Aortic dissection with branch vessel occlusion: percutaneous treatment with fenestration and stenting

Aortic dissection involves a tear in the intimal and medial layers of the aortic wall. Early surgical treatment of this condition can be fraught with complications especially when the procedure to be performed involves treatment of renal and visceral vessels. Additionally, patients with this problem can have severe compromise of the flow to branches or the entire aortic distribution. Methods of endovascular therapy for these problems limit the surgical stress and often can be performed in less time than surgical revascularization might require. The use of endovascular stenting to improve vessel perfusion and fenestration of the dissection membrane to decrease pressure within the false lumen can be performed to relieve ischemic vascular beds and potentially decrease the risk of aneurysmal dilatation of the aorta. The increasing use of these techniques may allow stabilization of these patients before open repair of more proximal aortic dissection or a combination of therapy with endovascular stent grafting techniques.