Echocardiography-Guided False Lumen Catheterization for "Cheese-Wire" Technique in Complicated Type A Aortic Dissection.

Endovascular treatment of both type A and type B aortic dissections complicated by organ malperfusion is gaining increasing interest and evidence. Different fenestration techniques of the dissection membrane have already been described. We present a 53-year-old patient with complicated type A aortic dissection after previous repair of the ascending aorta. The patient was treated with dissection membrane fenestration and "cheese-wire" technique. Owing to the mobility of the dissection flap, we encountered problems to perforate the dissection membrane with the use of a needle. Finally, on transesophageal echocardiography (TEE), a small dynamic dissection flap was visualized in the aortic arch, which could be catheterized by TEE for guidance. Downward traction of the through-wire caused infrarenal intima accumulation. Iliac outflow obstruction could be solved by placement of a bare-metal stent. Extensive screening for dynamic dissection of (re)-entry holes with the use of TEE is a valuable auxiliary in case needle perforation is difficult to achieve in complicated type A or B dissections.