Echocardiography-Guided False Lumen Catheterization for "Cheese-Wire" Technique in Complicated Type A Aortic...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Imaging

Background:

• Endovascular repair of aortic dissections, particularly types A and B with organ malperfusion, is increasingly utilized.
• Various fenestration techniques for the dissection membrane have been documented.

Observation:

• A 53-year-old patient with a complicated type A aortic dissection post-ascending aorta repair presented with challenges in needle perforation of the mobile dissection flap.
• Transesophageal echocardiography (TEE) identified a dynamic flap in the aortic arch, enabling catheterization and guidance for fenestration.
• The "cheese-wire" technique, guided by TEE, was employed, leading to infrarenal intima accumulation and subsequent iliac outflow obstruction.

Findings:

• TEE-guided fenestration proved effective in navigating a mobile dissection flap when standard needle techniques failed.
• Placement of a bare-metal stent successfully resolved the iliac outflow obstruction caused by the procedure.
• The case highlights the utility of TEE in visualizing and accessing dissection membranes for endovascular fenestration.

Implications:

• TEE guidance is a valuable adjunct for complex aortic dissections (types A and B) when direct needle fenestration is challenging.
• This approach may improve the success rates of endovascular repair in patients with malperfusion due to aortic dissection.
• Further research into TEE-guided fenestration techniques could refine endovascular treatment strategies for aortic dissections.