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Patients with aortic dissection (Type A or B) who develop intestinal/renal, etc. ischemia should be considered for aortic fenestration-a procedure in which holes are literally created in the aortic lumen to connect the true and false lumen-this allows perfusion of the involved vessel to occur from true lumen into the false lumen into the involved vessel.
Patients with large vessel malperfusion have a VERY HIGH mortality rate, AND most CT surgeons will not operate even on a Type A unless the involved vessels have been opened up.
This procedure is useful when major vessels (SMA as an example) branch from the aortic false lumen.
So, when to consider this procedure:
- Aortic Dissection (A or B) with severe abdominal pain, elevated lactate, OR imaging study showing malperfusion to a vessel (SMA, renal, etc)
- Most of the time in the ED we will see this on CT in a sick patient.
Who do you call?
- Vascular Surgery and IR-normally perormed percutaneously via a femoral approach