Percutaneous Balloon Fenestration Research Articles

Imaging-Guided Percutaneous Transperitoneal Balloon Fenestration of Postrenal Transplant Lymphocele: A Case Report of Experience with New Technique

AbstractRenal transplantation is the treatment of choice for improved survival and quality of life in patients with end-stage renal disease. However, perirenal fluid collections are common surgical complications after renal transplant, with about 0.6 to 18% of patients developing a lymphocele. Conventional treatments include percutaneous aspiration and drainage, laparoscopic fenestration, and open surgical decompression stepwise. Recently, a new image-guided percutaneous transperitoneal balloon fenestration technique has been described as an alternative to the laparoscopic or surgical technique. We present the case of a 25-year-old male patient diagnosed with a lymphocele after 2 months of transplantation and no resolution of the lymphocele with percutaneous aspiration and drainage. We used this new technique under ultrasound and fluoroscopy guidance, which resulted in the resolution of the lymphocele at 1 month postprocedure. This case report highlights this new technique's potential role in successfully managing the posttransplant lymphocele in a minimally invasive manner.

Management of Lymphoceles after Renal Transplant: Case Report of a Novel Percutaneous Image-guided Treatment Technique

A 65-year-old African American man with end-stage renal disease underwent renal transplantation and developed a perigraft lymphocele with an associated progressive increase in serum creatinine 6 weeks after surgery, which failed to resolve with percutaneous drainage and surgical therapy. Fluoroscopic and ultrasound-guided percutaneous transperitoneal balloon fenestration with a 22-mm, 2-cm-long balloon catheter resulted in resolution of the lymphocele as shown by ultrasound at 3 and 5 months.

Percutaneous Balloon Fenestration of Flow-limiting Iatrogenic Dissection of the Common Femoral Artery: Report of Two Cases

Acute iatrogenic arterial dissection is a known complication of endovascular techniques and can be treated with prolonged ballooning, stent placement, or balloon fenestration. Treatment of common femoral artery (CFA) dissection needs special attention because of the potential compromise of either the deep or superficial femoral artery origin and the enhanced mechanical stress to arteries in the groin. The authors report two cases with percutaneous balloon fenestration of flow-limiting localized iatrogenic dissection of the CFA with initial technical success in both cases and favorable short- to midterm outcomes.

Aortic Dissection Complicating Intraaortic Balloon Pumping: Percutaneous Management of Delayed Spinal Cord Ischemia

Iatrogenic acute type B dissection is a rare complication of intraaortic balloon pumping. Delayed visceral and spinal cord malperfusion can occur for distal progression of the dissection or relative hypotension. Cerebrospinal fluid drainage and percutaneous balloon fenestration provide a safe and effective method for managing ischemic complications.

Endovascular stent placement for acute type-B aortic dissection with malperfusion - an intentional surgical delay and a possible 'bridging therapy'

Acute aortic dissection frequently causes life-threatening organ ischemia. The optimal therapy for acute type-B aortic dissection is still controversial. Early surgery for acute dissections with organ malperfusion is known to carry a high morbidity and mortality. Endovascular treatment, such as stent placement for branch stenosis, percutaneous balloon fenestration for compression of the true channel and aortic stent placement to support collapsed true channel, is becoming an alternative form of treatment. However, it is not clear whether endovascular intervention alone is effective in the long term. We herein report a case of emergency percutaneous endovascular stenting with intentional surgical delay in a patient who had visceral and lower extremity malperfusion due to acute type-B dissection. A 10x57 mm bare metal stent was inserted into the obliterated true channel of the thoracoabdominal aorta 3 h after onset of symptoms. It immediately relieved the abdominal and lower limb ischemic symptoms. The advantage of small-sized stent placement is its easiness and being gentle to fragile intima. The small-sized stent placement for patients with acute aortic dissection with visceral organ ischemia may be a promising 'bridging therapy' before they undergo traditional central repair.

