Endovascular Electrocautery Septostomy During Thoracic Endovascular Aortic Repair for Type B Dissection Provides a Suitable Sealing Zone
Recommended Citation
Chamseddine H, Kadiyala D, Shepard A, Nypaver T, Weaver M, Kavousi Y, Onofrey K, Peshkepija A, Miletic K, Kabbani L. Endovascular Electrocautery Septostomy During Thoracic Endovascular Aortic Repair for Type B Dissection Provides a Suitable Sealing Zone. J Vasc Surg 2024; 79(6):e151.
Document Type
Conference Proceeding
Publication Date
6-1-2024
Publication Title
J Vasc Surg
Abstract
Objectives: Thoracic endovascular aortic repair (TEVAR) is prone to type Ib endoleak when treating chronic type B aortic dissection (cTBAD) and residual TBAD (rTBAD) after type A aortic dissection repair. Fenestration of the dissection flap proximal to the distal landing zone can provide a good seal zone to land the TEVAR in and reduce the risk of retrograde false lumen perfusion. This study aims to describe the outcomes of this technique, particularly the outcome of type Ib endoleak. Methods: A prospective registry of all patients receiving a distal dissection flap fenestration with septostomy using electrocautery during TEVAR at a quaternary medical center between 2019 and 2023 was queried. Medical records were reviewed. All aortic measurements were made using computed tomography scans. Descriptive statistics were used to describe the patient population. The primary outcome was the occurrence of type Ib endoleak. Results: A total of 16 patients (14 males, 2 females) with mean age 58 ± 9 years were included. Three were cTBAD, and 13 were rTBAD. The mean maximal aortic diameter was 57 ± 12 mm, and mean aortic diameter at the aortic hiatus was 45 ± 12 mm. All procedures were performed in the elective setting. No patients required conversions to open repair. In most patients, crossing the dissection septum was made using a sheathed 0.14 wire that was bent in the middle, sheathed on both ends so that only the middle section was in contact with the septum, and connected to an electric cautery. The septum was transected using the cut setting on the cautery. The average length of septostomy was 9 cm (range, 3-27 cm). All patients had a distal end of the septostomy in aortic zone 5. Fluoroscopy time was 58 ± 20 minutes, and contrast used was 171 ± 93 mL. Median follow-up time was 16 months. On follow-up, the mean maximal aortic diameter decreased by 2 mm, whereas the mean aortic diameter at the aortic hiatus increased by 1 mm. Occurrences of endoleaks are presented in Table I. There were three type Ib endoleaks – two were attributed to aortic degeneration at the distal landing zone and required graft extension, and one persisted despite re-ballooning and required coiling of the false lumen. Conclusions: Electrocautery septostomy is a feasible and safe method to optimize a distal landing zone for TEVAR. Despite good exclusion of the false lumen, close follow-up is required because distal seal zone degeneration may occur. [Formula presented]
Volume
79
Issue
6
First Page
e151
