J Korean Soc Vasc Surg.  2008 Nov;24(2):135-139.

Fenestration of the Common Femoral Artery in Patients with Acute Aortic Dissection Combined with Lower Limb Ischemia

• Kim SD
• Park JS
• Park SC
• Kim JI
• Won YS
• Yun SS
• Moon IS

Abstract

Acute aortic dissection is a catastrophic event. Nowadays, the management of aortic dissection can be challenging with performing procedures such as aortic fenestration, stenting and endovascular treatment. While most cases of acute Stanford type A dissection are managed surgically, many cases of acute Stanford type B dissection are treated medically, although open surgery or stent-graft placement is sometimes performed. Patients with Stanford type B dissection may develop vascular complications such as mesenteric or peripheral ischemia, which cannot be managed medically. Fenestration is a procedure for decompressing the hypertensive false lumen by creating a hole in the distal part of the dissection flap and this allows outflow from the false lumen, it relieves branch vessel obstruction, it restores the flow to the ischemic organ and it reduces the risk of extension or rupture of the dissection. Urgent revascularization is required to correct mesenteric and renal ischemia and to restore distal perfusion if there is rest pain and ischemia signs at the lower extremity. We report here on a case of successful surgical fenestration of an acute aortic dissection for relief of lower limb ischemia, and we utilized a transfemoral artery to puncture the obstructed intimal flap.

Keyword

Acute aortic dissection; Lower limb ischemia; False lumen fenestration

MeSH Terms

Arteries
Femoral Artery
Glycosaminoglycans
Humans
Ischemia
Lower Extremity
Perfusion
Punctures
Rupture
Stents
Glycosaminoglycans