Purpose: To present a technique that creates a neofenestration in the dissecting lamella of chronic aortic dissections using standard or intravenous ultrasound (IVUS)–guided reentry devices. Technique: To create a neofenestration, a standard or IVUS-guided reentry device is deployed in either the true or false aortic lumen while a balloon is simultaneously inflated in the opposite lumen to stabilize the lamella, provide needle counterforce, and prevent displacement of the lamella away from the reentry needle. Once the lamella is perforated and a guidewire passed across the 2 lumens, progressive dilation of the neofenestration is performed to establish persistent communication. Conclusion: The balloon-supported lamella neofenestration technique involving off-label application of two currently available reentry devices can be applied to endovascular treatment chronic aortic dissections. While the technique will definitely not become a standard of practice, it provides a safe, effective, and readily available option for endovascular management of those patients with complex chronic aortic dissections requiring bailout maneuvers or elective treatment.