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

• Published in: Cardiovascular and interventional radiology Vol. 42; no. 4; pp. 608 - 614
• Main Authors: Ghali, Rim, Maingard, Julian, Kok, Hong Kuan, Matalanis, George, Seevanayagam, Siven, Asadi, Hamed, Brooks, Duncan Mark
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2019; Springer Nature B.V
• Subjects: Adult; Aged; ANESTHESIA; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - surgery; Aneurysms; Angiography; Angioplasty - instrumentation; AORTA; Aortic dissection; Aortic Rupture - prevention & control; Aortography; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - surgery; Blood Vessel Prosthesis Implantation; Cardiology; Cardiovascular system; Complications; Computed Tomography Angiography; COMPUTERIZED TOMOGRAPHY; Diamond; Diamond drills; Diamonds; Dissection; Drilling; Female; Femur; FLUOROSCOPY; Humans; Imaging; ISCHEMIA; Ischemia - diagnostic imaging; Ischemia - surgery; Male; Medical instruments; Medicine; Medicine & Public Health; METABOLIC DISEASES; Middle Aged; Morbidity; Nuclear Medicine; Occlusion; PATIENTS; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Stents; SURGERY; Surgical Instruments; Technical Note; THROMBOSIS; Treatment Outcome; Tunica Intima - diagnostic imaging; Tunica Intima - surgery; ULTRASONOGRAPHY; Ultrasound; Vascular Access Devices; Aortic dissection; False lumen; Endovascular; True lumen; Intimal fenestration
• DOI: 10.1007/s00270-018-2124-8
• ISSN: 0174-1551

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.