Onozawa², Koichi Akutsu¹, Wataru Shimizu³, Shin-ichiro Kumita², Keiji Tanaka¹ and Satoru Murata²

¹Division of Intensive and Cardiovascular Care Unit, Nippon Medical School Hospital
²Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School Hospital
³Department of Cardiovascular Medicine, Nippon Medical School Hospital

Patients with acute type B aortic dissection (ABAD) are often treated medically. However, ABAD is a potentially serious emergency if complicated by acute organ ischemia. The therapeutic strategy for ABAD with visceral malperfusion remains controversial. Because emergent surgery has a high mortality rate, emergent endovascular treatment can be performed instead. We report a case of endovascular fenestration with stenting for visceral malperfusion in ABAD. One stent was inserted across the intimal flap to keep the fenestrated site open, and another stent was placed into the narrowed true lumen. This therapeutic strategy may be feasible for ABAD with acute malperfusion.

J Nippon Med Sch 2014; 81: 340-345

Keywords
acute type B aortic dissection, visceral malperfusion, fenestration

Correspondence to
Koichi Akutsu, Division of Intensive and Cardiovascular Care Unit, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
koichi-a@nms.ac.jp

Received, January 25, 2014
Accepted, March 3, 2014