Patient Selection and Technical Considerations for Electrocautery Septotomy in the Management of Aortic Dissection

Electrocautery septotomy has been proposed as an adjunctive technique during endovascular repair of aortic dissection with the aim of overcoming technical challenges associated with the presence of dual lumen.

We retrospectively analyzed the outcomes of patients treated with electrocautery septotomy, at a single institution, between July 2023 and November 2024. Early outcomes included septotomy technical success, procedural technical success, 30-day mortality, and 30-day major adverse events. Late outcomes included overall survival, positive aortic remodeling, freedom from aortic-related reintervention, and freedom from target vessel instability.

Between July 2023 and November 2024, 15 consecutive patients were treated with electrocautery septotomy at a single center. The underlying disease was chronic dissection in 13 patients (86.6%), subacute residual aortic dissection in 1 patient (6.7%), and acute type B dissection in 1 patient (6.7%). The primary indication for treatment was a maximum aortic diameter ≥5.5 cm in 8 patients (53.3%) and urgent repair in 7 patients (46.7%) due to pain in 4 patients (26.6%), malperfusion in 2 patients (13.3%), and aortic rupture in 1 patient (6.7%). Septotomy technical success was obtained in all the patients (100%), with full expansion of the true lumen. No aortic lesions, target vessels occlusion, or distal embolization were reported. Procedural technical success was 86.7%. Peri-operative major adverse events occurred in 3 patients (20%), with 1 death (6.7%). During follow-up, 1 additional non-aorta-related death was registered, and 2 reinterventions were performed. Positive aortic remodeling was observed in 78.6% of patients.

Electrocautery septotomy results in being valuable technique to address technical challenges in the endovascular treatment of postdissection thoracoabdominal aneurysms. Careful patient selection and tailored technical adjustments can further enhance the procedure success.Clinical ImpactThis study contributes to the growing body of evidence supporting electrocautery septotomy as a effective adjuntive technique during endovascular repair of post-dissection thoraco-abdominal aneurysm. However, it also underscores the limitations related to patient selection, highlighting the importance of careful pre-procedural evaluation to identify appropriate candidates and optimize clinical outcomes.