Distal true lumen compression after thoracic endovascular aortic repair for aortic dissection treated with endovascular fenestration

A 40-year-old man with a type B aortic dissection from the distal left subclavian to right common iliac artery, involving the renal arteries, underwent an endovascular repair complicated with distal malperfusion owing to true lumen compression. A cheese-wire fenestration was done distal to the stent graft down to the aortic bifurcation with bilateral femoral thrombectomy. At postoperative 57 month, he developed a dissection flap in the distal ascending aorta that was repaired with a 28-mm Terumo Gelweave graft. True lumen compression from a reentry tear distal to a stent graft can be managed acutely with a cheese-wire endovascular fenestration with minimal specialized instruments.