Technical Note: Dissection Flap Perforation with Use of a TIPS-Needle During Fenestrated Endografting for Post-dissection Thoracoabdominal Aneurysms.

INTRODUCTION: Fenestrated/branched thoracic endovascular aneurysm repair (F/Br-TEVAR) is a new minimal invasive treatment option for patients with post-dissection thoracoabdominal aortic aneurysms. This specific pathology is challenging to F/Br-TEVAR, especially when target vessels originate from the false lumen. Crossing from the true lumen into the false lumen to catheterize such target vessels may prove cumbersome in the usually thickened dissection flap. TECHNIQUE: We describe a bailout technique when standard catheterization techniques fail, by using a transjugular intrahepatic portosystemic shunt (TIPS)-needle to perforate the dissection flap. The fenestration is subsequently dilated using balloon angioplasty to allow for insertion and deployment of the bridging stent graft.
CONCLUSION: When other catheterization techniques fail in vessel originating from the false lumen, TIPS-needle perforation of the dissection flap is a useful bailout tool.