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Taste of Boston
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SVS-VESS Scientific Session @ VAM: Session 1b

VESS06 - Overcoming Distal Landing Zone Limitations in Chronic Dissection: Experience with Electrocautery Septotomy Prior to TEVAR

Wednesday, June 10, 2026
2:10 PM - 2:28 PM ET
Location: Hynes CC, Third Level, Room 304
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 1). 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 2019-2025 were reviewed. Outcomes included 30-day mortality, technical success [defined as absence of endoleaks (EL) on completion angiography], reduction in maximum aortic sac diameter [defined as less than 5 mm of change in aortic diameter], and freedom from type 1b 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 [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 three residual EL. 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 1b EL were detected in 7 patients (Table 1). Reintervention with TEVAR extension was completed in 4 patients and medical management was utilized in the remaining 3 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 1b EL remain a challenge, highlighting the need for rigorous surveillance as well as further refinement of distal aortic management strategies.