Intravascular ultrasound-guided creation of re-entry sites to improve intermittent claudication in patients with aortic dissection.

PURPOSE: To report percutaneous fenestration of aortic dissection flaps to relieve distal ischemia using a novel intravascular ultrasound (IVUS)-guided fenestration device. CASE REPORTS: Two men (47 and 62 years of age) with aortic dissection and intermittent claudication had percutaneous ultrasound-guided fenestration performed under local anesthesia. Using an ipsilateral transfemoral approach, the intimal flap was punctured under real-time IVUS guidance using a needle-catheter combination through which a guidewire was placed across the dissection flap into the false lumen. The fenestration was achieved using balloon catheters of increasing diameter introduced over the guidewire. Stenting of the re-entry was performed in 1 patient to equalize pressure across the dissection membrane in both lumens. The procedures were performed successfully and without complications. In both patients, ankle-brachial indexes improved from 0.76 to 1.07 and from 0.8 to 1.1, respectively. Both patients were without claudication at the 3- and 6-month follow-up examination. CONCLUSION: Percutaneous intravascular ultrasound-guided fenestration and stenting at the level of the iliac artery in aortic dissection patients with claudication is a technically feasible and safe procedure and relieves symptoms.

Cardiac magnetic resonance simultaneously evaluates Leriche syndrome and prior inferior myocardial infarction.

A woman with ECG findings suspicious of ischemic heart disease was referred for coronary angiography, but this was impossible via the left or right iliac arteries because of total occlusion. Cardiovascular magnetic resonance (CMR) was performed to assess the anatomy of the abdominal aorta, cardiac function, and myocardial viability in a single study. Contrast-enhanced magnetic resonance angiography (CE-MRA) revealed Leriche syndrome resulting from occlusion of the infrarenal aorta and common iliac arteries. Delayed contrast enhancement indicated full thickness nonviable myocardial infarction. Coronary angiography via the right radial artery revealed proximal occlusion of the right coronary artery. This is the first case that illustrates the value of CMR as a time-saving non-invasive imaging technique with the ability to do in a single study what might otherwise take two studies.