Endovascular Fenestration Using a Coaxial Wingman Catheter Through Preshaped Guiding Catheter for Revascularization of Abdominal Visceral Branches Originating From False Lumen in Aortic Dissection

Abstract

Introduction

Following thoracic endovascular aortic repair (TEVAR) for aortic dissection, visceral arteries arising from the false lumen may require revascularization when communication between the true and false lumens is naturally occluded or iatrogenically sealed. This study describes an endovascular technique using a Wingman catheter for intimal flap fenestration to establish access for revascularization of abdominal visceral arteries originating from the false lumen.

Materials and Methods

A coaxial system was developed by inserting an LRK-shaped catheter within a RE-SS-shaped guiding catheter to maintain shape retention. The Wingman 14C catheter was advanced coaxially through this system to penetrate the intimal flap under biplane fluoroscopic guidance. The created fenestration was dilated with an angioplasty balloon, and this communication pathway was utilized for stent-graft placement to revascularize abdominal visceral arteries arising from the false lumen.

Results

In 1 patient with type B aortic dissection requiring revascularization of the right renal artery, the coaxial insertion of a Wingman 14C catheter through the preshaped guiding catheter successfully achieved obtuse-angle penetration of the intimal flap without complications. Revascularization of the right renal artery was accomplished, with postoperative imaging demonstrating near-complete false lumen thrombosis and favorable aortic remodeling at 6-month follow-up.

Conclusion

This approach represents a useful and safe technique for establishing access to the false lumen in aortic dissection patients when communication between lumens has been eliminated, enabling successful revascularization of visceral arteries originating from the false lumen.