Endovascular Septal Fenestration and Stenting Under Intravascular Ultrasound Guidance for Complicated Acute Aortic Dissection

Percutaneous septal fenestration and stenting is a useful technique in acute aortic dissection when there is persistent malperfusion of renovisceral vessels, despite primary stenting of the thoracic aorta or when coverage of the primary entry tear is not technically feasible. Intravascular ultrasound provides reassurance to the interventionalist that the septal fenestration targets the level of malperfusion. Septal fenestration may promote continued false lumen perfusion into target vessels and aneurysmal degeneration, so this technique should be considered as a temporizing measure.Clinical ImpactHerein, we describe the indications and technical steps of endovascular fenestration for aortic dissection - related renovisceral or iliofemoral malperfusion. This step-by-step description and illustration will be of particular interest to endovascular aortic interventionalists, when stenting of the primary aortic entry tear is not feasible. Finally, IVUS and stenting of the septal fenestration and/or malperfused branch vessel can be useful adjuncts in these complex clinical scenarios.