Fenestration For Aortic Dissection

Aortic fenestration is a minimally invasive technique to repair an aortic dissection, a serious condition that obstructs blood flow.

The aorta is the major artery that carries blood out of the heart and to the rest of the body. When there is a tear in the inner wall, blood can flow between the layers of the artery walls, which is known as aortic dissection. This is a life-threatening condition, because the extra pressure in this false channel can create a flap that obstructs flow into other arteries. While this rare condition can affect anyone, it is usually seen in older men.

Symptoms of an aortic dissection

Symptoms of an aortic dissection may be similar to heart conditions – including a heart attack or stroke. While the symptoms are not a clear indication of an aortic dissection or another serious heart problem, the sooner you seek medical care the better chances you have of preventing more serious complications.

Some symptoms that may indicate an aortic dissection include:

• Severe and sudden pain in the chest, most often described as a tearing or ripping sensation, which may move to other areas such as the back, as the dissection gets worse
• Loss of consciousness
• Shortness of breath
• Sudden difficulty speaking
• Loss of vision
• Weakness or paralysis of one side of your body, similar to a stroke
• Weak pulse in one arm compared with the other

If left untreated, an aortic dissection can cause life-threatening complications including:

• Loss of blood flow to vital organs
• Further dissections of the aorta

If you have symptoms of an aortic dissection, call 911 or go to your nearest emergency room as soon as possible.

What is the aortic fenestration procedure?

One option to repair an aortic dissection is for an Interventional Radiologist to perform an aortic fenestration procedure.

• This treatment uses a catheter (tube) to create an artificial hole (fenestration) in the aortic flap.
• A balloon is then inflated in this opening to flatten the false channel and divert blood flowing through the channel in the artery wall back to the main channel of the artery.
• In addition, stents (small mesh tubes) are placed as necessary in the aorta and other arteries to enhance blood flow and reduce the risk of further dissection and loss of blood supply to vital organs.

People with aortic dissection typically are managed by a team of specialists that can include vascular surgery, thoracic surgery and critical care doctors. There are other treatments available besides fenestration, and the doctors involved in your care will work together to determine which treatment is the best one. Each case of this type is complex and usually has unique aspects or considerations that affect choice of treatment.

What happens during the aortic fenestration procedure?

An aortic fenestration is an advanced procedure that uses fluoroscopy – a type of medical imaging that displays a live X-ray image on a monitor – to ensure accurate placement of the balloon and stents.

During aortic fenestration:

• Your skin is sterilized at the injection site.
• A local anesthetic will be administered to numb the injection area. Patients may also receive moderate sedation or general anesthesia depending on the procedure performed.
• You are positioned on the fluoroscopy X-ray table.
• Your Interventional Radiologist makes a small incision in your groin area.
• A catheter is inserted into one of the blood vessels in your leg and guided to the targeted aortic flap.
• Once the catheter is positioned, a hole is punctured in the dissection flap and a balloon is placed across the flap and inflated.
• Stents are placed as necessary in the aorta and other arteries.
• The catheter is removed.
• This procedure is complex and can be lengthy.

What happens after the aortic fenestration procedure?

After your aortic fenestration procedure, you will be monitored by your care team. In most cases, aortic fenestrations are performed during the course of a hospital admission. Most often, patients undergoing this procedure are critically ill due to the organ systems affected by the aortic dissection. Recovery time is determined by recovery from the damage to other organs.