Hot wire technique for septal fenestration in chronic type B aortic dissection: A case report

Persistent false lumen in chronic type B aortic dissection complicates endovascular repair. The hot wire technique offers a precise method for septal fenestration, enabling endovascular treatment when standard approaches are not feasible. We present a case of a 65-year-old man with prior ascending aorta replacement and elephant trunk, who developed a large descending aortic aneurysm with residual dissection and a false lumen in which the elephant trunk resided, prohibiting conventional thoracic endovascular aortic repair. Septal fenestration allowing continuous flow was created using the hot wire technique, demonstrating the safety and effectiveness of this technique in complex chronic dissections with challenging anatomy.