In Situ Laser Fenestration for Subclavian Preservation During Aortic Dissection Repair

Laser fenestration is a novel technique to create an opening in an endograft to maintain perfusion to the arch vessels during thoracic endovascular aortic repair (TEVAR). A 40-year-old female who had undergone an emergent ascending aortic repair for acute dissection presented with aneurysmal degeneration of the descending thoracic aorta. She then underwent debranching of the left carotid and innominate arteries, followed by TEVAR. Herein, we describe our approach during repair with in situ laser fenestration of the endograft to preserve subclavian arterial flow.