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Fenestrated-branched endovascular aneurysm repair is increasingly utilized in managing chronic post-dissection thoracoabdominal aortic aneurysms (TAAAs), with multicenter data indicating outcomes comparable to those in degenerative TAAAs. However, the anatomical and technical considerations in chronic dissection are distinct, often involving collapse of the true lumen, separate origins of target vessels from the true versus false lumen, and persistent dissection flaps extending into the renovisceral segment. Transcatheter electrosurgical septotomy is an emerging adjunct technique that aids in expanding the true lumen and optimizing proximal and distal sealing zones and branch vessel alignment during subacute and chronic post-dissection TAAA repair. This article reviews the key principles in preoperative planning and device customization for FB-EVAR within this complex anatomical context.
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http://dx.doi.org/10.23736/S0021-9509.25.13416-2 | DOI Listing |
J Vasc Surg
August 2025
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address:
Objective: Aortic dissection is the second most common cause of aneurysmal degeneration. Although endovascular repair is preferred over open techniques, multiple secondary interventions are required to manage complications related to the dissection of potential landing zones (LZs). This study aims to report the outcomes of adjunctive use of transcatheter electrosurgical septotomy (TEAS) to optimize LZs for endovascular repair of post-dissection aortic aneurysms (PD-AAs).
View Article and Find Full Text PDFJ Vasc Surg
July 2025
Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address:
Objective: Endovascular repair of ascending aortic disease represents a last resort alternative for patients at high-risk for open surgery. The aim of this study was to describe outcomes of patients undergoing endovascular repair of the ascending aorta in a large international registry.
Methods: We retrospectively analyzed patients in the Vascular Quality Initiative who underwent endovascular repair isolated to the ascending aorta between 2013 and 2022.
J Cardiovasc Surg (Torino)
June 2025
Department of Vascular Surgery, University Hospital Munich, LMU Munich, München, Germany -
Background: Chronic aortic dissections extending into the iliac arteries present unique anatomical and procedural challenges. Iliac branch devices (IBDs) offer the potential to preserve pelvic perfusion and achieve distal false lumen exclusion, yet their use in dissected anatomies remains off-label and insufficiently studied. This study evaluates the safety, technical success, and mid-term outcomes of IBDs in patients with chronic post-dissection aneurysms.
View Article and Find Full Text PDFJ Cardiovasc Surg (Torino)
June 2025
Department of Surgery, Advanced Aortic Research Program at the Baylor College of Medicine, Houston, TX, USA.
Fenestrated-branched endovascular aneurysm repair is increasingly utilized in managing chronic post-dissection thoracoabdominal aortic aneurysms (TAAAs), with multicenter data indicating outcomes comparable to those in degenerative TAAAs. However, the anatomical and technical considerations in chronic dissection are distinct, often involving collapse of the true lumen, separate origins of target vessels from the true versus false lumen, and persistent dissection flaps extending into the renovisceral segment. Transcatheter electrosurgical septotomy is an emerging adjunct technique that aids in expanding the true lumen and optimizing proximal and distal sealing zones and branch vessel alignment during subacute and chronic post-dissection TAAA repair.
View Article and Find Full Text PDFJ Cardiovasc Surg (Torino)
June 2025
Department of Vascular Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Introduction: Fenestrated and branched endovascular aortic repair (F/B-EVAR) is increasingly used in the treatment of chronic aortic dissection (cAD), particularly for post-dissection thoracoabdominal aortic aneurysms (PD-TAAA). These aneurysms differ significantly from degenerative aneurysms due to the presence of a true and false lumen, complex target vessel (TV) anatomy, and the higher potential for ongoing aortic remodeling. These factors contribute to technical challenges in target vessel cannulation and raise concerns about the long-term stability of target vessel bridging stents.
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