Landing Zones Optimization Using Transcatheter Electrosurgical Septotomy for Endovascular Repair of Post-dissection Aortic Aneurysms

Andres V. Figueroa, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Mira T. Tanenbaum, Department of Surgery, George Washington University Hospital, Washington, DC.
Jose Eduardo Costa Filho, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Natalia I. Coronel, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Marilisa Soto Gonzalez, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Lucas R. Kanamori, Advanced Endovascular Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Titia Sulzer, Advanced Endovascular Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Thomas Mesnard, Advanced Endovascular Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Ying Huang, Advanced Endovascular Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Gerardo Gonzalez-Guardiola, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Mirza S. Baig, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Gustavo Oderich, Advanced Endovascular Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Carlos H. Timaran, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: carlos.timaran@utsouthwestern.edu.

Document Type

Journal Article

Publication Date

8-6-2025

Journal

Journal of vascular surgery

DOI

10.1016/j.jvs.2025.07.055

Keywords

endovascular repair; landing zone; post-dissection aortic aneurysms; transcatheter electrosurgical aortic septotomy

Abstract

OBJECTIVES: Aortic dissection is the second most common cause of aneurysmal degeneration. While 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). METHODS: Consecutive endovascular repairs with adjunctive TEAS performed for PD-AAs between 2022 and 2023 at two institutions were reviewed. TEAS was systematically performed to ensure all grafts were deployed within false lumen-free LZs. Endpoints included TEAS technical success, defined as successful retraction of the dissection septum to obtain an adequate landing zone, and clinical technical success, defined by the absence of any type Ia or Ib endoleak or entry flow, aortic true lumen (TL) diameter expansion, major adverse events (MAEs), and 30-day mortality. RESULTS: Among 121 patients who underwent endovascular repair for PD-AAs, 20 (74% male; mean age 63±13 years) underwent adjunctive TEAS to create false lumen-free LZs for the endovascular repair of either acute (10%) or chronic (90%) aortic dissections. Three patients (16%) were treated for genetic-related aortic dissection including two Marfan's and one Turner's syndrome. The mean aneurysm sac diameter was 58±13 mm and mean operative time was 203 min [interquartile range, IQR 126-254]. After TEAS, twenty-one optimized LZs were created. Sixteen distal LZs, including 12 aortic and 4 iliac, were optimized for 10 thoracic endovascular aneurysm repairs (TEVARs), 2 endovascular aortic arch repairs, 2 fenestrated and branched endovascular aneurysm repairs (FBEVARs) and 2 endovascular aneurysm repair (EVAR). Additionally, five optimized proximal LZs were achieved for 3 EVARs and 2 FBEVARs. TEAS technical success was 100%. Clinical technical success was 90%, with all grafts and stents deployed as planned. TL diameter increased from 12.2±3.2 mm to 30±8.4 mm (P<.001) following TEAS. Median follow-up was 15 months [IQR 6-25]. Two patients (10%) had a type Ib entry flow requiring reintervention. One patient had a TEAS-related MAE with a renal artery occlusion that required stenting. No 30-day mortality occurred. CONCLUSIONS: Transcatheter electrosurgical aortic septotomy can be used as an adjunct to create optimal landing zones for endovascular repair of post-dissection aortic aneurysms. Further studies should address the long-term outcomes of these repairs and identify long-term changes appreciated at the landing zones.

Department

School of Medicine and Health Sciences Resident Works

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