胸部血管内大動脈修復術後の大動脈解離に対する真腔圧迫に対する血管内窓形成術

A 40-year-old man with a type B aortic dissection from the distal left subclavian to right common iliac artery, involving the renal arteries, underwent an endovascular repair complicated with distal malperfusion owing to true lumen compression. A cheese-wire fenestration was done distal to the stent graft down to the aortic bifurcation with bilateral femoral thrombectomy. At postoperative 57 month, he developed a dissection flap in the distal ascending aorta that was repaired with a 28-mm Terumo Gelweave graft. True lumen compression from a reentry tear distal to a stent graft can be managed acutely with a cheese-wire endovascular fenestration with minimal specialized instruments.