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 dissection 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 'chees-wire' technique. Due 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 TEE guided. 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 (re)-entry holes with use of TEE is a valuable auxiliary in case needle perforation is difficult to achieve in complicated type A or Type B dissection.