Percutaneous fenestration of dissecting intima with a transseptal needle. A new therapeutic technique for visceral ischemia complicating acute aortic dissection.

Noncardiac visceral ischemia is a major complication with acute aortic dissection and is caused by obstruction of the major visceral arteries by dissecting intima. Two patients with this condition underwent emergency percutaneous fenestration of dissecting intima, and the blood flow to the lower extremity and kidney was restored. A transseptal needle and peripheral angioplasty balloon catheter were used for fenestration. There were no associated complications in either patient. One patient was treated medically and another had ascending aortic replacement surgery the day after percutaneous fenestration. Clinical follow-up of 10 and 5 months, respectively, revealed good clinical outcomes. Percutaneous fenestration should be considered the treatment of choice for visceral ischemia due to acute aortic dissection.