Electrosurgical septotomy across the full spectrum of aortic dissection

Transcatheter electrosurgical septotomy divides the dissection membrane to reconstitute a single aortic lumen. Reported experience is largely confined to chronic post-dissection aneurysms. We assessed the technique across the full spectrum of descending aortic dissection, including stand-alone treatment of malperfusion.

Retrospective intention-to-treat analysis of 21 consecutive patients scheduled for septotomy between June 2022 and May 2026. The membrane was crossed by needle re-entry and divided with an electrified through-and-through guidewire at 40-60 W under fluoroscopy, without routine intravascular ultrasound or image fusion. A perfused-lumen index (perfused lumen divided by total aortic diameter) was measured before and after the procedure.

Septotomy was performed in 20 of 21 patients (technical success 95% on an intention-to-treat basis). Indications were landing-zone preparation (57%), malperfusion (33%), preparation for open repair and true-lumen collapse. Malperfusion resolved in all 7 patients treated for that indication, and the perfused-lumen index rose from a median of 0.16 to 0.98 (18 patients, P < 0.001). There was no stroke, spinal cord ischaemia or retrograde type A dissection. Thirty-day, in-hospital and overall mortality were 10%, 14% and 19%, with one fatal delayed aortic rupture and no intraprocedural death. Three unplanned reinterventions occurred; median follow-up was 5.1 months.

Electrosurgical septotomy was feasible across the full spectrum of aortic dissection and, in selected patients, as stand-alone treatment for malperfusion, using standard electrosurgical equipment. Given the small heterogeneous cohort and short follow-up, these findings demonstrate feasibility rather than durability.