Introduction - Surgical aortic fenestration for acute and chronic aortic dissection has been used at our institution since 1986. The aim of the study is to define the indications for its use and to evaluate its success at relieving organ or limb malperfusion. Methods - The records of all patients (n=57) who underwent surgical fenestration of abdominal aorta at our department during the past decade (from 2007 to 2017) were identified. Emergency aortic fenestration for treatment of acute aortic dissection underwent 2 patients with type B dissection. Clinical presentation was malperfusion syndrome: 1 patient had bilateral lower limb and renal ischemia and 1 patient had acute renal and mesenteric ischemia. In both cases malperfusion syndrome occurred despite prior proximal descending throracic aortic replacement. The mean interval between malperfusion onset and fenestration was 7 hours (range, 6 - 8 hours). 55 patients underwent elective aortic fenestration for treatment of chronic aortic dissection. 2 patient had type A dissection, and 53 patients had type B dissection. The primary clinical presentation was chronic malperfusion syndrome in all 55 patients and infrarenal aortic aneurysmal disease in 5 patients. Among them 9 patients had lower limb claudication, 41 patients had renal ischemia, and 17 patients had severe refractory renovascular hypertension caused by the compressed true lumen. 7 patients had symptoms related to chronic mesenteric ischemia. 2 patients had prior ascending aortic Bentall procedure and 5 patients - prior proximal descending thoracic aortic replacement. The main condition and indication for surgical aortic fenestration was the absence of aneurysmal enlargement of the abdominal aorta at the para and suprarenal level (aortic diameter less then 5 cm). Abdominal aortic fenestration was performed through longitudinal aortotomy at the para- and suprarenal level by resection of the septum between the false and true lumen. The aortotomy then was sutured and reinforced with strips of Teflon, which resulted in a slightly redused aortic diameter. Concomitant graft replacement for the infrarenal abdominal aorta was done in 14 patients. Results - The malperfusion syndrome was relieved for 55 patients with organ or limb ischemia. Early operative survival from fenestration was 96.5 % (55 /57). In the acute dissection group the operative mortality was 50 % (1/2) and cause of death - anuria and bowel ischemia. In one patient, acute renal and lower limb malperfusion syndrome was successfully relieved. In the chronic dissection group, operative mortality was 1.8 % (1/55), with the cause of death being multi-systemic organ failure. The 54 patients with evidence of chronic malperfusion syndrome had complete relief. None of the patients were seen with complications that called for reoperation. The mean follow-up for 54 survivors was 3 years (range, 3 months to 5 years). All patients remained free from symptomatic recurrence of malperfusion syndrome and had postoperative imaging studies done. Among all patients there was no evidence of aneurysmal formation at the site of aortic fenestration. Conclusion - Surgical fenestration of the abdominal aorta is a safe and effective method for the treatment of ischemic complications associated with the aortic dissection and malperfusion.