Pitfalls in sizing and planning for fenestrated and branched stent-grafts in patients with chronic post-dissection thoracoabdominal aortic aneurysms.

Abstract

Fenestrated-branched endovascular aneurysm repair is increasingly utilized in managing chronic post-dissection thoracoabdominal aortic aneurysms (TAAAs), with multicenter data indicating outcomes comparable to those in degenerative TAAAs. However, the anatomical and technical considerations in chronic dissection are distinct, often involving collapse of the true lumen, separate origins of target vessels from the true versus false lumen, and persistent dissection flaps extending into the renovisceral segment. Transcatheter electrosurgical septotomy is an emerging adjunct technique that aids in expanding the true lumen and optimizing proximal and distal sealing zones and branch vessel alignment during subacute and chronic post-dissection TAAA repair. This article reviews the key principles in preoperative planning and device customization for FB-EVAR within this complex anatomical context.