Fenestration of an Iatrogenic Aortic Dissection After Endovascular Aneurysm Repair

Abstract

To present a case of percutaneous fenestration of a type B aortic dissection after endovascular aneurysm repair (EVAR). An 82-year-old patient with an earlier conventionally inserted aortobi-iliac prosthesis presented with a proximal anastomotic pseudoaneurysm, which was excluded successfully by EVAR. Standard follow-up computed tomographic angiography (CTA) 48 hours after the procedure, however, revealed a type B aortic dissection. Despite conservative antihypertensive therapy, the patient developed abdominal and back pain, and intervention was indicated. Endovascular balloon fenestration of the intimal flap was performed, resulting in relief of pain even though the false lumen remained patent. At 8 months after the procedure, the patient was symptom free, and CTA showed no progression of the persistent type B dissection. Percutaneous fenestration can be used as a therapy of first choice in patients with an acute aortic dissection post EVAR.