Percutaneous Balloon Fenestration of Flow-limiting Iatrogenic Dissection of the Common Femoral Artery: Report of Two Cases

Abstract

Acute iatrogenic arterial dissection is a known complication of endovascular techniques and can be treated with prolonged ballooning, stent placement, or balloon fenestration. Treatment of common femoral artery (CFA) dissection needs special attention because of the potential compromise of either the deep or superficial femoral artery origin and the enhanced mechanical stress to arteries in the groin. The authors report two cases with percutaneous balloon fenestration of flow-limiting localized iatrogenic dissection of the CFA with initial technical success in both cases and favorable short-to midterm outcomes.

Recanalization of Iatrogenic Dissection of the Superior Mesenteric Artery

“…7 Balloon fenestration aims at decreasing the inflow-to-outflow capacity ratio of the false lumen by widening an existing or artificially created re-entry tear, leading to reopening of the true lumen and reperfusion of the compromised branch vessels. 8 Although recently some cases of dissections of visceral arteries treated with balloon fenestration have been reported, 9,10 to our knowledge, SMA dissections treated with balloon fenestration have not. In this case, balloon fenestration of the intimal flap immediately reopened the true lumen of the branch vessels, which resulted in complete resolution of the symptoms.…”

Retrograde deep femoral artery puncture for the treatment of an iatrogenic dissection flap of the common femoral artery bifurcation

“…Fornaro et al reported this access for treatment of a CFA dissection. 9 Testi and colleagues described such access to treat a CFA dissection caused by a high CFA reentry. 10 Zander et al reported retrograde access through a large DFA collateral after an iatrogenic SFA rupture during antegrade revascularization attempt.…”