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Stent-graft entry closure and balloon fenestration for a case of aortic dissection accompanied by organ malperfusion.

that was treated successfully by stent-graft entry closure and balloon fenestration to secure kidney and intestinal blood flow. Clinical summary. A 42-year-old man with a chronic Stanford type B dissection was a candidate for stent-graft treatment. A primary entry site was detected at the proximal descending thoracic aorta. The superior mesenteric artery and left renal artery could not be delineated by preoperative angiograms of the true lumen, which indicated that they were perfused from the false lumen (Fig 1). After informed consent was obtained, the endovascular procedure was performed in the operating room with the patient under general anesthesia. An intravascular ultrasonic (IVUS) catheter (6F, 12.5 Mz, Sonicath; Boston Scientific Co, Boston, Mass) was introduced via the right femoral artery into the aorta. On the contralateral femoral artery, a 5F pigtail catheter (Cook Group Incorporated, Bloomington, Ind) was introduced over a 0.035-inch stiff guide wire (Amplatz Super Stiff; Boston Scientific Co). Under IVUS monitoring The advantages of stent-graft entry closure for aortic dissection were introduced by the Stanford group.1 Stent-graft placement is expected to be a promising treatment for acute aortic dissection. The purpose is to seal a primary entry by endovascular stentgrafting, thereby decompressing the false lumen and leading to thrombosis in the false lumen. However, in the case of renal or mesenteric artery malperfusion from a false lumen, stent-graft entry closure might result in ischemic organ failure caused by thrombosis of the false lumen. We report on a case of aortic dissection associated with renal and mesenteric artery malperfusion STENT-GRAFT ENTRY CLOSURE AND BALLOON FENESTRATION FOR A CASE OF AORTIC DISSECTION ACCOMPANIED BY ORGAN MALPERFUSION