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. 2023 Jan 20;9(2):101108.
doi: 10.1016/j.jvscit.2023.101108. eCollection 2023 Jun.

Novel technique to fenestrate an aortic dissection flap using electrocautery

Loay Kabbani  1 , Marvin Eng  1 , Kevin Onofrey  1 , Mitchell Weaver  1 , Timothy Nypaver  1
Affiliations

Novel technique to fenestrate an aortic dissection flap using electrocautery

Loay Kabbani et al. J Vasc Surg Cases Innov Tech. .

Abstract

Chronic distal thoracic dissections treated with thoracic endovascular repair are prone to type Ib false lumen perfusion. When the supraceliac aorta is of normal caliber, fenestration of the dissection flap proximal to the visceral vessels creates a seal zone for the thoracic stent graft and eliminates the type Ib false lumen perfusion. We describe a novel way of crossing the septum using electrocautery delivered through a wire tip then fenestrating the septum using electrocautery delivered over a 1-mm area of uninsulated wire to cut the septum. We believe the use of electrocautery creates a controlled and deliberate aortic fenestration during endovascular repair of a distal thoracic dissections.

Keywords: Aortic dissection; Fenestration; Septostomy; TEVAR; Type B aortic dissection.

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Figures

Fig 1
Fig 1
A, Computed tomography angiography at 4 weeks after type A repair showing a distal aortic diameter of 36 mm. B, Computed tomography angiography at 4 months showing an increase in diameter to 51 mm.
Fig 2
Fig 2
Setup for traversing the septum. The angled guide is aimed to the snare, and a Bovie is connected to the distal wire. IVUS, Intravenous ultrasound.
Fig 3
Fig 3
Back table preparing the wire. A, Using a blade to shave off wire coating at the apex of the bend. B, Exposed metal under the coating.
Fig 4
Fig 4
Septostomy with wire using electrocautery. IVUS, Intravenous ultrasound.
Fig 5
Fig 5
Follow-up computed tomography angiography showing apposition of the endograft.
See this image and copyright information in PMC

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