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Laser Fenestration For The Treatment Of A Complicated Type B Aortic Dissection
Chris Werter, M.D.1, Tara Talaie, M.S.2, Thomas Monahan, M.D.1, Shahab Toursavadkohi, M.D.1.
1University of Maryland Medical Center, Baltimore, MD, USA, 2University of Maryland School of Medicine, Baltimore, MD, USA.

Objectives: Patients with type B aortic dissections complicated by thoracoabdominal aneurysmal degeneration and visceral arteries arising from both true and false lumens are rare and leave very limited options for repair. Despite advancements in endovascular techniques, aortic fenestration remains one of the only safe and effective procedures to restore flow to otherwise malperfused organs. To our knowledge, laser fenestration of a dissection septum has not been previously described. This new procedure greatly increases flexibility when managing this challenging problem. Methods: We report a case of a TEVAR for complicated chronic Type B dissection repair in which we used laser fenestration of the aortic septum to preserve flow to branches originating from the false lumen.Results: Postoperatively, the patient developed neurological deficits requiring left subclavian artery stent placement. Immediately following stent placement, the patient had rapid resolution of neurologic symptoms. Conclusion: Aortic fenestration can be effectively utilized for carefully selected patients to preserve flow to vessels originating from the false lumen and offers benefits in achieving durable endovascular repair. While further study and follow-up must be conducted, our modification of this procedure could offer a reasonable adjunct for delivering a long-term endovascular solution to these complicated aortic dissections.

Figure 1: Preoperative CT abdomen illustrating renal branches off of the true lumen of the thoraco-abdominal aortic dissection.

Figure 2: Intraoperative angiography illustrating the laser-created fenestration, appearing as a jet of dark contrast connecting the true and false lumens of the dissection.

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