Percutaneous balloon fenestration and stent placement for lower limb ischemia complicated with type B aortic dissection

We report a case of lower limb ischemia secondary to type B aortic dissection, which was successfully treated with endovascular aortic fenestration and stent placement. In this case, we were not able to restore adequate flow to the ischemic limb by means of aortic balloon fenestration alone, so additional stent placement was required to buttress the true lumen and fenestra. There was no recurrence of lower limb ischemia complications during the follow-up period. Aortic balloon fenestration with stent placement seems to be a safe and effective technique to salvage an ischemic lower limb complicated by acute aortic dissection.

Percutaneous fenestration for the treatment of ischemia caused by aortic dissection

目的 评价经皮开窗术治疗主动脉夹层引起的内脏及下肢缺血.方法 6例主动夹层并发内脏及下肢缺血患者行经皮开窗术,所有患者皆是 Stanford B型夹层,累及的血管有肾动脉(3条)、肠系膜动脉(1条)和下肢动脉(6条).4例行单纯经皮开窗术,1例行开窗及左肾动脉支架置入治疗,1例行开窗及腹主动脉和双侧髂总动脉支架置入治疗.1例患者于开窗后1个月行支架移植物复合体(stent-graft)腔内隔绝术.结果所有6例患者血管重建均成功,其中4例缺血症状消失,2例明显减轻.随访4～12个月,平均 7.6个月,1例患者术后3个月死于主动脉破裂出血,余5例仍存活.无严重的手术相关并发症.结论经皮开窗术或经皮开窗结合支架置入是1种安全、有效的治疗主动脉夹层引起的内脏及下肢缺血的方法。

Interventional management of aortic dissection.

Modern high-resolution imaging techniques have provided new insights into the pathogenesis of aortic dissection during recent years. Distinct pathologic entities or potential precursors of classic false-lumen aortic dissection such as intramural hematoma or penetrating atherosclerotic ulcer have been identified. As a result, a novel classification according to Svensson used in addition to the standard differentiation according to DeBakey or Stanford has been introduced. Due to improved diagnostic imaging, preoperative mortality has decreased but mortality remains substantial (up to 1.4% per hour within the first 2 days) related to complications of aortic dissection such as aortic rupture, bleeding, pericardial tamponade, critical branch vessel ischemia, multiorgan failure, and myocardial infarction. Transesophageal echocardiography, angiography, magnetic resonance imaging or computed tomography as well as intravascular ultrasound are used for a complete vascular "staging" of patients with aortic dissection after initial stabilization (with or without surgery). New catheter-based interventional techniques have been developed to improve the poor prognosis of aortic dissection: 1 Percutaneous balloon fenestration (PTF) of the intimal flap improves perfusion in case of bowel, limb, or renal ischemia. 2. Aortic stent-graft placement allows for occlusion of the intimal entry tear by implantation of a membrane-covered, self-expanding stent-graft to initiate progressive thrombus formation within the false lumen. Compared to the traditional surgical approaches, both techniques have a low complication rate. The development of these techniques may help to further improve to decrease patients' morbidity and mortality.

Aortic Intimal Dehiscence: A Complication of Percutaneous Balloon Fenestration for Aortic Dissection

A patient with acute type B dissection and a tube configuration of the intimal flap presented with signs of advanced mesenteric and renal ischemia as well as decreased pulses in the lower extremities. The patient was referred for emergency percutaneous fenestration of the abdominal aorta as a salvage procedure and a possible bridge to later surgery. After fenestration, femoral pulses became transiently stronger and then disappeared. The patient died after exploratory laparotomy. Postmortem examination demonstrated dehiscence of the infrarenal abdominal aortic intima with occlusion of the aortic bifurcation.

Percutaneous Balloon Fenestration and Endovascular Stent Placement for Type B Acute Aortic Dissection with Renal Ischemia

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.

