ORIGINAL ARTICLES  VASCULAR PAPERS 

The Journal of Cardiovascular Surgery 1998 June;39(3):273-80

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

The abdominal aortic fenestration procedure in acute thoraco-abdominal aortic dissection with aortic branch artery ischemia

Harms J., Hess U.*, Cavallaro A.*, Naundorf M., Maurer P. C.

From the Department of Vascular Surgery, Klinikum rechts der Isar Technische Universität *Department of Diagnostic Radiology Munich, Germany

Objec­tive. Diag­nostic ­work-up and treat­ment strat­e­gies ­have ­improved the prog­nosis of ­acute tho­raco-abdom­inal ­aortic dis­sec­tion. ­Little atten­tion to ­aortic ­branch ­artery ­ischemia or ­even ­failed res­to­ra­tion fol­lowing pros­thetic ­repair of tho­raco-abdom­inal dis­sec­tion ­still ­merit a ­problem ­with ­high mor­bidity and mor­tality.
Set­ting. Depart­ment of Vas­cular Sur­gery, Tech­nische ­Universität ­München, Ger­many.
Pur­pose. ­Reflecting on vis­ceral and neu­ro­log­ical ­ischemic com­pli­ca­tions in ­acute tho­raco-abdom­inal ­aortic dis­sec­tion indi­ca­tions and lim­i­ta­tions of the abdom­inal-­aortic-fen­es­tra­tion pro­ce­dure are dis­cussed ­with a re­view on our own clin­ical expe­ri­ence and the ­results ­reported in the lit­er­a­ture.
Con­clu­sions. The abdom­inal-­aortic-fen­es­tra­tion pro­ce­dure is accom­plished ­with min­imal dete­ri­ora­tion of the crit­i­cally ill ­patient. In new ­onset or ­relief of ­aortic ­branch ­ischemia, fol­lowing ­initial pros­thetic ­repair of ­either ­type A or B dis­sec­tion ­aortic fen­es­tra­tion is ­found to be an effec­tive and ­secure adjunc­tive pro­ce­dure to ­restore the ­blood ­flow of com­pro­mised ­organs. Pri­mary abdom­inal ­aortic fen­es­tra­tion is rec­om­mended ­instead of pros­thetic ­repair in ­cases of ­acute ­type B dis­sec­tion. It is the treat­ment of ­choice ­because of ­branch ­artery ­ischemia ­becoming the ­focal ­point of dete­ri­ora­tion.