Advertisement

Catheter-Directed Fenestration for Branch Vessel Reconnection in Aortic Dissection Using a Novel Diamond-Tipped Chronic Total Occlusion Drilling Device: A Technical Report

  • Rim Ghali
  • Julian Maingard
  • Hong Kuan Kok
  • George Matalanis
  • Siven Seevanayagam
  • Hamed Asadi
  • Duncan Mark Brooks
Technical Note
  • 12 Downloads

Abstract

Purpose

Aortic dissection is a complex condition with high morbidity and mortality. Endovascular treatments including percutaneous fenestration can be used to manage branch vessel ischaemia or risk of aortic rupture. A variety of techniques for aortic fenestration have been described. We describe the novel use of the TruePath Chronic Total Occlusion (CTO) device for aortic intimal fenestration to achieve side branch reconnection.

Materials and Methods

We present three cases of aortic dissection presenting with symptoms of aortic side branch occlusion and end organ malperfusion, treated with aortic fenestration using the TruePath CTO device via trans-brachial and trans-femoral approaches.

Results

Technical success was achieved in all three cases. No complications were encountered. Flow was restored in compromised visceral branches. Branches remained patent on follow-up CT angiography over a minimum 2.5-year follow-up period.

Conclusion

Percutaneous aortic fenestration techniques enable a minimally invasive approach to treat visceral branch malperfusion associated with aortic dissection. The TruePath CTO device improves the control of the fenestration procedure with the potential to improve efficacy and safety.

Keywords

Aortic dissection Intimal fenestration False lumen True lumen Endovascular 

Notes

Compliance with Ethical Standards

Conflict of interest

We declare that we have no conflict of interest.

References

  1. 1.
    Golledge J, Eagle KA. Acute aortic dissection. Lancet. 2008;372(9632):55–66.CrossRefGoogle Scholar
  2. 2.
    Oderich GS, et al. Aortic dissection with aortic side branch compromise: impact of malperfusion on patient outcome. Perspect Vasc Surg Endovasc Ther. 2008;20(2):190–200.CrossRefGoogle Scholar
  3. 3.
    Vendrell A, et al. Acquired cardiovascular disease: aortic dissection: Aortic dissection with acute malperfusion syndrome: Endovascular fenestration via the funnel technique. J Thorac Cardiovasc Surg. 2015;150:108–15.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chavan A, et al. Endoluminal treatment of aortic dissection. Eur Radiol. 2003;13(11):2521–34.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rousseau H et al. Endovascular treatment of the complications of aortic dissection: fenestration and stenting. 2006;247.Google Scholar
  6. 6.
    Australasian Vascular Audit Report. 2016, Australian and New Zealand Society for vascular surgery; 2016. p. 37.Google Scholar
  7. 7.
    Hartnell GG, Gates J. Aortic fenestration: A why, when, and how-to guide. RadioGraphics. 2005;25(1):175–89.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Elefteriades JA, Escalon JC. Cardiac surgery: aortic fenestration for dissection. Oper Tech Thorac Cardiovasc Surg. 2009;14:12–22.CrossRefGoogle Scholar
  9. 9.
    Wolfschmidt F, et al. Aortic dissection: accurate subintimal flap fenestration by using a reentry catheter with fluoroscopic guidance-initial single-institution experience. Radiology. 2015;276(3):862–72.CrossRefGoogle Scholar
  10. 10.
    Midulla M, et al. Acquired cardiovascular disease: endovascular fenestration in aortic dissection with acute malperfusion syndrome: Immediate and late follow-up. J Thorac Cardiovasc Surg. 2011;142:66–72.CrossRefGoogle Scholar
  11. 11.
    International, B.S. TruePath CTO. [pdf] 2012 [cited 2017 10/06/2017]; 01:[Instruction Manual for use of TruePath CTO Device]. Available from: https://www.bostonscientific.com/content/dam/Manuals/us/current-rev-en/90741285-01A_TruePathCTO_dfu_us_S.pdf.
  12. 12.
    Patel HJ, et al. Acquired cardiovascular disease: long-term results of percutaneous management of malperfusion in acute type B aortic dissection: Implications for thoracic aortic endovascular repair. J Thorac Cardiovasc Surg. 2009;138:300–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Bosiers M, et al. Revascularization of lower extremity chronic total occlusions with a novel intraluminal recanalization device: results of the ReOpen study. J Endovasc Ther. 2014;21(1):61–70.CrossRefGoogle Scholar

Copyright information

© Crown 2018

Authors and Affiliations

  1. 1.Interventional Radiology Service - Department of RadiologyAustin HospitalHeidelberg, MelbourneAustralia
  2. 2.Department of RadiologyNorthern HospitalEppingAustralia
  3. 3.Department of Cardiac SurgeryAustin HospitalHeidelbergAustralia
  4. 4.Department of ImagingMonash UniversityMelbourneAustralia
  5. 5.Interventional Neuroradiology Service – Radiology DepartmentAustin HospitalMelbourneAustralia
  6. 6.School of Medicine – Faculty of HealthDeakin UniversityWaurn PondsAustralia

Personalised recommendations