Percutaneous balloon fenestration in a case of traumatic abdominal aortic dissection with lower extremity ischemia

A 38-year-old man was involved in a traffic accident and experienced a heavy blow to the abdomen. He had traumatic abdominal aortic dissection with right lower extremity ischemia. He underwent percutaneous balloon fenestration, which is safe and minimally invasive, for relief of right lower extremity ischemia. He has been working for 2 years without any signs of vascular compromise. Percutaneous balloon fenestration is one of the few treatments for traumatic abdominal aortic dissection. (J Vasc Surg 2000;32: 616-8)

Percutaneous balloon fenestration and stenting in acute aortic dissection

Percutaneous balloon fenestration and stenting in acute aortic dissection

Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection

Objectives: Acute aortic dissection frequently causes life-threatening ischemia of end-organs, historically associated with mortality exceeding 60%. Reperfusion with the use of interventional radiologic methods has evolved as a promising treatment. We report results of our initial 6 years of experience with percutaneous balloon fenestration of the intimal flap and endovascular stenting. Methods: Forty patients (32 male and 8 female) with a median age of 53 years (range 16-86 years) underwent percutaneous treatment for peripheral ischemic complications of 10 type A and 30 type B acute aortic dissections since 1991. Twenty patients had ischemia of multiple organ systems. Thirty patients had renal, 22 had leg, 18 had mesenteric, and 1 had arm ischemia. Results: Fourteen patients were treated with stenting of either the true or false lumen combined with balloon fenestration of the intimal flap, 24 with stenting alone, and 2 with fenestration alone. Successful revascularization was achieved in 93% ± 4% (±70% confidence levels) of patients (37/40). Nine patients had procedure-related complications. The 30-day mortality rate was 25% ± 7% (10/40), often related to irreversible ischemia of intra-abdominal organs that was present before the procedure. Of the remaining 30 patients, 5 have died and the remaining 25 continue to have relief of ischemic symptoms at a mean follow-up of 29 months. Conclusion: Percutaneous balloon fenestration of the intimal flap and endovascular stenting is an effective treatment for life-threatening ischemic complications of acute aortic dissection. (J Thorac Cardiovasc Surg 1999;117:1118-27)

Type 1 Aortic Dissection Complicated by Lower Extremity and Renal Ischemia Treated with Surgical Aortic Replacement and Percutaneous Balloon Fenestration

After successful replacement of the ascending aorta and the aortic arch for a Type 1 aortic dissection, a persistent intimal tear resulted in expansion of the false lumen and in lower extremity and renal ischemia. This was successfully treated with percutaneous fenestration of the suprarenal abdominal aorta by means of a transseptal needle and balloon angioplasty. There were no complications, and benefits continued to result from the procedure at 4 months' follow-up.

Creation of Reentry Tears in Aortic Dissection by Means of Percutaneous Balloon Fenestration: Gross Anatomic and Histologic Considerations

To study the safety and efficacy of percutaneous fenestration in aortic dissection, transmural tears in canine and human aortae were created with conventional angioplasty balloons. Tears created in the aortae of five living dogs were compared with tears created in postmortem specimens. Percutaneous fenestration was performed in a woman with acute type I dissection and ischemic hepatitis who died in multisystem failure, and the balloon tear was documented at autopsy. Additional tears in the human aorta were studied in necropsy specimens of normal, Marfanoid, atherosclerotic, and acutely and chronically dissected thoracic and abdominal aortae. In the canine aorta, transmural balloon tears resulted in rapid death of all five animals, and the tears were approximately 10% longer than tears created post mortem with the same balloon. In human aortic specimens, most transmural and all transseptal tears were linear and were oriented nearly perpendicular to the longitudinal axis of the aorta. Tears that were initiated near calcified plaques or large aortic branches extended in unpredictable directions. The transverse orientation of the tears coincided with the long axis of smooth muscle cells in the media of the intact aorta or the dissection septum. Percutaneous balloon fenestration, when performed in areas of the aorta relatively free of atherosclerosis, results in transverse tears in the aortic dissection septum. Percutaneous fenestration of the aortic dissection septum appears feasible and should be considered as a treatment option in carefully selected cases of aortic dissection with ischemic complications. A final conclusion regarding the safety and efficacy of percutaneous fenestration undertaken to relieve organ ischemia requires further clinical experience.