Percutaneous Fenestration of the Aorta for Mesenteric Ischemia Complicating Acute Aortic Dissection

Thoracic aortic dissections are estimated to occur approximately 0.5–4/100,000/year. Given the relatively low frequency as well as the myriad of symptoms, up to half of the patients will die without an antemortem diagnosis. Due to the complex morphology of descending thoracic aortic dissections, they can result in acute mesenteric ischemia, renal failure, and ischemic limbs. Oftentimes, it can be difficult to completely delineate the true and false lumens and what arteries arise from each. In the patient that presents with acute mesenteric ischemia complicating an aortic dissection, one treatment option involves the intentional fenestration of the aorta. This may allow for improved blood flow into the compromised visceral artery. A case of percutaneous fenestration of an aortic dissection for acute mesenteric ischemia is presented. This case further highlights need for close monitoring and aggressive re-intervention if necessary.