Novel method for endovascular fenestration using radiofrequency transseptal needle for aortic dissection with malperfusion syndrome

Abstract

Malperfusion syndrome is considered one of the most significant adverse events in aortic dissection disease and often requires invasive strategies to improve ischemia. We report the case of a patient who was presented with worsening claudication and leg rest pain due to malperfusion syndrome of type B aortic dissection. We successfully performed endovascular fenestration therapy to relieve the symptom by using a NRG radiofrequency transseptal needle (Baylis Medical, Montreal, Canada). We suggest that this novel method would be available for the patients with malperfusion syndrome of aortic dissection.

Keywords: Aortic Dissection; Claudication; Endovascular Fenestration; Interventional Radiology; Malperfusion Syndrome; Radiofrequency Transseptal Needle.

Fig. 1

Contrast-enhanced computed tomography on admission. A three-dimensional reformation of the entire aorta A: Sagittal view of the aortic arch B: Axial view of the celiac artery C: superior and inferior mesenteric arteries D: and left renal artery E: The true lumen is remarkably compressed by the false lumen in the abdominal aorta F: The dissection extends to the right common iliac artery G:

Fig. 2

The tip of a radiofrequency (RF) needle is positioned under both intravascular ultrasound (IVUS) guidance and biplane fluoroscopic guidance A: IVUS imaging confirms adequate tenting position with the RF needle B: Illustration of tenting position with the RF needle C: Angiogram shows dilatation of the created re-entry tear using a balloon catheter D.

Fig. 3

Contrast-enhanced computed tomography in sagittal A and axial B views at 3-month follow-up shows the created re-entry tear maintained under stable conditions. The sagittal view of the aortic arch shows that aortic arch aneurysm has not been rapidly dilatated.