Aortic Septotomy - A Useful Technique During Complex Aortic Dissection Intervention
Manish Mehta, MD, MPH, Philip Paty, MD, Saamy Teymouri, BS.
Vascular Health Partners, Queensbury, NY, USA.
Complex endovascular aortic intervention for complicated thoracic aortic dissection often requires novel innovative techniques to maintain visceral perfusion. Endovascular aortic septotomy is an adjunctive technique that can sometimes be used to create the double barrel true and false aortic lumen into a single lumen and this could have a significant impact in enhancing proximal and distal stentgraft landing zones. Aortic septotomy technique can also be used as a bailout during complex TEVAR & EVAR to preserve visceral and lower extremity perfusion. The video presentation is narrated and explains in a stepwise fashion how to perform aortic septotomy and in particular maneuvers to preserve visceral and lower extremity perfusion during complex TEVAR and EVAR. We present a case of a 62-year-old woman with complicated Type B Aortic Dissection and visceral malperfusion. Following deployment of thoracic stentgrafts in the true lumen from distal the subclavian to just above the celiac artery, abrupt interruption of celiac and superior mesenteric flow was noted, likely form a tear in the aortic septum at the distal stentgraft attachment site. Access into the true and false lumen was obtained, the visceral vessels cannulated, and snare techniques with glide wire and catheter used to perform paravisceral aortic septotomy and create the double lumen paravisceral aorta into a single lumen and preserve flow to the visceral arteries. The technique involves transfemoral access into the true and false lumen, reentry from false lumen back into true lumen above the planned site of septotomy through a fenestration, and use of snare to capture the single glide wire that is pulled out form the contralateral sheath. Gentle downwards traction on the glide wire from across the sheaths is used to create the septotomy across the paravisceral aorta, and buddy wires and catheters are used to maintain access into the visceral vessels. Subsequently iliac limb stentgrafts were deployed in ‘kissing stent’ technique to reperfuse the iliac arteries across the aortic bifurcation and exclude the prolapsed septum at the aortic bifurcation.
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