Related Experiment Video
Updated: Aug 24, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Total transfemoral repair of thoracoabdominal aortic aneurysm and aortic dissection
Christian H Summa1, Daniel Swink1,2, Joseph AbouAyash3
1Department of Endovascular and Vascular Surgery, Geisinger Wyoming Valley, Wilkes Barre, PA.
Insights
This study shows a successful minimally invasive repair of complex aortic dissection using a total transfemoral approach with a thoracoabdominal multibranch endoprosthesis, preserving vital branch vessel perfusion.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Aortic Disease
Background:
- Chronic type A aortic dissection presents complex anatomical challenges.
- Paravisceral aneurysmal degeneration necessitates advanced treatment strategies.
- Prior interventions like carotid-subclavian bypass can complicate surgical approaches.
Purpose of the Study:
- To demonstrate the feasibility of a total transfemoral approach for endovascular repair.
- To showcase the use of a thoracoabdominal multibranch endoprosthesis in complex aortic anatomy.
- To highlight a novel technique for endograft delivery in dissected aortas.
Main Methods:
- Successful endovascular repair in a 66-year-old male with chronic type A aortic dissection and paravisceral aneurysm.
- Utilized a total transfemoral approach to avoid upper extremity access due to prior bypass.
- Performed transcatheter electrosurgical septotomy for true and false lumen communication.
- Stented all visceral branches using a dual-sheath telescoping technique.
Main Results:
- Successful deployment of a thoracoabdominal multibranch endoprosthesis.
- Controlled communication between aortic lumens achieved via electrosurgical septotomy.
- All visceral branches successfully stented, maintaining perfusion.
- Completion angiography confirmed no endoleak.
Conclusions:
- Total transfemoral endovascular repair is feasible for complex aortic pathologies.
- Thoracoabdominal multibranch endoprostheses can be effectively deployed in challenging anatomies.
- This approach preserves branch vessel perfusion and offers a less invasive alternative.
Abstract:
We present the case of a 66-year-old man with chronic type A aortic dissection and paravisceral aneurysmal degeneration who underwent successful endovascular repair using the thoracoabdominal multibranch endoprosthesis. Owing to a prior carotid-subclavian bypass, we elected a total transfemoral approach to avoid upper extremity access. A transcatheter electrosurgical septotomy was performed to establish controlled communication between the true and false lumens, facilitating endograft delivery. All visceral branches were stented via dual-sheath telescoping technique. A completion angiography showed no endoleak. This case demonstrates the feasibility of total transfemoral thoracoabdominal multibranch endoprosthesis deployment in complex anatomy while preserving branch vessel perfusion.
