Overcoming Distal Landing Zone Limitations in Chronic Dissection: Experience with Electrocautery Septotomy Prior to Tevar

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Vasc Surg

Keywords

acute hypoxemic respiratory failure, adult, aortic diameter, clinical article, comorbidity, complication, conference abstract, controlled study, dissection, electrocautery, endoleak, endovascular aneurysm repair, female, fenestration, follow up, human, hypertension, male, respiratory failure, surgery, therapy, thoracic aortic dissection, type B aortic dissection

Abstract

Objectives: In chronic thoracic aortic dissection, achieving a durable distal seal with thoracic endovascular aneurysm repair (TEVAR) is often limited by the persistent septum separating true and false lumens. Electrocautery septotomy fenestration (ESF) is a novel endovascular technique designed to precisely create a single-lumen distal landing zone and facilitate graft sealing (Figure). This study reviews a single institution experience with ESF in patients undergoing TEVAR for chronic type B aortic dissection (cTBAD) or chronic residual type A dissection (cTAAD). Methods: Patients with cTBAD or cTAAD who underwent ESF followed by TEVAR between 2019 and 2025 were reviewed. Outcomes included 30-day mortality, technical success (defined as absence of endoleaks [ELs] on completion angiography), reduction in maximum aortic sac diameter (defined as <5 mm of change in aortic diameter), and freedom from type Ib EL. Results: Thirty-two patients—cTBAD (n = 27) and cTAAD (n = 5) underwent TEVAR with ESF. Median age was 59 years, 84% male, with comorbidities including hypertension in 100%. The preoperative median maximum aortic diameter was 60 mm (interquartile range [IQR], 53-68). Median time from the initial dissection to TEVAR was 9 months (IQR, 4-44). Technical success was achieved in 29 of 32 cases (91%) with no procedural complications, and 3 residual ELs. One patient died within 30 days due to acute hypoxic respiratory failure. Median follow-up was 15 months (IQR, 1-42). Survival was 88% at 1 year and 81% at 3 years. At last follow-up, 81% of patients’ aortic sac diameter had decreased in size or remained stable. On follow-up imaging, type Ib ELs were detected in seven patients (Table). Reintervention with TEVAR extension was completed in four patients and medical management was utilized in the remaining three patients. Conclusions: ESF creates an improved distal landing zone in chronic dissections and boasts high procedural success. However, degeneration at the distal seal site and persistent/recurrent type Ib ELs remain a challenge, highlighting the need for rigorous surveillance as well as further refinement of distal aortic management strategies. [Formula presented] [Formula presented]

Volume

84

Issue

1

First Page

e27

Last Page

e28

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