Peripheral Vascular Surgery Society

#16 PERCUTANEOUS BALLOON FENESTRATION AND ENDOVASCULAR STENT PLACEMENT FOR TYPE B ACUTE AORTIC DISSECTION WITH RENAL ISCHEMIA.

Marc A. Passman, MD, William A. Marston, MD, Mark Farber, MD, Fatejeet S. Sandhu, MD, Paul F. Jaques, MD, and Blair A. Keagy, MD

The University of North Carolina, Chapel Hill, NC.

Case Presentation: A 68-year-old male presented to the emergency department with a "dull," constant, mid-back pain of two days duration. Past medical history was significant for hypertension, which had been previously managed with a single medication. On initial examination, the blood pressure was 210/110 and peripheral pulses were palpable. Contrast enhanced spiral computed tomography revealed an aortic dissection beginning at the left subclavian artery and extending distally into the iliac vessels. Immediate management included blood pressure control with intravenous antihypertensive medications. Magnetic resonance angiography confirmed a Type B aortic dissection with the mesenteric and right renal arteries supplied by the false lumen, and the left renal artery from the true lumen. Although the hypertension was manageable during the early hospital course, on hospital day #6 the blood pressure became more difficult to control, which was associated with an increase in creatinine from 1.0 mg/dl on admission to 2.4 mg/dl. Angiography was performed with percutaneous access into the true lumen through the left femoral artery, and into the false lumen through the right femoral artery. Findings confirmed compromised flow to the right kidney with associated bilateral renal artery dissections. Percutaneous balloon fenestration was performed to the intimal flap followed by bilateral renal artery endovascular stenting. After the procedure, blood pressure was well controlled and renal function returned to normal. The patient was discharged on hospital day #10, with no further complications at 6 months follow-up.

Discussion: Acute aortic dissection can cause life-threatening ischemia of distal end organs. This case illustrates the feasibility and effectiveness of percutaneous balloon fenestration and endovascular renal artery stenting for Type B acute aortic dissection with associated renal ischemia. Percutaneous balloon fenestration and endovascular stent placement should be considered as an alternative to traditional surgical approaches to restore blood flow to arteries compromised by acute aortic dissection.

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Last updated January 1,2000