Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissection

Abstract

ObjectiveEfficacy of thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection (CTBAD) is dependent on eliminating retrograde false lumen perfusion and remodeling the aorta. We describe the efficacy of a novel transcatheter electrosurgical technique to fenestrate the dissection flap and create a distal seal zone for TEVAR in CTBAD. MethodsA retrospective review of the Emory Aortic Database from 2016 to 2023 identified 33 patients who underwent TEVAR with intentional endovascular rupture of the dissection flap (Knickerbocker; KNICK) for CTBAD. In 11 patients, we performed transcatheter electrosurgical aortic septostomy (TECSAS) before KNICK. The technical aspects of TECSAS + KNICK are described and results compared with TEVAR + KNICK alone. ResultsDissection chronicity, aortic size, and preoperative demographics were similar between groups. Technical success was 100%, with zero stroke or paraplegia in both groups. Thirty-day mortality for TECSAS versus KNICK was 0% versus 13.6% (P = .199). Median follow-up was shorter after TECSAS versus KNICK, although not statistically significant (14.6 months vs 21.9 months; P = .065). Elimination of retrograde false lumen perfusion (TECSAS 100% vs KNICK 68.2%; P = .035) and complete false lumen thrombosis or obliteration (TECSAS 91.9% vs KNICK 54.6%; P = .037) were more frequent after the TECSAS procedure. Aortic reinterventions were less frequent after TECSAS versus KNICK (0% vs 13.6%, P = .199), although not statistically significant. ConclusionsThe addition of TECSAS to intentional endovascular rupture of the dissection flap in CTBAD improves distal seal, eliminating retrograde false lumen perfusion. This technique is a safe and precise method to fenestrate a dissection flap and optimize TEVAR in CTBAD.