Introduction: Aortic replacement surgery is generally required for patients with ischemic organ malperfusion of aortic dissection even for type-B, but endovascular therapy may offer a lower-risk method of reperfusion. We report the use of balloon fenestration without stent-graft, in the limb ischemic complication of aortic dissection Case and Results: A 41-year-old man developed left buttock claudication that had been persisted for 2 months after experiencing acute back pain. His history included hypertension diagnosed 1 year earlier, but no medication. A dissection flap with entry site was noted just distal to the left subclavian artery and the true lumen supplied the celiac, SMA, left renal and IMA on the CT image. The flap was extended to both iliac arteries and the true lumen was compressed by the false lumen. The left ankle-brachial index (ABI) was 0.78. After replacement of 8-F introducer sheath through a left femoral artery, a 0.035 guide wire (Radifocus, Terumo) was inserted into the true lumen of left common iliac artery (CIA). Aortogram revealed a dissection of aorta that compressed true lumen to the left common iliac artery without retrograde flow from the true lumen of the left external iliac artery to the false lumen of left CIA. With use of fluoroscopic guidance, a 5-F JR catheter acts as a guiding for the stiff end of Radifocus guide wire M(0.035" Terumo짰) and advanced into the level to be punctured. Balloon fenestration at the level of left CIA was performed. The mean transseptal pressure gradient, 10 mmHg between the false and true lumen was disappeared after 7 mm-sized balloon fenestration. On final angiography, there was a reentry tear created at the level of left CIA for restoring lower extremity perfusion. The patient���s claudication has resolved, and the left ABI was increased to 0.95. Three-dimensional CT image showed relieving the compressed true lumen of left CIA at 5 months after the procedure. Conclusions: Although endovascular stent-graft offers a non-surgical method of reperfusion of compromised vascular branch in aortic dissection, our experience adds aortic balloon fenestration to the non-surgical restoration of limb ischemic complication.