# Unsuccessful aortic fenestration for aortic dissection complicated with mesenteric malperfusion analyzed using computational fluid dynamics: a case report

## TL;DR

A case report shows how computational fluid dynamics analyzed a failed surgical treatment for aortic dissection with poor blood flow to the intestines.

## Contribution

The study uses computational fluid dynamics to explain why a fenestration surgery failed in a complex aortic dissection case.

## Key findings

- CFD analysis showed persistent false lumen flow and true lumen compression after fenestration.
- A large entry tear and residual stenosis likely caused inadequate false lumen depressurization.
- The case highlights the importance of CFD in understanding surgical outcomes in aortic dissection.

## Abstract

We report a computational fluid dynamics (CFD)-based analysis of an unsuccessful open fenestration for aortic dissection with mesenteric malperfusion.

A 75-year-old male was admitted for acute type B aortic dissection complicated by mesenteric malperfusion. He had a concomitant infrarenal abdominal aneurysm, prompting surgical infrarenal fenestration. Intraoperatively, the proximal intimal flap was resected near the renal arteries, and the aneurysm was replaced with a prosthetic graft. Despite the intervention, mesenteric malperfusion worsened, requiring additional endovascular aortic repair. CFD analysis revealed persistent false lumen flow and true lumen compression due to a large entry tear and residual proximal anastomotic stenosis.

CFD analysis suggests that a large entry tear and residual stenosis from insufficient fenestration may result in inadequate false lumen depressurization.

The online version contains supplementary material available at 10.1186/s44215-025-00212-7.