Aortic Intimal Invagination and Septectomy Following Electrosurgical Septotomy in a Patient With a Type B Dissection

Thoracic endovascular aortic repair (T-EVAR) is the standard treatment in patients with a type B aortic dissection and appropriate indications for repair. The procedure requires anatomical, clinical, and technical scrutiny, as well as consideration for potential further repair. Supplementary procedures are not uncommon. Septotomy has received renewed interest as an adjunctive procedure, in the form of electrosurgical techniques, with the objective of improving true lumen landing zones and better access to important target branch vessels. Emerging reports suggest favourable clinical outcomes, although there are associated thromboembolic risks that clinicians should recognise.

This case report describes an important complication of electrosurgical septotomy causing aortic intimal invagination in a patient with a type B aortic dissection.

Electrosurgical septotomy is an effective method to gain improved landing zones for TEVAR endograft placement, but caution is warranted in the timing of this procedure.